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Cardiology Flashcards

1
Q

What are the 3 fetal shunts

A

Ductus venosus

Foramen ovale

Ductus arteriosus

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2
Q

Where does blood get shunted through the ductus venosus

A

From umbilical vein to inferior vena cava

Blood bypasses liver

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3
Q

Where does blood get shunted through the foramen ovale

A

From right atrium to left atrium

Blood bypasses right ventricle and pulmonary circulation

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4
Q

Where does blood get shunted through the ductus arteriosus

A

From pulmonary artery to aorta

Blood bypasses pulmonary circulation

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5
Q

What happens with the first breath at birth

A

Expansion of alveoli

Decreased pulmonary vascular resistance

Fall in pressure in right atrium (now < left atrium)

Foramen ovale closes (takes a few weeks to seal)

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6
Q

What is the role of prostaglandins in fetal circulation

A

Keep ductus arteriosus open

Increased blood oxygenation at birth reduces prostaglandin levels

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7
Q

When does the ductus venosus stop functioning

A

When umbilical cord is clamped (no blood flow through umbilical vein)

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8
Q

What are innocent murmurs

A

Flow murmurs (due to fast blood flow through heart)

Often do not need investigation

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9
Q

What are the typical features of innocent murmurs

A

Soft

Short

Systolic

Symptomless

Situation dependent (quiet on standing, appear when unwell)

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10
Q

When do murmurs need to be referred to paediatric cardiologists

A

Louder than 2/6

Diastolic

Louder on standing

Symptomatic (failure to thrive, difficulty feeding, cyanosis, shortness of breath)

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11
Q

What investigations may be needed for murmurs in children

A

ECG

Chest X-ray

ECHO

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12
Q

What are the pan-systolic murmurs

A

Mitral regurgitation

Tricuspid regurgitation

Ventral septal defects

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13
Q

What are the ejection-systolic murmurs

A

Aortic stenosis

Pulmonary stenosis

Hypertrophic obstructive cardiomyopathy

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14
Q

What causes splitting of the 2nd heart sound

A

Pulmonary valve closing slightly later than aortic valve

Often normal with inspiration

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15
Q

Describe the murmur of atrial septal defect

A

Mid-systolic

Crescendo-decrescendo

Loudest at upper left sternal border

Fixed split second heart sound

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16
Q

Describe the murmur of patent ductus arteriosus

A

Normal first heart sound

Continuous crescendo-decrescendo murmur

Continuation during second heart sound

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17
Q

What is the murmur in tetralogy of Fallot

A

Ejection systolic murmur

Due to pulmonary stenosis

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18
Q

What are the potentially cyanotic heart diseases in babies

A

Due to blood bypassing lungs (right to left shunt)

Ventral septal defect (not cyanotic)

Atrial septal defect (not cyanotic)

Patent ductus arteriosus (not cyanotic)

Transposition of great arteries (cyanotic)

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19
Q

When does the ductus arteriosus normally close

A

Within 1-3 days of birth

Complete closure by 2-3 weeks

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20
Q

If missed in childhood, how may patients with patent ductus arteriosus present as adults

A

With heart failure

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21
Q

How might a patient with patent ductus arteriosus present

A

Murmur

Shortness of breath

Difficulty feeding

Poor weight pain

Lower respiratory tract infections

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22
Q

What investigation is needed for the diagnosis of patent ductus arteriosus

A

ECHO

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23
Q

What is the management for patent ductus arteriosus

A

ECHO monitoring (1 year, after this, unlikely to close spontaneously)

Closure (trans-catheter, surgical)

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24
Q

What are the indications for early treatment of patent ductus arteriosus

A

Evidence of heart failure

Symptomatic

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25
What is the pathophysiology of atrial septal defects
Shunting of blood from left atrium to right atrium Non-cyanotic Right sided overload (get right heart failure and pulmonary hypertension) Right heart strain
26
What are the types of atrial septal defects
Ostium primum (fails to close fully) Ostium secundum (fails to close fully)
27
How might a patient with an atrial septal defect present
Murmur Antenatal scanning/newborn examination Symptomatic children (short of breath, difficulty feeding, poor weight gain, LRTIs) Symptomatic adults (shortness of breath, heart failure, stroke)
28
What is the management of atrial septal defects
Watch and wait (if small and asymptomatic) Surgery (femoral catheter,, open heart surgery) Anticoagulation (aspirin, warfarin, NOACs)
29
What are the potential complications of atrial septal defects
Stroke Atrial fibrillation Atrial flutter Pulmonary hypertension Right sided heart failure Eisenmenger syndrome
30
What conditions are ventricular septal defects often associated with
Down's syndrome Turner's syndrome
31
How is the blood shunted in ventricular septal defects
Left to right Patient not cyanotic Right sided overload Right heart failure
32
How might a patient with a ventricular septal defect present
Initially asymptomatic (some into adulthood) Antenatal scanning Murmur Symptomatic (poor feeding, dyspnoea, tachypnoea, failure to thrive)
33
What would be found on examination of a patient with a ventricular septal defect
Pan-systolic murmur Systolic thrill on palpation
34
What is the management of ventricular septal defects
Watch and wait (if small and asymptomatic) Surgery (transvenous catheter, open heart surgery)
35
What is the main complication associated with ventricular septal defects
Increased risk of infective endocarditis
36
What is Eisenmenger syndrome
Due to: atrial septal defect, ventricular septal defect, patent ductus arteriosus Right to left shunt Develops at 1-2 years (if defect very small, in adulthood) More likely in pregnant women
37
What would be found on examination of a patient with Eisenmenger syndrome that is associated with pulmonary hypertension
Right ventricular heave Loud second heart sound Raised JVP Peripheral oedema
38
What would be found on examination of a patient with Eisenmenger syndrome that is associated with a septal defect
Atrial septal defect: mid-systolic, crescendo-decrescendo murmur Ventricular septal defect: pan-systolic murmur Patent ductus arteriosus: continuous crescendo-decrescendo 'machinery' murmur Arrhythmias
39
What would be found on examination of a patient with Eisenmenger syndrome that is associated with chronic hypoxia
Cyanosis Clubbing Dyspnoea Red complexion (due to polycythaemia)
40
What is the management for Eisenmenger syndrome
Heart-lung transplant (only definitive treatment) Oxygen Treat pulmonary hypertension (sildenafil) Treat polycythaemia (venesection) Anticoagulation Prophylactic antibiotics (prophylactic antibiotics)
41
What is the prognosis for Eisenmenger syndrome
Reduced life expectancy (by 20 years) Main causes of death: heart failure, infection, VTE, haemorrhage
42
What is coarctation of the aorta
Narrowing of aortic arch Usually around ductus arteriosus Increased pressure proximally, reduced pressure distally
43
What syndrome is coarctation of the aorta most commonly associated with
Turner's syndrome
44
How may a patient with coarctation of the aorta present
Weak femoral pulses Systolic murmur Symptoms in infants (tachypnoea, poor feeding, grey and floppy baby) Symptoms developing over time (left ventricular heave, underdeveloped left arm, underdeveloped legs)
45
What is the management for coarctation of the aorta
Mild cases often do not need management Prostaglandin E (keep ductus arteriosus open until surgery) Emergency surgical correction
46
What is aortic valve stenosis
Narrowing of aortic valve Restricted blood flow from left ventricle to aorta Valve can have 1-4 leaflets (normal is 3)
47
What are the symptoms associated with aortic valve stenosis
Mild disease may be asymptomatic (incidental murmur finding) Fatigue Shortness of breath Dizziness Heart failure Fainting Worse on exertion
48
What would be found on examination of a patient with aortic valve stenosis
Ejection systolic murmur (crescendo-decrescendo, radiation to carotids) Ejection click Palpable systolic thrill Slow rising pulse Narrow pulse pressure
49
What main investigation is needed in aortic valve stenosis
ECHO
50
What is the management for aortic valve stenosis
Regular monitoring (ECHO, ECG, exercise test) Percutaneous balloon aortic valvuloplasty Surgical aortic valvotomy Valve replacement
51
What are the complications of aortic valve stenosis
Left ventricular outflow tract obstruction Heart failure Ventricular arrhythmia Bacterial endocarditis Sudden death (usually on exercise)
52
What conditions are associated with pulmonary valve stenosis
Tetralogy of Fallot William syndrome Noonan syndrome Congenital rubella syndrome
53
How might a patient with pulmonary valve stenosis present
Often asymptomatic (incidental finding) Fatigue on exertion Shortness of breath Dizziness Fainting
54
What may be found on examination of a patient with pulmonary valve stenosis
Ejection systolic murmur Palpable thrill Right ventricular heave Raised JVP
55
What is the main investigation needed in pulmonary valve stenosis
ECHO
56
What is the management for pulmonary valve stenosis
Watch and wait (if mild and asymptomatic) Balloon valvuloplasty (femoral) Open heart surgery
57
What are the 4 features of tetralogy of Fallot
Ventricular septal defect Overriding aorta Pulmonary valve stenosis Right ventricular hypertrophy
58
What happens in severe cases of tetralogy of Fallot
Heart failure before age 1
59
What are the risk factors for tetralogy of Fallot
Rubella infection Maternal age > 40 Alcohol during pregnancy Maternal diabetes
60
How might a patient with tetralogy of Fallot present
Cyanosis Clubbing Poor feeding Poor weight gain Ejection systolic murmur (pulmonary area) Tet spells
61
What investigations are needed in tetralogy of Fallot
ECHO Chest X-ray (boot shaped heart)
62
What are tet spells
Intermittent symptomatic episodes of tetralogy of Fallot Right to left shunt temporarily worsens Worsening cyanosis Due to physical exertion Reduced consciousness, seizures, death
63
What is the management for tet spells
Tell older children to squat, young children knees to chest Oxygen Beta blockers IV fluids Morphine (decreases respiratory drive) Sodium bicarbonate (buffer metabolic acidosis) Phenylephrine infusion (increase systemic vascular resistance)
64
What is the management of tetralogy of Fallot
Prostaglandin infusion (maintain ductus arteriosus) Open heart surgery
65
What is Ebstein's anomaly
Tricuspid valve set low (get big right atrium, small right ventricle) Poor blood flow from right atrium to right ventricle Poor blood flow to pulmonary vessels Right to left shunt (get cyanosis) Associated with Wolff-Parkinson-White syndrome
66
How might a patient with Ebstein's anomaly present
Evidence of heart failure Gallop rhythm (3rd and 4th heart sounds) Cyanosis Shortness of breath Tachypnoea Poor feeding Collapse Cardiac arrest
67
What investigation is needed for the diagnosis of Ebstein's anomaly
ECHO
68
What is the management for Ebstein's anomaly
Treat arrhythmia Treat heart failure Prophylactic antibiotics (infective endocarditis) Surgical correction
69
What is transposition of the great arteries
Attachments of aorta and pulmonary trunk swapped Get 2 separate circulations that do not mix Immediate survival depends on a shunt being present Often picked up in antenatal scans
70
What conditions are associated with transposition of the great arteries
Patent ductus arteriosus Atrial septal defect Ventricular septal defect
71
How might a patient with transposition of the great arteries present
Cyanosis Respiratory distress Tachycardia Poor feeding Poor weight gain Sweating
72
What is the management of transposition of the great arteries
Prostaglandin infusion (maintain patent ductus arteriosus) Balloon septostomy (catheter into foramen ovale, create a large atrial septal defect) Open heart surgery

Paeds (17 decks)

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