Cardiology Flashcards
FETAL SHUNTS
i) what connects the umbillical vein to the IVC? what organ does this allow blood to bypass?
ii) what connects the right and left atrium? what does this allow blood to bypass? (2)
iii) what connects the pulmonary artery with the aorta? what does this allow blood to bypass? what does it become after birth?
i) ductus venosus > bypass the liver
ii) foramen ovale > bypass RV and pulm circ
iii) ductus arteriosis > bypass pulm circulation
becomes ligamentum venosum
PATENT DUCTUS ARTERIOSUS
i) when does the DA usually stop functioning? when does it close? name a key RF for its failure to close?
ii) if patients remain asymptomatic through life what can they present with in adulthood?
iii) how may it be picked up on newborn examination? name four other presenting symptoms?
iv) name a characteristic of the pulse (2) how may the apex beat feel?
i) stops functioning within 1-3 days of birth and closes completely in first 2-3 weeks of life
RF for failure to close is prematurity
other RFs are genetic or infections eg rubella
ii) can px as an adult with HF (due to high pulm pressures > RV hypertrophy > LV hypertrophy)
iii) on newborn exam may be picked up through hearing a murmur
px with SOB, difficulty feeding, poor weight gain, LRTI
iv) wide pulse pressure and large volume, bounding, collapsing pulse
apex beat may feel heaving
PATENT DUCTUS ARTERIOSUS MURMUR AND MANAGEMENT
I) what type of murmur can be heard if it is significant? why may the second heart sound be difficult to hear?
ii) what investigation can be used to diagnose it?
iii) how is it managed? which two drugs may be given and why do they work?
iv) when may a surgical cloure be performed?
i) continous crescendo decrescendo murmur > hard to hear second heart sound due to the murmur continuing
ii) echo > doppler flow to assess size and characteristics and look for hypertrophy
iii) monitor until 1yr using echo
may give paracetamol or ibuprofen/inodmethacin to help close it as inhibtiing prostaglandins causes it to close
iv) surgical close if after 1 year of age as wont close spontaneously
ATRIAL SEPTAL DEFECTS
i) which way does blood move? what does this ultimately lead to?
ii) why does the patient not become cyanotic? what is eisenmenger syndrome?
iii) what is ostium secondum? what is patent foramen ovale? what is osteium primum, what does this lead to?
iv) why may patients present later in life with complications of stroke?
i) blood moves from LA to RA due to pressure gradient > leads to continuous flow through the pulm vessels and lungs
right sided overload > R heart strain > pulmonary hypertension
ii) patient is not cyanotic as lots of blood is moving to the pulmonary vessels/lungs therefore is oxygenated
eisenmenger = pulmonary pressure is greater than systemic pressure > shunt reverses from R to L and therefore blood bypasses the lungs and patient becomes cyanotic
iii) ostium secondium - septum secondum doesnt close leaving a hole in the wall
patent FO - FO fails to close
ostium primum - septum primum fails to close > hole in wall > AV valve defects
iv) stroke from a VTE (DVT) - usually would go to pulm vasc > lungs but in ASD clot can pass septum into LV > brain and cause a stroke
ATRIAL SEPTAL DEFECT CONTINUED
i) what type of murmur does ASD cause? where is it loudest? how does the second heart sound sound?
ii) when may ASD be picked up? name three features they may present with in adulthood?
iii) name three typical symptoms in childhood? what condition has been associated with patent foramen ovale?
iv) what is the conservative management? how can they be corrected? what medication may be given to adults?
i) mid systolic crescendo descrescendo murmur loudest at upper left sternal border
fixed split second heart sound due to aortic and pulm valves closing at different times
ii) picked up on antenatal scan or newborn exam
adults - SOB, HF, stroke
iii) in childhood - SOB, difficulty feeding, poor weight gain, LRTIs
migraine with aura has been assoc with PFO
iv) cons mx is watch and wait
surgical correct with TV catheter through femoral
anticoagulate adults - aspirin, warfarin NOAC
VENTRICULAR SEPTAL DEFECTS
i) name two genetic conditions they are commonly associated with? which way does blood flow? do these patients present with cyanosis?
ii) what can this lead to in terms of the right side of the heart? what is eisenmenger syndrome and how do patients appear?
iii) name two occassions they may be picked up? name four symptoms
iv) what type of murmur will be heart? where will it be most prominent?
v) what may be felt on palpation? name two other causes of this type of murmur
i) hole in septal wall between ventricles > seen in downs syndrome and turner syndrome
blood flows left to right - blood still flowing through the lungs so patients are acyanotic
ii) L to R shunt causes R sided overload > RHF extra blood through RV puts pressure on pulm vessels > pulm hypertension
if pressure becomes high enough on RHS > LHS where blood avoids lungs > cyanotic - eisenmenger sydndrome
iii) can be asymptomatic and present in adulthood
can also be picked up on antenatal scans or hearing a murmur during baby check
symptoms = poor feeding, dyspnoea, tachypnoea and fail to thrive
iv) pan systolic murmur more prominent at L sternal border in 3rd and 4th IC space
v) feel systolic thrill on palpation
pan systolic murmur also caused by MR and TR
VSD MANAGEMENT
i) which type of VSDs can be just be watched?
ii) name two surgical correction techniques?
iii) which infection is there an increased risk of? what should be done pre-emptively during surgical procedures?
i) small or no evidence of pulm HTN or HF can be watched and may close spontaneously
ii) correct with TV catheter closure via femoral or by open heart surgery
iii) inc risk of infective endocarditis > give abx prophylaxis during surgery
COARCTATION OF AORTA
i) what type of condition is it? what usually happens? which genetic syndrome can it be associated with?
ii) how does it affect pressure distal and proximal to the narrowing?
iii) what may be the only indication in a neonate? which area may higher BP be found? which area may lower BP be found?
iv) what type of murmur may be heard? name three other signs in infancy?
v) name three signs that may develop over time? which arm may be under developed and why
i) congential condition where there is narrowing of the aortic arch around ductus arteriosus
often assoc with turners syndrome
ii) distal - reduced pressure
proximal - increased pressure eg branches of aorta
iii) weak femoral pulses
high BP in limbs supplied by arteries that come before the narrowing
low BP in limbs supplied by vessesls that come after the narrowing
iv) mid systolic murmur heard below L clavicle and L scapula
signs - inc RR, inc WOB, poor feeding, grey/floppy baby
v) over time - LV heave due to LV hypertrophy
under dev L arm where there is reduced flow to the L subclavian
underdev legs
COARCTATION OF AORTA MX
i) what can be done in mild cases?
ii) what is there a risk of in critical coarctation? what is given to keep the ductus arteriousus open while waiting for surgery?
iii) what is done in surgery?
i) mild - can live symptom free until adulthood
ii) critical - risk of HF and death shortly after birth
give prostaglandin E to keeo DA open to allow some blood flow through to keep systemic circ going
iii) correct coarctation and ligate the DA
CONGENITAL AORTIC VALVE STENOSIS
i) what are patients born with? how may leaflets does the aortic valve have? how many may patients with AS have?
ii) name three symptoms it may present with? when may this be worse? how may severe AS present?
iii) what is the key examination finding? where is it heard loudest? what is the character?
iv) name three other signs that may be present on examination
i) born with a narrow aortic valve that results blood flow from LV to aorta
should have three leaflets but patients with AS may have 1/2/3/4
ii) px with fatigue, SOB, dizzy, fainting - especially on exertion
severe can present with HF within months of birth
iii) key finding is ejection systolic murmur heard loudest in aortic area (2nd IC space)
crescendo descrescendo that radiates to carotids
iv) may also hear an ejection click just before the murmur, palpable systolic thrill and slow rising pulse/narrow pulse pressure
MX AND COMPLICATIONS OF AORTIC STENOSIS
i) what is the gold standard investigation? name three ways the condition can be monitored in children?
ii) what are the three options for treating it?
iii) what is the main complication? name three others
i) echo
monitor with cardiology follow up, echo, ECGs and exercise testing
ii) perc baloon aortic valvuloplasty, surgical aortic valvotomy, valve replacement
iii) LV outflow tract obstruction
HF, ventricular arrhythmia, bac endocarditis, sudden death on exertion
PULMONARY VALVE STENOSIS
i) how many leaflets does it have? what happens if they become thickened or fused?
ii) name four conditons it may be associated with? how may it be picked up? how may significant disease present? (3)
iii) what type of murmur is heard? where is it loudest? what may be felt? (2) what may also be raised?
iv) what is gold standard investigation? how are mild cases treated?
v) what can be done if the patient is symptomatic?
i) pulmonary valve has three leaflets thick or fused causes narrow opening between RV and PA > PV stenosis
ii) can be assoc with tetralogy of fallot, william syndrome, noonan syndrome, congenital rubella syndrome
iii) ejection systolic murmur heard loudest in pulm area
palpable thrill and RV heave (due to RV hypertrophy)
raised JVP
iv) gold standard is echo
mild - watch and wait by cardiologist
v) symptomatic > balloon valvuloplasty by venous catheter (catheter through fem veine > IVC > right heart > PV)
TETRALOGY OF FALLOT
i) what are the four conditions? (VORP) name three risk factors?
ii) what investigation is used to diagnose? what study is also used? what may be seen on CXR?
iii) how are most cases picked up? what type of murmur may be heard on newborn baby check? what is this caused by?
iv) what will severe cases present with? name four signs and symptoms
v) what is given to neonates to maintain a patent ductus arteriosus? what is the definitive tx?
i) VSD, overriding aorta, PV stenosis, RV hypertrophy
RF - rubella infection, inc maternal age >40yrs, ETOH in pregnancy, diabetic mother
ii) echo to dx and doppler flow studies to look at shunted blood
CXR - boot shaped heart due to RV thickening
iii) most picked up on antenatal scans
hear ejection systolic murmur caused by pulm stenosis on newborn check
iv) severe - px with HF before one year of age
symptoms - cyanosis, clubbing, poor feeding, poor weight gain, ejection sys murmur in pulm area
v) give neonates a PG infusion to main the DA
definitive repair by open heart surgery
TET SPELLS
i) what are they? what can be seen in the child? when do they happen?
ii) name three things they can be ppt by? what symptoms may the child have? (2) what can a severe spell lead to?
iii) what position can older children take to help resolve the spell? what can be done to younger children?
iv) what can be given to relax the RV and improve pulm flow? what can be given in crease pre load? what can be given to decrease resp drive > more effective breathing?
v) what can be given to buffer the metab acidosis that can occur? what is given to increase systemic vasc resistance?
i) intermittent symptomatic periods where R>L shunt becomes worse and ppt a cyanotic episode
happen when there is physical exertion > produce CO2, vasodilate, reduces sys vasc resistance
ii) ppt by waking, physical exertion, crying
child will become irritable, cyanotic and SOB
severe > reduced conc, seizure, death
iii) squatting can increase sys vasc resistance and encourages blood through pulm vessels
young children > bring knees to chest
iv) beta blockers relax RV
IV fluids increase pre load
morphine can decrease resp drive
v) sodium bicarb can buffer metab acidosis
pheylephrine infusion to inc sys vasc resistance
TRANSPOSITION OF THE GREAT ARTERIES
i) what happens? name three conditions it can be associated with?
ii) how will the baby appear after birth? what is needed for immediate survival?
iii) how is it usually diagnosed? what may they have in the first few weeks of life (3)
iv) what defect gives time for definitive tx? what can be infused to maint PDA?
v) how may an atrial septal defect be created? what does this allow?
vi) what is definiteive mx?
i) attachments of aortia and pulm trunk are swapped > RV pumps through aorta and LV pumps through pulm vessels
can be asoc with VSD, coarctation of aorta, pulm stenosis
ii) baby will appear cyanosed
immediate survival - need a shunt eg PDA, VSD, ASD
iii) dx on antenatal US > birth in a tertiary centre
will present cyanosed
later may develop resp distress, inc RR, poor feeding, sweating
iv) VSD will allow mixing of blood and give time for definitive mx
infuse prostaglandins to maintain DA
v) create ASD with baloon sepstomy > catether into foramen ovale via umbilicus to allow flow from R heart to body
vi) definitive - open heart surgery
