Cardiology Flashcards
What are the three fetal shunts
Ductus venosus - umbilical vein to inferior vena cava, bypasses the liver
Foramen ovale - right atrium and left atrium, bypasses pulmonary circulation
Ductus arteriosus - pulmonary artery to aorta, bypasses pulmonary circulation
What keeps the ductus arteriosus open
Prostaglandins
Define innocent murmurs
Also known as flow murmurs, are common in children. Caused by fast blood flow through various areas of the heart during systole
Features of an innocent murmur
S
Soft
Short
Systolic
Symptomless
Situation dependant
Examples of a pan systolic murmur
Mitral regurgitation - mitral area
Tricuspid regurgitation - tricuspid area
Ventricular septal defect - left lower sternal border
Examples of an ejection systolic murmur
Aortic stenosis - aortic area
Pulmonary stenosis - pulmonary area
Hypertrophic obstructive cardiomyopathy
What murmur is heard in an atrial septal defect
Mid-systolic, crescendo-decrescendo murmur heard loudest at the upper left sternal border with a fixed split second heart sound
What murmur is heard in a patent ductus arteriosus
Continuous crescendo-decrescendo machinery murmur.
What murmur is heard in tetralogy of fallot
Ejection systolic murmur heard loudest at the pulmonary area - pulmonary stenosis
Define cyanotic heart disease
Where deoxygenated blood enters the systemic circulation - there is a right to left shunt that bypasses the pulmonary circulation
Examples of cyanotic heard disease
Transposition of the great arteries
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
(Eisenmenger syndrome)
Define patent ductus arteriosus
Ductus arteriosus that fails to close - normal happens within first 2-3 weeks. Often caused by genetics, infection or prematurity
Which direction is the shunt in patent ductus arteriosus
Left to right
Aorta at much higher pressure than pulmonary artery.
Shunt increased pressure leading to right heart strain and hypertrophy
Presentation of patent ductus arteriosus
Shortness of breath
Difficulty feeding
Poor weight gain
LRTI
Machinery like murmur heard
Investigation in patent ductus arteriosus
Echocardiogram
Managment of patent ductus arteriosus
Monitoring echos until 1 year when should close
If not - trans-catheter or surgical closure
Define Eisenmenger syndrome
Where pulmonary pressure is greater than systemic pressure causing a reversal of a right to left shunt making the patient cyanotic
Examples of atrial septal defects
Ostium secondum
Patent foramen ovale
Ostium primum
Complications of atrial septal defects
Stroke - VTE
Atrial fibrillation or flutter
Pulmonary hypertension
Eisenmenger syndrome
Presentation of atrial septal defect
Mid-systolic murmur with fixed split second heart sound
Shortness of breath
Difficulty feeding
Poor weight gain
LRTI
Management of atrial septal defects
Conservative
Surgical closure
Anticoagulants in adults
What genetic conditions are VSD associated with
Down’s and Turner
Presentation of a ventricular septal defect
Pan-systolic murmur at lower sternal border
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive
Management of ventricular septal defects
Conservative
Surgical closure
Abx for infective endocarditis
Clinical signs of Eisenmenger syndrome
Right ventricular heave
Loud P2
Raised JVP
Peripheral oedema
Murmur
Cyanosis
Clubbing
Dyspnoea
Plethoric complexion
Management of Eisenmenger syndrome
Management of underlying defect
Heart-lung transplant
Oxygen
Treat pulmonary hypertension
Treat arrythmia
Prevent thrombosis
Prevent endocarditis
Define coarctation of the aorta
Congenital condition where there is narrowing of the aortic arch - usually around the ductus arteriosus
What genetic conditions are associated with coarctation of the aorta
Turners syndrome¬
Presentation of coarctation of the aorta
Weak femoral pulses
Four limb blood pressure - variation
Systolic murmur -
Tachypnoea
Poor feeding
Grey and floppy
Left ventricular heave
Underdevelopment
Management of coarctation of the aorta
Prostaglandin - keep ductus arteriosus open
Surgical correction and removal of ductus arteriosus
Presentation of aortic stenosis
Fatigue
Shortness of breath
Dizziness
Fainting
Worse on exertion
Ejection systolic murmur
Ejection click
Palpable thrill
Management of aortic stenosis
Echo!
Balloon aortic valvoplast
Surgical aortic valvotomy
Valve replacement
Complications of aortic stenosis
Left ventricular outflow tract obstruction
Heart failure
Ventricular arrhythmia
Bacterial endocarditis
Sudden death
What conditions are associated with pulmonary valve stenosis
Tetralogy of fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome
Presentation of pulmonary valve stenosis
Fatigue
Shortness of breath
Dizziness
Fainting
Ejection systolic murmur
Palpable thrill
Raised JVP - A waves
Management of pulmonary stenosis
Echo!
Conservative
Balloon valvuloplasty
Define tetralogy of Fallot
Ventricular septal defect
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy
Define overriding aorta
An aorta that sits further right overlying a VSD
As a result right ventricular blood passes through VSD and directly up aorta
Risk factors for tetralogy of Fallot
Rubella
Increased maternal age
Alcohol consumption during pregnancy
Diabetic mothers
Investigations in tetralogy of Fallot
Echo! - dopple flow
Chest xray
What is seen on CXR in tetralogy of Fallot
Boot shaped hear - due to right ventricular thickening
Clinical signs of tetralogy of Fallot
Cyanosis
Clubbing
Poor feeding
Poor weight gain
Ejecction systolic murmur
Tet spells
Define tet spells
Intermittent symptomatic periods where the right to left shunt becomes worsenedm causing a cyanotic episode. This happens because of increased pulmonary resistance or decreased systemic resistance - during exercise build up CO2 which causes dilation decreasing resistance
Management of Tet spells
Squat to increase systemic vascula rresistance
Oxygen
Beta blockers
IV fluids - increase preload
Morphine - decrease resp drive,
Sodium bicarbonate
Phenylephrine
Management of tetralogy of Fallot
Prostaglandin infusion to maintain ductus arteriosus
Total surgical repair
Define Ebstein’s anomaly
Congenital heart condition where the tricuspid valve is set lower in the right causing a bigger atrium and smaller ventricle.
Leads to poor flow to pulmonary vessels
Define transposition of the great arteries
Condition where the attachment of the aorta and pulmonary trunk are swapped - the pulmonary and systemic systems are completely separate
Presentation of transposition of the great arteros
Antenatal scans
Cyanosis at birth - patent shunt allows initial compensation
Respiratory distress
Tachycardia
Poor feeding
Poor weight gain
Sweating
Management of transposition of the great arteries
Prostaglandin infusion - maintain right to left shunt
Balloon septostomy
Surgical management
