Cardiology Flashcards
How does the foramen ovaleclose
First breath decreases pulmonary vascular resistance
Fall in pressure in RA, LA pressure greater squashing the atrial septum and closing foramen
What are the features of an innocent paediatric murmur
Things that start with S
Systolic, soft, short, symptomless, situational (when standing/ unwell etc)
What are the features of pan systolic murmurs
Different ones dependent on where they are loudest
-Mitral regurgitation- mitral area
-Tricuspid regurgitation- tricuspid area
-Ventricular septal defect- loudest at left lower sternal boarder
What are the differentials for an ejection systolic murmur
Aortic stenosis - aortic area loudest
Pulmonary stenosis- pulmonary area
Hypertrophic obstruction cardiomyopathy- 4th ICS, left sternal boarder
What type of murmur is heard in an atrial septal defect
Mid-systolic crescendo decrescendo murmur
Loudest at left sternal boarder
Fixed split second heart sound- doesn’t change on inspiration or expiration (splitting HS on inspiration is normal)
What type of murmur is heard in patent ductus arteriosus
Normal first heart sound
Continuous crescendo- decrescendo machinery murmur making the second HS hard to hear
What type of murmur is heard in tetralogy of fallot
It comes from pulmonary stenosis
Ejection systolic murmur loudest at the pulmonary area
What are the features of cyanotic heart disease
Blood bypasses the pulmonary circulation in a right to left shunt
Deoxygenated blood goes into systemic circulation
Types of Heart disease you get it in
-Ventricular septal defect
-Atrial septal defect
-Patent ductus arterioles
These 3 will not be cyanotic as pressure in left is usually bigger than right
-Transposition of great arteries
This will always have cyanosis - right side of heart has a higher pressure in this case
What is Eisenmenger syndrome
Pulmonary pressure goes beyond systemic pressure and blood starts to flow right to left causing cyanosis
What are the features and management of patent ductus arteriosus
Failure of ductus arteriosus to close within 2-3 weeks
Risk factors
Prematurity, genetic, rubella/ maternal infections
Left to right shunt- high pressure in LV causes pulmonary hypertension on right leading to right sided heart strain and right ventricular hypertrophy- eventually will cause left ventricular hypertrophy
SOB, Difficult feeding, poor weight gain , LRTI
Continuous cues-decres murmur machinery
Diagnosed with echo and doppler
Management
Indomethacin or ibuprofen (prostaglandin inhibitors) given to neonate after approx 1 week if not closed
Monitor until 1 with echos
Transcatheter or surgical closure
What are the features of atrial septal defects?
Types
-Ostium secondum (least common)
-Patent foramen ovale
-Ostium primum (most common)
Complications
-Stroke -AF/ flutter -Pulmonary HTN -Eisenmenger syndrome
Stroke with a DVT think atrial septal defect
Presentation
Mid systolic crescendo decresendo murmur- fixed split heart sound
SOB, difficulty feeding/ weight gain, LRTI, HF
Management
Paedatric cardiologist referral
Transvenous catheter closure/ open heart surgery
-Anticoagulants
What are the features of ventricular septal defects
Associated with a genetic condition- Down’s/ Turner’s
Left to right shunt causing right sided overload and right sided HF - eventually Eisenmenger syndrome
Can present in late adulthood- no symptoms
Or similar symptoms to other defects in baby’s
Pan-systolic murmur in left lower sternal boarder (3rd and 4th ICS)
Systolic thrill
Treatment
Watched over time
Transvenous catheter closure/ open heart surgery
Increased risk of infective endocarditis- antibiotic prophylaxis given
What are symptoms and management of Eisenmeneger syndrome
Happens 1-2 years after large shunts or in adulthood for small shunts- can exacerbate in pregnancy
Right to left shunt- deoxygenated blood and cyanosis
Polycythaemia will occur as more Hb is made due to low 02 sats
Signs
Right ventricular heave
Loud HS2
Raised JVP
Peripheral oedema
Cyanosis, clubbing, dyspnoea, plethoric face
Reduced life expectancy by about 20 yrs
Management
Heart lung transplant (high mortality)
Oxygen
Treat pulmonary HTN (sildenafil)
Treat arrhythmia
Venesection
Anticoagulant (thrombosis)
Antibiotics (IE)
What are the features of coarctation of the aorta
Narrowing of aortic arch around the ductus arteriosus
Linked to Turner’s syndrome
Reduced pressure below the narrowing and increased pressure above
Presentation
Weak femoral pulses
4 limb BP
Systolic murmur below left clavicle and left scapula
Tachypnoea
Grey and floppy
LV heave
Underdeveloped limb
Management
Leave mild cases
Prostaglandin E keeps ductus arteriosus open while waiting for surgery
Surgery to correct
What are the features of congenital aortic stenosis
Born with narrow aortic valve (LV)- normally 3 leaflets on this valve- these patients can have between 1-4
Fatigue, SOB, dizzy fainting
Worse on exertion
Heart failure if severe
Ejection systolic murmur in aortic area
Cres-decres and radiates to the carotids
Management
Echo
Percutaneous balloon aortic valvoplasty
Surgical aortic valvotomy
Valve replacement
Can cause left ventricular outflow tract obstruction/ Sudden death on exertion
What are the features of congenital pulmonary valve stenosis
thickened and fused valve leaflets- narrow opening
Can be associated with
Tetralogy of fallout
William Syndrome
Noonan syndrome
Congenital Rubella syndrome
Presentation
Fatigue, SOB, dizzy, fainting
Ejection systolic murmur loudest in pulmonary area
Palpable thrill
Right ventricular heave (hypertrophy)
Raised JVP
Management
Echo
Watch and wait if mild
Balloon valvuloplasty via venous catheter
Open heart surgery
What are the features of tetralogy of Fallot
4 existing pathologies
1. Ventricular septal defect
- Overriding aorta - aortic valve is displaced to the right - deoxygenated blood from right side can enter the aorta on contraction
- Pulmonary valve stenosis- higher pressure due to this encourages blood flow through the shunt
- Right ventricular hypertrophy
Right to left cardiac shunt - blood bypasses childs lungs- cyanosis
how bad it is relates to severity of pulmonary stenosis
Risk factors
Rubella
Increased age mother <40
Alcohol consumption
Diabetic mother
Echo investigation with doppler flow studies
CXR- boot shaped heart
Presentation
Antenatal scans
Ejection systolic murmur
Cyanosis, clubbing, poor weight gain and feeding
Tet spells- shunt temporarily becomes worsened giving a cyanotic episode eg. on physical exertion/ crying - irritable, SOB and cyanotic
Management
Prostaglandin infusion to maintain ductus arteriosus
Total surgical repair- open heart surgery
What are the treatment options for tet spells
Older children squat
Younger- knees to chest
To increase systemic vascular resistance
Supplementary oxygen
Beta blockers
IV fluids - increase pre load and blood getting to pulmonary vessels
Morphine - decrease respiratory drive
Sodium Bicarb - buffer metabolic acidosis
Phenylephrine infusion - increase systemic vascular resistance
What are the features of Ebstein’s anomaly
Tricuspid valve is lower on the RHS of the heart- makes a bigger RA and smaller RV - poor flow between both
Associated with right to left shunt in ASD causing cyanosis
Associated with WPWS
Presentation
Heart failure- oedema
Gallop rhythm- 3rd and 4th HS
Cyanosis
SOB, tachypnoea
Collapse, cardiac arrest
Within a few days of birth they present
Diagnosed via Echo
Treat arrhythmia and HF, prophylactic abx
Surgical correction of defect
What are the features of the transposition of the great arteries
RV pumps blood into the aorta and the LV pumps blood into pulmonary vessels - no connection at all between systemic and pulmonary circulation so life threatening straight after birth
Associated with ventricular septal defect, coarctation of aorta and pulmonary stenosis
Diagnosed on antenatal scans
Cyanosis at birth
Management
When there is a ventricular septal defect this will provide time as some blood will mix
Prostaglandin infusion given to maintain ductus arterioles so blood from aorta can get to pulmonary veins
Balloon septostomy- catheter into foramen oval via umbilicus and inflating a balloon to create an ASD so blood from lungs can get to body
Open heart surgery with cardiopulmonary bypass
What are the features and management of Kawasaki
Small/ medium vasculitis
Non purulent conjunctivitis
Long lasting fever
Can cause heart disease- need echo
Most serious complication- coronary artery aneurysm
Red tongue
Rash- red palms and soles, desquamation
Treatment
IV immunoglobulin plus aspirin
+ steroids
