Cardiology Flashcards
Characteristics of innocent murmurs?
systolic
soft
short
symptomless
situational (squatting, sick)
Causes of pan-systolic murmurs?
mitral regurgitation (mitral area)
tricuspid regurgitation (tricuspid area)
VSD (left lower sternal border)
Causes of ejection systolic murmurs?
aortic stenosis (aortic area)
pulmonary stenosis (pulmonary area)
HOCM
What is a patent ductus arteriosus?
failure of the ductus arteriosus to close after birth
Presentation of PDA?
murmur
dyspnoea
difficulty feeding
poor weight gain
LRTIs
What murmur does a PDA cause?
continous crescendo-decrescendo ‘machinery’ murmur
Diagnosis of PDA?
echo
Mx of PDA?
monitoring with echo for the first year -> high probability that PDA will spontaneously resolve
after 1 yr -> trans-catheter or surgical closure
What is an Atrial Septal Defect?
hole in the wall between the two atria
Types of ASD?
ostium secondum
patent foramen ovale
ostium primum (tends to lead to AVSD)
Complications of ASD?
stroke (in DVT)
AFib or AFlutter
pulmonary HTN
right-sided heart failure
Eisenmenger’s syndrome
What murmur does an ASD cause?
mid-systolic crescendo-decrescendo with a fixed split second heart sound
Presentation of ASD?
murmur
asymptomatic in childhood (presents as an adult with HF or stroke)
dyspnoea
difficulty feeding
poor weight gain
LRTIs
Mx of ASD?
referral to cardiology
watch and wait
transvenous catheter closure or open heart sx
anticoagulation
Presentation of VSD?
murmur
poor feeding
dyspnoea
tachypnoea
failure to thrive
What murmur is associated with VSD?
pan-systolic murmur mor prominently heard at left lower sternal border in the third and fourth intercostal spaces
+/- pansystolic thrill on palpation
Mx of VSD?
referral to cardiology
watch and wait
transvenous catheter closure
open heart sx
consider antibiotic prophylaxis in sx for infective endocarditis
What is Eisenmenger’s syndrome?
when a left-to-right shunt causes a build-up of pressure and pulmonary HTN causing reversal of the shunt to a right-to-left
can occur in childhood, adulthood or v quickly during pregnancy
Presentation of Eisenmenger’s syndrome?
cyanosis
clubbing
dyspnoea
plethoric complexion (polycythaemia)
Mx of Eisenmenger’s syndrome?
prevention is key-> once pulmonary pressure is high enough to cause the syndrome it can not be reversed
only definitive tx is heart-lungs transplant
symptomatic management
What is coarctation of the aorta?
congenital condition where there is narrowing of the aortic arch, usually around the ductus arteriosus
results in reduction of the pressure in arteries distal to the narrowing and increase in the pressure proximally
What condition is particularly associated with coarctation of the aorta?
Turner’s syndrome
Presentation of coarctation of the aorta?
weak femoral pulses
systolic murmur
tachypnoea
incr. work of breathing
poor feeding
grey floppy baby
left ventricular heave
underdeveloped left arm
underdeveloped legs
Investigations for coarctation of the aorta?
four limb BP measurement
echo
Mx of coarctation of the aorta?
ranges depending on severity
surgery
critical cases -> prostaglandins to keep PDA open while waiting for surgery
What is Tetralogy of Fallot?
congenital cyanotic heart condition
VSD
overriding aorta
pulmonary valve stenosis
right ventricular hypertrophy
Risk Factors for ToF?
rubella infection
maternal age >40
alcohol consumption in pregnancy
maternal diabetes
Investigations for ToF?
echo
doppler flow studies
CXR - boot shaped heart due to right ventricular thickening (not used)
Presentation of ToF?
mostly picked up antenatally
ejection systolic murmur (pulmonary stenosis)
cyanosis
clubbing
poor feeding
poor weight gain
‘tet spells’
What are ‘tet spells’?
intermittent symptomatic periods where there is a worsening of the right to left shunt, resulting in cyanosis
walking, physical exercise, crying
irritable, SOB, cyanotic
Treatment for Tet spells?
squatting, bringing knees to chest
oxygen
beta blockers
IV fluids
morphine
sodium bicarbonate
phenylephrine infusion
Mx of ToF?
prostaglandin infusion in neonates to maintain PDA
total surgical repair by open heart surgery is definitive mx (5% mortality rate)
90% live into adulthood with corrective sx
What is Ebstein’s anomaly?
cyanotic congenital heart condition where the tricuspid valve is set lower in the right side of the heart, causing a bigger atrium and smaller ventricle
often associated with ASD and right-to-left shunt
Presentation of Ebstein’s anomaly?
HF symptoms
gallop rhythm
cyanosis
dyspnoea
tachypnoea
poor feeding
collapse or arrest
Diagnosis of Ebstein’s anomaly?
echo
Mx of Ebstein’s anomaly?
definitive is surgery
medical mx to treat arrhythmias and HF
prophylactic antibiotics to prevent infective endocarditis
What is transposition of the great arteries?
cyanotic congenital heart condition where the aorta and the pulmonary artery are transposed to the wrong position
only compatible with life when there is a shunt - ASD, VSD, PDA
Presentation of transposition of the great arteries?
usually diagnosed antenatally
cyanosis
respiratory distress
tachycardia
poor feeding
poor weight gain
sweating
Mx of transposition of the great arteries?
prostaglandins to maintain PDA
balloon septostomy to create an ASD
open heart sx is definitive management -> cardiopulmonary bypass machine is used to perform an arterial switch
correction of ASD or VSD can be performed at the same time
Murmur for congenital aortic stenosis?
ejection systolic murmur loudest at the second intercostal space on the right sternal border
crescendo-decrescendo
radiates to the carotids
Presentation of congenital aortic stenosis?
fatigue
dyspnoea
dizziness
fainting
symptoms worse on exertion
palpable systolic thrill
slow rising pulse
narrow pulse pressure
Management of congenital aortic stenosis?
percutaneous balloon aortic valvoplasty
surgical aortic valvoplasty
valve replacement
Complications of congenital aortic stenosis?
left ventricular outflow obstruction
heart failure
ventricular arrhythmia
bacterial endocarditis
sudden death on exertion
Associations of pulmonary valve stenosis?
ToF
William’s syndrome
Noonan syndrome
Congenital rubella syndrome
Presentation of pulmonary valve stenosis?
fatigue on exertion
dyspnoea
dizziness
fainting
murmur
palpable thrill
right ventricular heave
raised JVP
Murmur for pulmonary stenosis?
ejection systolic murmur loudest at the second intercostal space on the left sternal border
Mx of pulmonary valve stenosis?
watch and wait
balloon valvoplasty via venous catheter
open heart surgery
Acyanotic congenital heart disease?
VSD
ASD
PDA
coarctation of the aorta
aortic valve stenosis
Cyanotic congenital heart disease?
Tetralogy of Fallot
Transposition of great arteries
Tricuspid Atresia
Ebstein’s anomaly
