Cardiology Flashcards
Name two innocent murmurs and their features
Venous hums - Heard as continuous blowing noise just below clavical.
Still’s murmur - Low pitched sound heart at lower left sternal edge
What are the characteristics of an innocent murmur?
Soft- blowing murmur in pulmonary area
Short buzzing murmur in aortic area.
May vary with posture,
Localised with no radiation.
No diastolic component.
No thrill.
No added sounds.
Asymptomatic
Different causes of Acyanotic heart disease?
VSD
ASD (present later in life),
Patient ductus arteriosis,
Coarctation of the aorta,
Aortic valve stenosis
Different causes of cyanotic heart disease?
Tetralogy of fallot
Transposition of the great arteries,
Tricuspid atresia
Presentation and management of ventricular septal defects?
Poor feeding,
Dyspnoea,
Tachypnoea,
Failure to thrive,
Pan-systolic murmur - left lower sternal border.
Can lead to pulmonary HTN and heart failure
Rx - Transcatheter closure vis femoral vein or open heart surgery.
Associations of VSDs?
Down’s syndrome
Truner syndrome
Risk of progression to Eisenmenger syndrome
Types of atrial septal defects?
Ostium secondum - failure of septum secondum to close.
Osteum primum - failure of septum primum to close.
Presentation, complications, and management of ASDs
Often asymptomatic and therefore diagnosed later in life. Can present with:
SOB,
Difficulty feeding,
Poor weight gain,
LRTI,
Mid-systolic cresendo-decrescendo murmur heard louded over upper left sternal edge.
Complications - stroke, atrial fibrillation, pulmonary HTN, eisenmenger syndrome.
Rx - Wait and watch, surgical closure, anticoagulation in adults.
Explain Eisenmonger’s syndrome
Can occur in ASD, VSD or patient ductus arteriosus.
Occurs when pulmonary pressure exceeds systemic pressure so blood flow swaps and flows from right to left. Thus blood bypasses lungs and patient becomes cyanotic.
Presents with signs of Pulmonary HTN (RV heave, raised JVP, peripheral oedema) and cyanosis, clubbing, dyspnoea and plethoric complexion (due to polycythaemia).
Definitive management - heart and lung transplant.
The four defects of tetralogy of Fallot and its risk factors?
- VSD
- Overriding aorta,
- Pulmonary valve stenosis,
- Right ventricular hypertrophy
Risk factors = Rubella infection, increased age of mother, alcohol consumption in pregnancy and diabetic mother/
What is the presentation, investigations, and treatment for tetralogy of fallot?
Presentation -Cyanosis, clubbing, poor feeding, poor weight gain, pulmonary stenosis and tet spells (episodes where shunt is worse. precipitating cyanotic episode).
Investigations - ECHO and CXR (boot shaped heart)
Treatment - In neonates, give prostaglandins to maintain ductus arteriosus. Then perform total surgical repair by open heart surgery
Describe features of tet spells
Episode of cyanosis due to worsened right to left shunt.
Older children may squat when spell occurs. Younger children bring knees to chest.
Management - Oxygen, beta blockers (improve blood flow through pulmonary vessels), IV fluids, morphine, sodium bicarb and phenylephrine infusion.
What is ebstein’s anomaly, the presentation, investigations and management?
Tricuspid valve is set lower down in the heart so there is bigger atrium and smaller ventricle.
Presentation - heart failure, gallop rhythm, cyanosis, SOB, poor feeding and collapse/arrest.
Investigations - ECHO.
Management - Treat arrythmias and heart failure. Definitive management is by surgical correction.
Explain features of Transposition of the Great Arteries?
Aorta and pulmonary trunk come are swapped. So deoxygenated blood goes through aorta and into systemic system and oxygenated blood goes into lungs.
Presentation - Often diagnosed antenatally. If not then baby presents cyanosed within first few days.
Management - When there is VSD, there is mixing of blood so treatment can be less urgent. Prostaglandins can be used to maintain ductus arteriosus, balloon septostomy - opens foramen ovale and finally open heart surgery is the definitive management.
Features of Eisenmenger’s syndrome?
What - Reversal of left-right shunt so blood starts to bypass lungs.
Associated with - VSD, ASD and patent ductus arteriosis.
Features - Cyanosis, clubbing, RVF, haemoptysis and embolism.
Management - Heart-lung transplant is only definitive option.
