Cardiology Flashcards
5 reasons for right lateral thoracotomy scar
Cardiac (2): BT shunt, PA banding
Lung: lobectomy
GI (2): tracheoesophageal fistula repair, (CDH repair if scar has migrated upwards)
6 reasons for left lateral thoracotomy scar
Cardiac (4): BT shunt, PA banding, Coarctation of aorta repair (subclavian flap), PDA ligation
Lung: Lobectomy, thoracotomy
Midline sternotomy scar
Any open heart or bypass surgery
3 other scars/signs on chest examination
Chest drain scars
mediastinal drain scars
pacemaker or reveal device (left pectoral)
Site of normal apex beat
4th-5th intercostal space mid-clavicular line
Fixed split S2
Atrial septal defect
Ejection systolic murmurs
Aortic stenosis
Pulmonary stenosis
Innocent murmurs
Pansystolic murmurs
Mitral regurgitation
Tricuspid regurgitation
Mitral valve prolapse
VSD (LLSE)
Early diastolic murmurs
Aortic regurgitation
Best heard with bell at LLSB sitting forwards
Mid-diastolic murmurs
mitral stenosis
tricuspid stenosis
Murmurs heard at ULSE
pulmonary stenosis
PDA
pulmonary artery stenosis
RVOT (TOF)
(Shunt procedure?)
Murmurs heard at URSE
Aortic stenosis
Murmurs heard at LLSE
Aortic regurgitation
VSD
Still’s (innocent) murmur
AVSD
HOCM
Tricuspid regurgitation
Murmurs heard at apex
Mitral regurgitation
Mitral valve prolapse
Mitral stenosis
Expiration will magnify what murmurs?
Left-sided murmurs:
AS, AR, MR, MS
R-I-L-E
right inspiration, left expiration
Murmur grading
I - barely audible
II - medium intensity
III - audible with steth, no thrill
IV - audible + thrill
V - Very loud
VI - can hear without placing steth on chest
Cyanotic heart conditions
(Right to left shunting)
5 Ts and a P
1. Truncus arteriosus (1 vessel)
2. Transposition of the great arteries (2 vessels switched)
3. Tricuspid regurgitation (tri=3)
4. Tetralogy of fallot (4=tetralogy)
5. Total anomalous pulmonary venous drainage (5 words)
Pulmonary atresia
Non-cyanotic heart conditions
Aortic stenosis
Pulmonary stenosis
ASD
VSD
Coarctation of the aorta
Management of VSD
Depends on patients symptoms
Small VSD likely to close on their own
Medical management includes diuretics +/- ACEi
They should have their growth closely monitored, are likely to need high calorie diet
Syndromes associated with dextrocardia
Kartagener syndrome
Primary ciliary dyskinesia
Important to check if dextrocardia present
Listen to lungs for bronchiectasis (PCD)
Feel for position of liver (isolated dextrocardia or situs inversus)
Thrill at left sternal edge?
VSD
Pansystolic murmur maximal at LLSE
VSD
Second heart sound in VSD?
Loud S2 indicates high pulmonary arterial pressure and thus pulmonary hypertension - so a significant VSD
Post-operative complications of AVSD repair
AV valve dysfunction (tricuspid + mitral)
AV node dysfunction
Ongoing high pulmonary vascular resistance
Cardiac anomalies in Down Syndrome (in order)
- AVSD
- VSD
- ASD (secundum)
- TOF
- PDA
Syndromes associated with aortic regurgitation
Marfan’s syndrome
Ehlers-danlos syndrome
Turner syndrome
Acquired causes of aortic regurgitation
rheumatic fever
SLE
Associated with Supravalvular aortic stenosis
William syndrome
Congenital rubella
Peripheral pulmonary artery stenosis
Associated with Alagille
Clinical signs in child with pulmonary stenosis (post-repair)
Residual systolic or diastolic murmur (because of PV incompetence)
Midline sternotomy scar OR
No scar (balloon valvuloplasty
Pulmonary murmurs radiate
to the back
Pulmonary stenosis is associated with
Noonans syndrome
Williams (supravalvular)
DiGeorge (tetralogy of fallot)
Complication of PS
right ventricular failure:
Sacral or pedal oedema
Hepatomegaly
Syndromes associated with aortic stenosis
Turner syndrome
Williams syndrome
Coarctation repair operation
Sub-clavian flap (left thoracotomy scar)
end-to-end anastamosis
Complications post repair of coarctation of the aorta
Residual hypertension
re-coarctation
Clinical sign post coarctation repair
left pulse may be weak or absent post subclavian flap repair
Congenital cardiac lesions associated with VACTERL
- VSD
- Tetralogy of fallot
Cardiac problems associated with Noonans
ASD
Pulmonary stenosis (dysplastic)
Cardiomyopathy
Heart problems associated with DiGeorge
Pulmonary atresia and VSD
Aortic arch anomalies
Truncus arteriosus
Heart problems in infants of diabetic mothers
HOCM
VSD
Heart problems in CHARGE
- double outlet right ventricle
- TOF
- VSD
- AVSD
Heart problems in fetal alcohol syndrome
ASD
VSD
PDA
TOF
Long-term postoperative complications following cardiac surgery
- vocal cord palsy
- protein losing enteropathy (Fontan)
- developmental problems
- Arrythmias
- Diaphragmatic palsy
Tell me about the Norwood procedure
1st stage in surgical Mx of HLH
When? first few weeks of life
What? Joins bottom part of the pulmonary artery to the aorta (better aorta), shunt (BT or Sano) to move blood from RV to lungs, close PDA, make ASD bigger (more oxygenated blood back to RV and body)
Tell me about the Glenn procedure
For HLH, tricuspid atresia, double outlet right ventricle
When? 4-6 months of life
WHAT? SVC connected straight to pulmonary artery so blood from upper body goes straight to lungs
Tell me about the Fontan procedure?
HLH, tricuspid atresia, double outlet right ventricle
When? 18-36 months
What? Blood from IVC (lower body) goes straight to lungs - completes single ventricle circulation
Pulmonary/tricuspid atresia vs stenosis
Atesia = valves!
stenosis/regurg = vessels!
Examination findings in TOF
(pre-operative)
Ejection systolic murmur at ULSE (pulmonary stenosis)
Pansystolic murmur at LLSE (VSD)
Right ventricular heave (RVH)
Thrill over ULSE (pulmonary stenosis)
Absent radii on cardiac exam?
- Holt-oram - ASD
- VACTERL - 50% have VSD
- thrombocytopaenia and absent radii (25% have congenital heart disease)
