Cardiology Flashcards by Deleted Deleted

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)

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6 reasons for left lateral thoracotomy scar

Cardiac (4): BT shunt, PA banding, Coarctation of aorta repair (subclavian flap), PDA ligation
Lung: Lobectomy, thoracotomy

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Midline sternotomy scar

Any open heart or bypass surgery

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3 other scars/signs on chest examination

Chest drain scars
mediastinal drain scars
pacemaker or reveal device (left pectoral)

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Site of normal apex beat

4th-5th intercostal space mid-clavicular line

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Fixed split S2

Atrial septal defect

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Ejection systolic murmurs

Aortic stenosis
Pulmonary stenosis
Innocent murmurs

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Pansystolic murmurs

Mitral regurgitation
Tricuspid regurgitation
Mitral valve prolapse
VSD (LLSE)

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Early diastolic murmurs

Aortic regurgitation
Best heard with bell at LLSB sitting forwards

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Mid-diastolic murmurs

mitral stenosis
tricuspid stenosis

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Murmurs heard at ULSE

pulmonary stenosis
PDA
pulmonary artery stenosis
RVOT (TOF)
(Shunt procedure?)

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Murmurs heard at URSE

Aortic stenosis

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Murmurs heard at LLSE

Aortic regurgitation
VSD
Still’s (innocent) murmur
AVSD
HOCM
Tricuspid regurgitation

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Murmurs heard at apex

Mitral regurgitation
Mitral valve prolapse
Mitral stenosis

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Expiration will magnify what murmurs?

Left-sided murmurs:
AS, AR, MR, MS

R-I-L-E

right inspiration, left expiration

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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

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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

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Non-cyanotic heart conditions

Aortic stenosis
Pulmonary stenosis
ASD
VSD
Coarctation of the aorta

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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

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Syndromes associated with dextrocardia

Kartagener syndrome
Primary ciliary dyskinesia

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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)

1. AVSD 2. VSD 3. ASD (secundum) 4. TOF 5. 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

1. VSD 2. 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

1. double outlet right ventricle 2. TOF 3. VSD 4. AVSD

Heart problems in fetal alcohol syndrome

ASD VSD PDA TOF

Long-term postoperative complications following cardiac surgery

1. vocal cord palsy 2. protein losing enteropathy (Fontan) 3. developmental problems 4. Arrythmias 5. 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)