Cardiology 2 Flashcards
What is a persistent ductus arteriosus? (PDA)
Failure of ductus arteriosus to close by 1 month after the EDD due to a defect in the constrictor mechanism of the duct (in a preterm infant PDA is not caused by congenital heart disease but is due to prematurity)
Blood flows from the aorta to the pulmonary artery (i.e. left to right)
How does a PDA present?
Usually asymptomatic, if the duct is large there’ll be HF and pulmonary hypertension
Continuous murmur beneath the left clavicle, continues into diastole
Bounding or collapsing pulse due to increased pulse pressure
How is a PDA treated?
NSAIDs or surgical closure with a coil or occlusion device introduced via a cardiac catheter at about 1 year of age
What are right to left shunts?
Blood flow from the pulmonary artery to the aorta
Presentation is with cyanosis (blue, sats <94, collapse), usually in the 1st week of life
What is tetralogy of fallot?
a large VSD pulmonary stenosis right ventricular hypertrophy an overriding aorta (blood from both ventricles enters the aorta) Clubbing, murmur at left sternal edge
What is the treatment for tetralogy of fallot?
Open heart surgery at 6 months-1 year Tet spells: Knee chest position (blocks the femoral to increase peripheral resistance) Oxygen, IV morphine, IV beta blocker Surgery: Closure of VSD Relieving the right ventricular outflow tract obstruction (increasing size of pulmonary valve)
What is the management for very cyanosed patients with tetralogy of fallot?
BT shunt- An artificial tube placed between subclavian and pulmonary arteries
Balloon dilatation- of the right ventricular outflow tract
What is transposition of great arteries?
The aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle (discordant ventriculo-
arterial connection)
How does transposition of great arteries present?
Usually on day 2, when the duct closes always present cyanosis loud and single second heart sound usually no murmur (but may be if there is other abnormality present too)
What is the treatment for transposition of great arteries?
Maintain patency of ductus arteriosus with a prostaglandin E1 infusion is mandatory
Life-saving balloon atrial septostomy
Arterial switch procedure
What are the features of Eisenmenger syndrome?
No murmur
Right heart failure (late)
Medication to delay transplantation
What syndromes are associated with congenital heart disease?
Down syndrome- ASDs
Noonan syndrome- pulmonary valve stenosis, ASDs, hypertrophic cardiomyopathy
Marfan’s syndrome- mitral valve prolapse, aortic aneurysm
Turner syndrome- coarctation of aorta
What is coarctation of the aorta?
Due to arterial duct tissue encircling the aorta just at the point of the insertion of the duct
How does coarctation of the aorta present?
Normal examination on first day of life
Acute circulatory collapse at 2 days of age when the duct closes
Older children may be asymptomatic or present with chest pain/claudication with physical exertion.
Heart failure
Absent femoral pulses
Severe metabolic acidosis
What are the investigations for coarctation of the aorta?
Cardiomegaly from heart failure and shock on CXR Older children: murmurs, pulses, blood pressure
What us the treatment for coarctation of the aorta?
Resection of the narrowed segment
What is hypoplastic left heart syndrome?
Underdevelopment of the entire left side of the heart
Small or atretic mitral valve
Diminutive (extremely small) left ventricle
Usually aortic valve atresia
Very small, to the point of coarctation,
ascending aorta
How does hypoplastic left heart syndrome present?
After birth- sickest of all neonates with duct-dependent circulation
Profound acidosis
Rapid CV collapse
weakness or absence of all peripheral pulses (in contrast to weak femorals in
coarctation of aorta)
What is the treatment for hypoplastic left heart syndrome?
Norwood procedure
Some may require revision of surgery
How does supraventricular tachycardia present?
HR: 250-300
Poor cardiac output and pulmonary oedema
Causes hydrops fetalis and IU death
How does myocarditis present?
Most commonly to viral infection, but also bacterial or immune in origin
Chest pain, decreased exercise tolerance, arrythmia
What are the normal heart ranges for children?
<1: 110-160
2-5: 95-140
5-12: 80-120
>12: 60-100
What is Eisenmenger’s syndrome?
Long standing left to right shunt causes pulmonary hypertension and reversal of shunt to cyanotic right to left
Considered irreversible, heart transplant required
What are the symptoms of Eisenmenger’s syndrome?
Cyanosis Clubbing Syncope Polycythemia Heart failure Infections Kidney problems Gallstones/gout
What is the management for heart failure?
Bed rest in semi-upright position
Supplemental oxygen (not in L to R shunt)
Sufficient calorie intake
Diuretics and ACE-1 (captopril)- R to L shunt and high pulmonary flow
BB and digoxin
Prostaglandin infusion- duct dependent circulation
What are the signs of a pathological heart murmur
All diastolic & pansystolic murmurs Late systolic murmurs Loud murmurs- >3/6 Continuous murmurs Associated with cardiac abnormalities
What are the features of a venous hum?
Innocent hear murmur
Heard above right clavicle and over right jugular vein
Heard throughout cardiac cycle
Placing finger on jugular vein will abolish sound
May disappear if patient is supine or if the patient turns their head to one side
