Cardiology Flashcards
What is a sign of heart failure in children? (You wouldn’t normally test in a adult)
Hepatomegally
When describing murmurs which 5 things do you describe?
Timing - systolic/diastolic/continuous Duration - ejection or pan Loudness - grade 1-6 Site of maximal intensity Radiation
What is the likely cause of a collapsing pulse in a child?
PDA
Aortic regurg
What is the purpose of the firemen ovale?
In the fetus blood return from the lung is limited but return to the RA from body and placenta is increased.
It allows the blood to shunt R to L to spread the pressure
What two structures does the ductus arteriosus connect?
Pulmonary artery and aorta
What are the two types in innocent murmurs?
Ejection murmur
Venous hum
What causes a venous hum?
Turbulent flow in head and neck veins
Where is the venous hum heard best?
What can make it louder?
Beneath each clavicle
Inspiration
Exercise
What can make a venous hum quiter?
Lying flat
Occluding the jugular vein on ipsilateral (same) side
Does the vascular resistance in the lungs increase or decrease after birth?
Decrease to allow more blood to flow into lungs and therefore increase blood flow to LA
When would you want to maintain a PDA?
In a duct dependant pulmonary circulation ie blood flows from aorta into pulmonary artery to lungs as pulmonary artery isn’t attached to RV
What is the usual cause of heart failure in neonates?
Left hear obstruction eg coarctation of the aorta
What percentage of VSD requires closure?
10%
What are the 4 components of tetralogy of Fallots?
Large VSD
Overriding aorta
Pulmonary infundibular stenosis
Right ventricular hypertrophy
In tetralogy of Fallots what might the X-ray show?
Boot shaped heart
At what age is surgical correction carried out?
2/3 months
Does tetralogy of Fallots lead to cyanotic heart disease or heart failure?
Cyanotic
In tetralogy of Fallots is there a L to R R to L shunt
R to L as the deoxygenated blood moves from the right to left to cause cyanosis
What are the 4 defects in Fallots tetralogy?
Pulmonary stenosis (R outflow obstruction)
Large VSD
Overriding aorta
R ventricular hypertrophy
(1st 2 are more important)
What is the incidence of congenital heart disease?
7-8/1000 live births
What does the transposition of the great arteries look like on X-ray?
Egg on a string on its side
What is the immediate management of transposition of great arteries?
Prostaglandin E1
Balloon atrial septostomy
What would the murmur sound like in 1) Fallots or 2) transposition
1) loud ejection systolic
2) no murmur usually
What murmur does atrial septal defect present with?
Were is this best heard?
Fixed split S2 (no variation with resp)
Ejection systolic murmur
Also mid diastolic
(More blood going to R side of heart making blood flow more noisy at tricuspid and pulmonary valve)
Second intercostal L sternal edge
Does ASD lead to L to R or R to L shunt?
L TO R
What symptoms for you get with ASD?
Mainly assymptomatic, picked up as murmur
In VSD where is the murmur best heard?
What type of murmur is it?
Where does it radiate?
Left lower sternal edge
Harsh pan systolic
All over the chest
What are the signs of heart failure in neonates?
failure to thrive Tachycardia Tachypnoea Crepitations Hepatomegaly
If VSD remains uncorrected either by not closing naturally or not getting surgery what happens to the shunt?
Clinically what is seen?
It reverses from R to L sure to pulmonary hypertension the R can’t push the blood through Pulmonary artery so goes backwards through the shunt.
Intractable cyanosis
What are the 3 categories that cause heart failure in children?
Obstructive causes
Left to right shunt
Cardiomyopathy
What is a complication of VSD?
Infective endocarditis (No longer give antibiotic prophylaxis though)
Describe a murmur with persistent PDA?
In younger children systolic murmur at L sternal edge
In older continuous murmur under left clavicle (is continuous as pressure is alway higher in the aorta)
What is the triad of symptoms in aortic valve stenosis
Chest pain (less so in children)
SOB
Syncope
What condition is associated with AVSD? W
Down’s syndrome
Describe a a murmur associated with pulmonary valve stenosis
Ejection systolic radiating to back loudest over upper L sternal edge
There are two types of ASD secundum and ostium, what is the difference in a Anatomy?
Secundum - defect in foramen ovale and surrounding atrial septum
Primium - defect of atrioventricular septum
