cardiology Flashcards
treatment of ASD
- 80% close spontaneously
- large defects should be closed surgically before school age
typical murmur and heart sounds of an ASD
- ejection systolic murmur, loudest in the left upper sternal border
- fixed splitting of S2
Which heart defects are associated with Noonan’s syndrome
Pulmonary stenosis
pulmonary branch stenosis
Sx of cardiac failure in infants
- feeding difficulties
- early fatiguability
- diaphoresis while sleeping/eating
- respiratory distress
- lethargy
- FTT
treatment of a patient with coarctation of the aorta
- medical - prostaglandin E2 in neonates (to reopen the ductus arteriosus)
- surgery or catheter
which major congenital heart diseases cause high pulmonary blood flow
ventricular septal defect
atrial septal defect
patent ductus arteriosus
at what age is the most likely time you will hear a Still’s murmur
2-6 years
classic venous hum murmur
- low pitch continuous murmur
- maximal over the upper sternal edges, but often R>L
- louder when erect
- quieter when head turned away or jugular vein compression
which Congenital heart disease is associated with fixed splitting of S2
atrial septal defect
the figure 3 sign is suggestive of
coarctation of the aorta
4 main types of innocent murmur
still’s murmur
pulmonary flow murmur
branch pulmonary stenosis
venous hum
4 key findings on examination of a child in heart failure
tachycardia
tachypnoea
cardiomegaly
hepatomegaly
4 components of tetralogy of fallot
- ventricular septal defect
- pulmonary stenosis
- over-ride of the aortic valve
- right ventricular hypertrophy
haemodynamic consequence of TOF
right to left shunting
treatment of TGA
- prostaglandins to maintain ductal patency
- balloon atrial septostomy ASAP
- arterial switch surgery in first 2 weeks
which congenital heart disease is associated with a delay in P2
pulmonary stenosis
which VSD location has the highest rate of spontaneous closure
muscular
what are the 3 locations that a VSD can be in
perimembranous
muscular
double committed
innocent murmurs always:
- are systolic
- vary with position
- vary with respiration
- have normal heart sounds
what is the Eisenmenger complex
pulmonary vascular resistance changes caused by CHD may be irreversible at ~1 year
main DDx you want to exclude when you think you hear a venous hum
patent ductus arteriosus
typical heart sounds of a patient with a patent ductus arteriosus
- continuous machinery murmur that obliterates the second heart sound heart best below the left clavicle
at what age is the most likely time you will hear a pulmonary flow murmur
children-adolescents
at what age is the most likely time you will hear a branch pulmonary stenosis murmur
infants
classic murmur and heart sounds of pulmonary stenosis
- ejection systolic murmur with an ejection click, loudest at the left upper sternal edge
- radiation to back
- delay in P2
classic branch pulmonary stenosis murmur
- systolic murmur radiating to the axilla and back
management includes prostaglandin infusion and balloon atrial septosomy
TGA
which VSD location has the lowest rate of spontaneous closure
double committed
haemodynamic consequence of a large VSD
volume loading of the left ventricle and increased pulmonary blood flow –> decreased pulmonary compliance –> increased WOB
which heart defects are associated with Down syndrome
AVSD
VSD
classic still’s murmur
- musical hum
- early to mid systolic
- crescendo then decrescendo
- maximal over the LLSE
- disappears when erect and audible when erect
when would you give medical treatment over surgical treatment for a large VSD
usually to defer surgery in very small infants until slightly older
which heart defects are associated with Turner’s syndrome
coarctation of the aorta
2 major cyanotic congenital heart diseases
tetralogy of fallot
transposition of the great arteries
clinical presentation of TGA
severe progressive cyanosis developing over first days of life
typical clinical presentation of a patient with coarctation of the aorta
- tachypnoea
- weak or absent femoral pulses
- radio-femoral delay
- classic murmur
- marked discrepancy between BP of arms and legs
classical murmur and heart sounds of a ventricular septal defect
- harsh pan-systolic murmur heart best over the left lower sternal border
- thrill
which congenital heart disease has associations with other heart defects
coarctation of the aorta
typical murmur and heart sounds of a patient with coarctation of the aorta
- continuous murmur heard over the back
treatment of pulmonary stenosis
first line - catheter
second line - surgery
treatment of a PDA
- medical = indomethacin in a premature infant
- majority will close spontaneously
- surgery for symptomatic infant
classic pulmonary flow murmur
- ejection to mid systolic
- medium to high pitch
- maximal over the 2-3rd intercostal in the LUSE
treatment of TOF
always surgical
common location for an atrial septal defect
in the region of the fossa ovalis
clinical presentation of TOF
- intermittent cyanosis over 6-12 months often not obvious in newborn period
- hypercapnic spells
typical murmur and heart sounds of TOF
- Harsh ejection systolic murmur audible at the left sternal edge radiating to the back
- second heart sound is often quite loud
which heart defects are associated with foetal alcohol syndrome
ASD
VSD
TOF
typical clinical presentation of a patient with an ASD
- not until the 3rd or 4th decade
- Right heart symptoms
typical clinical presentation of a large PDA
- present around 4 weeks
- weight gain
- tachypnoea
- collapsing pulses
- wide pulse pressure
which Congenital heart disease murmurs can be heart on the back
coarctation
pulmonary stenosis
TOF
which congenital heart disease is the most common
ventricular septal defect
haemodynamic consequence of an ASD
volume loading of the right ventricle and increased pulmonary blood flow –> decreased pulmonary compliance –> increased WOB
pulmonary flow murmurs need to be further investigated to rule out which DDx
pulmonary stenosis
atrial septal defect
