Cardiology Flashcards
What are the features of an innocent murmur?
What causes them?
The 5 S’s
InnoSent murmur = Soft Systolic aSymptomatic L Sternal edge
Febrile illness or anaemia
You hear a murmur while listening on the left sternal border. It’s a quiet systolic murmur. The child is well.
What’s the cause of the murmur?
An innoSent murmur
Often audible during febrile illness, anaemia
Where should you listen during a cardiac examination? What are you listening to at each place?
This is a long one, stay strong!
- 2nd IC space, R sternal border
AORTIC - 2nd IC space, L sternal border
PULMONARY - 4th IC space, L sternal border
TRICUSPID - 5th IC space, mid-clavicular line
MITRAL - Same as above, but leaning onto left
MITRAL - Axilla
MITRAL REGURGITATION - Carotid arteries
AORTIC STENOSIS - 2nd IC, R sternal border, leaning forward
AORTIC - Lung bases
FOR PULMONARY OEDEMA
List the heart defects which cause left-right shunts.
What’s the characteristic symptom? (1 word)
Patent ductus arteriosus
Ventricular septal defect
Atrial septal defect
Breathless
If the patient is breathless what shunt do they probably have? Why? What are the potential causes?
Left to right
Because extra blood is going from LV to RV, too much blood is going to the lungs, causing pulmonary hypertension
This means that the pulmonary vasculature become thicker and stiff, and so blood can’t exchange oxygen as effectively.
Potential causes:
- Patent ductus arteriosus
- Ventricular septal defect
List the heart defects that cause a right to left shunt?
What’s the characteristic symptom? (1 word)
Tetralogy of fallot
Blue
If the patient is blue, what shunt do they probably have? Why? What are the possible causes?
Right to left shunt
Oxygen poor blood is going from RV to LV, because pressure in RV is higher due to hypertrophy. LV then pumps poorly oxygenated blood around the body, so they get cyanosed
Tetralogy of fallot
What is transposition of great arteries? What symptoms does it cause?
When the aorta and p. artery swap places.
Blood from the body arrives in the RA, then goes to the RV. From there blood goes straight to body without blood being oxygenated by lungs first.
Blood from LV goes to the lungs, then straight back to the LA, it never oxygenates the body.
There are two separate circuits. Causes cyanosis, and death
Describe circulation of blood in a fetus?
Blood flows from umbilical cord into the RA.
There is an ASD so most of the blood goes through there to the LA, to the LV and then to the body via the aorta.
Some blood does go from the RA to the RV and into the P. artery. However as lungs are collapsed v little blood goes into them as pressure is so high.
Most of this blood goes through the PDA into the aorta and then to the body.
A baby presents as having spells of becoming cyanotic, during feeding and crying.
What’s the likely diagnosis?
ToF
Tet spells, due to increased CO (because of crying, feeding) the heart can’t keep up even more than usual.
If the patient is breathless AND blue, what is the likely cause?
AVSD
Mixing of deoxygenated and oxygenated blood in both pulmonary and body circulation
Management of transposition of great arteries?
Prostaglandin E2 (dinoprostil) to maintain PDA, so some oxygenated blood can get from pulmonary to body circulation
Surgery
Management of PDA?
Ibuprofen, a prostaglandin E2 inhibitor to close it
4 features of ToF?
- overriding aorta
- VSD
- pulmonary artery stenosis
- RV hypertrophy
List the causes of cyanosis (cardiac)?
Tetralogy of Fallot Transposition of great arteries (most common) Truncus arteriosus Tricuspid atresia (no formation) TAPVC
