Cardiology Flashcards
How may congenital heart disease present?
Antenatal screening
Detection of a heart murmur (innocent vs pathological)
Cyanosis
Heart failure (usually from L–>R shunt)
Shock (when duct closes in severe L heart obstruction)
What is the epidemiology and clinical course of an ASD?
- Most likely congenital heart defect to be found in adulthood
- Significant mortality: 50% dead by 50 years old
What are the two types of ASD?
Ostium Secundum
Ostium Primum
What are the clinical features of an ASD?
Ejection systolic murmur
Fixed splitting of S2
Embolisation may pass from venous system to L side of heart causing stroke
CXR: cardiomegaly
What are the features of ostium secundum on ECG?
RBBB with RAD
What are the features of ostium primum on ECG?
Present earlier
RBBB with LAD
Increased PR interval
What is the epidemiology of VSD?
- Most common cause of congenital heart disease
- Close spontaneously in 50%
What congenital conditions is VSD associated with?
DS, Edward’s Syndrome, Patau Syndrome
What are the clinical features of a VSD?
Pan-systolic murmur which is louder in smaller defects
What are some of the complications of VSD?
Aortic regurgitation IE Eisenmenger's complex Right HF Pulmonary hypertension
How does PDA arise?
- Classified as acyanotic, can however eventually lead to late cyanosis in the lower extremities (terminal cyanosis) if uncorrected
- Connection between the pulmonary trunk and descending aorta
What are the risk factors for PDA?
More common in premature babies, born at high altitude or maternal rubella infection in 1st trimester
What are the clinical features of PDA?
Left subclavicular thrill Continuous machinery murmur Large volume, collapsing pulse Wide pulse pressure Heaving apex beat
What is the tx and complication of PDA?
Tx: Indomethacin
-Risk of failure for DA to close by 1month
What is the epidemiology of tetralogy of Fallot?
- Most common cause of cyanotic congenital heart disease
- Typically presents at 1-2months (up to 6months)
What are the 4 characteristic features of TOF?
- VSD
- Right ventricular hypertrophy
- Right ventricular outflow obstruction, pulmonary stenosis
- Over-riding aorta
What determines the degree of cyanosis and clinical severity in TOF?
The severity of the right ventricular outflow tract obstruction
What are the clinical features of TOF?
- Cyanosis
- R–> L shunt
- Ejection systolic murmur due to pulmonary stenosis
- R sided aortic arch seen in 25% patients
What is seen on CXR and ECG in TOF?
CXR: ‘boot-shared’ heart
ECG: Right ventricular hypertrophy
What is the tx of TOF?
- Surgical repair undertaken in two parts at 6-9months
- Cyanotic episodes may be helped by beta-blockers to decrease infundibular spasm.
What happens in transposition of the great arteries?
- The aorta is connected to the R ventricular and the pulmonary artery to the L ventricle.
- Unoxygenated blood is returned to the body and oxygenated blood returned to the lungs: two parallel circuits.
What are the clinical features of transposition of the great arteries?
- Cyanosis is the predominant symptom.
- May be profound and life-threatening.
- Presentation usually on day 2 of life when ductal closure leads to a marked decrease in mixing of the desaturated and saturated blood.
- 2nd HS is often loud and singular–> usually no murmur
What is seen on CXR in transposition of the great arteries?
Narrow upper mediastinum
‘Egg on side’ appearance of cardiac shadow
What is the aim of tx in transposition of the great arteries?
- Aim to improve mixing in sick, cyanotic neonate.
- Maintain patency of DA with prostaglandin infusion.
- Balloon atrial septostomy is a life-saving procedure.
- All neonates will require surgery–> arterial switch procedure in neonatal period.
