cardiology Flashcards
what is transposition of great arteries
aorta is connected to the right ventricle and pulmonary artery is connected to left ventricle
what other CHD is transposiotion of the great arteires usually associated with
vsd
asd
pda
what is the presentation of transposiotion of the great arteires
not compatible with life unless another CHD is present
then:
cyanosis
loud 2nd HS
what findings would you find on xray with transposition of the great arteries
narrow mediastimun with an ‘egg’ on the side
what is the management of transposition of the great arteries
o2
maintain PDA w prostaglandins
surgery within days of life
what are complex CHD
rarer CHD most commonly tricuspid atresia with the R ventricle being small and innaffective
also:
mital atresia
double inlet L ventricle
Common arterial trunk
what is thepx of tricuspid atresia
like a common mixing CHD
cyanosis when newborn
breathlessness
what is the management of tricuspid atresia
shunt between subclavian and pulmonary artery for very cyanosed children + pulmonary artery binding
corrective surgery
what is a VSD
ventricular septal defects
most common CHD
defects antwhere in septum, perimembranes and muscle
what are the types of VSD
small (under 3mm)
large (larger than Ao valve)
what is the presentation of small VSD
asymptomatic with pansystolic murmur
what is the px of large VSD
herft failure - at 1 week old
- breathlessness
- faiulure to thrive
recurrent chest infections
tachycardia
tahyopnea
hepatomegaly
soft pansystolic murmur
what ix would you perform for VSD
usually all negative apart from echo but:
cxr
ecg
echo
what results may you find on CXR for VSD
cardiomegaly
enlarged pul
arteries
pulmonary oedema
how would you manage a VSD
surgery at 3-6m
if large = diuretics+captopril and high calorie diet
what is a PDA
patent ductus arteriosis
the ductus arteriosis is a part of fetal circulatory system, in PDA it remains open and doesnt close shortly after birth causing a L -> r shunt
what are the signs of a PDA
continous murmur at clavicle
collapsingpulse
failure to thrive
what may you find on CXR for PDA
cardiomegaly (biventricular hypertrophy)+ dilated pulmonary arteries
how would you treat a PDA
surgery at 1y
what type of CHD is AVSD
common mixing
what is AVSD
atrioventricular septal defect
a defect in the middle of the heart with a single 5 leafelet valve between the atria and the ventricles with a tendancy to leak
what is the presentation of AVSD
cyanosis at birth
heart failure at 2-3 weeks
what condition is avsd associated with
downs
how would you investigate AVSD
antenatal us
ecg
echo
how would you manage an AVSD
diuretics + captopril
high calorie diet
surgery at 3-6m
what is tetrogy of fallot
most common cause of cyanotic CHD
a right to left shunt
has 4 cardinal features
- overring aorta
- large VSD
- R ventricular hypertrophy
- subpulmonary stenosis
what is the presentation of tetrogy of fallot
severe cyanosis with hypercyanotic spells
finger clubbing
harsh ejection systolic murmur
what are would you find on CXR of tetrogy of fallot
right ventricular hypertrophy
overriding aorta
small heart
what is the management of tetrogy of fallot
surgery at 6 m
what are hypercyanotic spells
fainting followed by sleep for 15 mins
usually self limiting, intervene only if sleep is prolonged
what is the management of hypercyanotic spells
morphene
iv propranolol
iv fluids
bicarbonate
muscle paralysis and ventilation
what type of CHD is pulmonary stenosis
an outflow obstruction
what is pulmonary stenosis
pulmonary valve leaflets are partly fused together
what may you find on XRAY with pulmonary stenosis
post stenotic dilatation of pulonary artery
right ventricular hypertrophy
what is the presentation of pulmonary stenosis
mostly asymptomatic
unless critical pulmonary stenosis
- ejection systolic murmur
- r ventricular heave
- cyanosis
what is the management of pulmonary stenosis
surgery onlyif critical/pressure gradient becomes too high
what is aortic stenosis
aortic valve leaflets are fused causing outflow obstruction
what other CHD is aortic stenosis commonly associated with
mitral valve stenosis
coarctation of the aorta
what is the presentation of aortic stenosis
asymptomatic unless severe / critical
severe =
low excersise tolerence, chest pain, syncope
critical = neonatal shock and HF
what are signs of aortic stenosis
slow risisng pulses
carotid thrill
ejection systolic murmur radiation to neck
epical ejection click
what would you find on xray in aortic stenosis
prominent left ventricle(L ventricular hypertrophy) and post stenotic dilatation
what is the management of aortic stenosis
regular echo
treat if symptomatic on excersise or a high pressure gradient
surgery once in infancy and a valve replacement later in life
what type of CHD is coarctation of the aorta
an outflow obstruction
what is coarctation of the aorta
arterial duct tissue encirculating the aorta at the point of insertion of the arterial duct, so at constriction it causes outflow obstruction
what is the presentation of coarctation of the aorta
occurs after the duct closes at 2 days
then:
shock
what other CHD is commonly found with coarctation of the aorta
VSD
what murmur is present with coarctation of the aorta
ejection systolic murmur
how would yo diagnose coarctation of the aorta
x ray - usually normal
abnormal ECG + echo
how do you treat coarctation of the aorta
surgery in first few days of life
what is ASD
a leeft to right shunt in the atria of the heart
what are the types of ASD
secundum
partial
describe a secundum ASD
defect un the centre of the atrial septum involving the soramen ovale
what is a partial ASD
communication between bottom of the atrial septum and the atrioventricular valves, with a tendancy to regurgitate
what is the presentation of an ASD
arrythmias
recurrent chest infections
but mostly asymptomatic
what is the murmurs of ASD
partial = pansystolic
secundum = ejection _s_ystolic
what is the management of ASD
treat if symptomatic or have a dilated right ventricle
surgery at 3-5y
what would you find on x ray is ASD
cardiomegaly w enlarged pulmonary arteries
what would you find on ECG on secundum ASD
RBBB
what would you find on ecg on pASD
superior QRS
what is heart failure
inability of the heart to meeet the bodys demands
what is the presentation of heart failure
breathlessness + poor feeding leading to failure to thrive
sweating
tachycardia and tachyopnea
recurrent chest infections
gallop rythmn murmur
cardiomegaly
hepatomegaly
what are the causes of left sided heart failre
younger than 1 week = coarctation of the aorta (ie L sided obstruction)
older than 1w= left to right shunts, pulmonary vascular resistance will fall increasing shunting and causing HTN
what is Eisenmengers syndrome
untreated HF due to L>R shunt leading to pulmonary HTN
how do you treat HF
digoxin
diuretics
ACEi
BBlockers
what is rhumatic fever
inflammatory disease of the heart that can develop with untreated strep infections
what is the Jones criteris
a way of classifying rheumatic fever based on severity of Sx
can be major or minor
what is the presentation of minor RF
fever
polyarthria
raised inflam markers
prolonged PR interval
what are the features/ presentations of major rheumatic fever
pancarditis
endocarditis = murmur
myocarditis = oedema / HF
pricarditis= pleural rub
polyarthritis
sudden chorea
emotional liability
how do you investigate rheumatic fever
echo
how do you manage rheumatic fever
bedrest
asprin +/- corticosteriods
diuretics
ACEi
treat infections with Benzathine penicillin + PO
erthromycin
+/- dain pericardial effusion
what is a consequece of prolonged rheumatic fever
mitral stenosis
what are the Rf for bacterial endocarditis
CHD’s - due to turnulent blood flows
but not secundum ASD
what is the presentation of bacterial endocarditis
fever
anaemia
splinter haemorrages
necrotic skin lesions
splenomegaly
cerebral and retinal infarcts
arthritis
microscopic haematuria
how would you diagnose bacterial endocarditis
blood cultures : ESR, CRP, FBC
echo
what is the most common cause of bacterial endocarditis
strep. viridant
what is the treatement for strep. viridans bacterial endocarditis
IV penecillin for 6 weeks
+ aminoglycodised
surgery if they have prothetic HV
