Cardiology Flashcards
1
Q
Murmurs
A
- Pan systolic
- VSD, MR, TR
- Ejection systolic
- AS, PS (ASD and tetralogy of Fallot)
- Continuous
- PDS, shunt
- Early diastolic
- AR, PR
- Mid diastolic
- MS, TS
2
Q
Common lesions
A
- Acyanotic
- VSD
- ASD
- PDA
- Coarctation
- Aortic stenosis
- Pulmonary stenosis
- Interrupted aortic arch
- Cyanotic
- Transposition of the great arteries
- Tetralogy of Fallot
- Pulmonary atresia
- Tricuspid atresia
- DILV
- DORV
- HLHS
- Ebsteins
- TAPVD
3
Q
VSD
A
- Commonest cardiac anomaly
- Membranous VSD and muscular VSD
- Associated with Down’s, Edward’s and Patau’s
- Variable size and presentation
- Typically no murmur early on
- Large VSD
- Develop symptoms when PVR falls
- SOB, poor feeding, poor weight gain
- Heave, loud S2, systolic murmur
- Diuretics and surgical repair before 6/12
- Small VSD
- Asymptomatic
- Loud systolic murmur appears after PVR falls
- No other signs
- Often closes spontaneously
- Good long term outlook
- Larger defects lead to shunting with eventually reverses as pulmonary vascular resistance rises past a certain point. This results in unoxygenated blood passing into the systemic arterial circulation leading to cyanosis. The increased back pressure also ultimately leads to heart failure.
- Investigation
- ECHO
- Visualisation of the defect
- ECG
- LVH
- RVH
- CXR
- Pulmonary plethora
- Cardiomegaly
- ECHO
4
Q
ASD
A
- Secundum (centre of septum)
- Primum (partial AVSD, centre of heart, cleft in mitral valve, often MR)
- Usually asymptomatic in childhood
- Later breathless and arrhythmias
- Parasternal heave
- Soft ESM
- Wide fixed split S2
- Transcatheter device closure (secundum only)
- Surgical repair (secundum and primum)
- Good long term outlook
- Pathophysiology
- Ostium secundum-type ASDs develop due to a lack of development of septum secundum.
- Ostium primumtype ASDs develop due to lack of closure of ostium primum by the endocardial cushions.
- Sinus venosus-type ASDs are thought to occur because of resorption of wall between the superior vena cava and pulmonary veins.
- Occasionally, sinus venosus ASDs can develop between the inferior vena cava and the right atrium.
- Investigation
- ECG
- Secundum RAD
- CXR
- Pulmonary oedema
- Cardiomegaly
- Pulmonary oedema
- ECHO
- Diagnostic
5
Q
PDA - arterial duct
A
- Commonest in premature babies
- Embryological remnant that connects the pulmonary artery to thge left subclavian artery
- Can be associated with congenital rubella syndrome and Down’s
- Sometimes causes FTT in infants
- Otherwise asymptomatic murmur - continuous ‘machinery’
- Heave
- Big pulse volumes
- Prem baby - NSAID, surgical ligation
- Otherwise device closure
- Good long term outlook
6
Q
Coarctation
A
- Often ‘duct dependent’
- When duct constricts so does aorta causing severe obstruction
- Infants present moribund with CV collapse, impalpable femoral pulses
- Prostin to open duct, resuscitate
- Surgical repair
- May present as asymptomatic murmur or HTN
- Respiratory tract infections
- Failure to thrive
- Poor femoral pulses
- Radiofemoral delay
- Upper body HTN
- Upper body pink and lower body cyanosed
- Murmur at back
- Surgical repair, balloon angioplasty, stenting
- Long term risk of HTN and aneurysms
- Investigation
- CXR
- Rib notching
- ECG
- LV strain
- CT angiography
7
Q
TGA
A
- Commonest neonatal cyanotic heart problem
- Aorta rises from RV and pulmonary artery arises from LV
- Seperate circulations, mixing at duct and PFO
- Typically no signs other than cyanosis
- CXR ‘egg on side’
- Breathless and acidotic when duct shuts
- Good long term outlook
8
Q
Tetralogy of Fallot
A
- Commonest cyanotic heart problem
- Systolic murmur from RVOT obstruction not VSD
- Spectrum of severity, may be pink with murmur initially
- As obstruction increases, more cyanosed
- Hypercyanotic spells result from ‘steal’ to systemic circulation (propranalol)
- May need Blalock Taussig shunt before repair
- Complete repair removes obstruction and closes VSD
- Usually need pulmonary valve replacement in long term
- The key morphological abnormality is anterior and cephalad deviation of the muscular outlet of the ventricular septum causing the following:
- Malalignment VSD
- Aorta overriding the VSD
- Right ventricular outflow tract obstruction
- Secondary concentric RV hypertrophy
- Investigation
- ECG
- RVH + RBBB
- CXR
- Coeur en sabot (boot shaped heart)
- ECHO
- Anatomy and degree of stenosis
- ECG
9
Q
Summary of clinical findings
A
- Small VSD - harsh murmur weith no heave
- ASD - soft pulmonary flow murmur +/- heave, split S2
- PDA - continuous machinery murmur below left clavicle, big volume pulses
- Coarctation - HTN, poor femoral pulses, murmur at back
- Valve PS or AS - rumbling murmur with click
- Tetralogy of Fallot - cyanosis with harsh murmur
- Transposition - cyanosis and no other signs
10
Q
Fetal circulation
A
- Fetus does not use lungs
- 4 main differences:
- Foramen ovale
- Ductus venosus
- Arterial duct
- High PVR
11
Q
Chromosomal abnormalities and cardiac associations
A
- Down’s syndrome (trisomy 21) - AVSD, VSD, ASD, ToF
- Edward’s syndrome (trisomy 18) - Complex
- Patau’s syndrome (trisomy 12) - Complex
- Turner’s syndrome (45XO) - AS, CoA, bicuspid aortic valve
- DiGeorge syndrome (22q. 11 microdeletion) - Conotruncal abnormalities
12
Q
Congenital bicuspid aortic valve
A
- Associated with Turner’s syndrome (45X)
- Can cause AS, AR and dilated aortic root
- Requires aortic valve replacement to treat
13
Q
Main issues in congenital heart disease
A
- Eisenmenger’s syndrome
- Obstructive pulmonary vascular disease causing pulmonary HTN
- Thromboembolism
- IE
- Arrhythmias
- Contraception
- COCP contraindicated in Eisenmenger’s and primary pulmonary HTN
- Pregnancy
- Contraindicated in primary pulmonary HTN, Marfan’s with dilated aortic root, AS, MS and LVSD
- Gour
