Cardiology Flashcards
What are the 8 commonest lesions that account for most congenital heart diseases?
Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrial septal defect (ASD) Pulmonary stenosis Aortic stenosis Coarctation of the aorta Transposition of great arteries Tetralogy of Fallot
What is the aetiology of most congenital heart diseases?
Genetic susceptibility
Teratogenic insult
What are the environmental factors that might cause congenital heart diseases?
Drugs: alcohol, amphetamines, cocaine, ecstasy, phenytoin, lithium
Infections: TORCH
Maternal: DM, SLE
What are the TORCH infections?
Toxoplasma
Rubella
CMV
Herpes
30% of what have CHD?
Chromosomal abnormalities
Which chromosomal abnormalities in particular can have CHD?
Trisomy 13, 18 and 21
What is trisomy 21 particularly associated with?
AVSD
ASD and VSD more common
Which CHD is Turner syndrome associated with?
Co-arctation of aorta
Which CHD is Noonan syndrome associated with?
Pulmonary stenosis
Which CHD is Williams syndrome associated with?
Supravalvular aortic stenosis
What do you ask in a history about CHD?
Feeding, weight, development Cyanosis Tachypnoea, dyspnoea Exercise tolerance Chest pain Syncope Palpitation Joint problems
What should you examine a child with CHD?
Weight/height Dysmorphic features Cyanosis Clubbing Tachy-/dyspnoea Pulses/apex (femoral) Heart sounds Murmurs
What investigations would you do in a child with potential CHD?
BP O2 sats, ABG ECG CXR ECHO Catheter Angiography MRI/A Exercise testing
What can the timing of murmurs be in the cardiac cycle?
Systole
Diastole
Continuous
What can the duration of murmurs be?
Early/mid/late
Ejection/holo- or pan systolic
What can the pitch/quality of murmurs be?
Harsh or mixed frequency (turbulence)
Soft or indeterminate
Vibratory/pure frequency (laminar flow)
What percentage of innocent murmurs are innocent?
70-80%
What are the 4 types of innocent murmurs?
- Still’s murmur (LV outflow murmur)
- Pulmonary outflow murmur
- Carotid/brachiocephal IC arterial bruits
- Venous Hum
What are common features of innocent murmurs?
Systolic murmur (cont. venous hum) No other signs cardiac disease Soft murmur Vibratory/musical Localised Varies with position, respiration, exercise
What age does Still’s murmur usually present?
2-7yrs
What are the characteristics of Still’s murmur?
Soft systolic, vibratory/musical
Where is Still’s murmur heard best?
Apex, left sternal border
When does Still’s murmur increase?
Respiration
With exercise
What age does pulmonary outflow murmur usually present?
8-10yrs
What are the characteristics of a pulmonary outflow murmur?
Soft systolic, vibratory
Where is a pulmonary outflow murmur heard best?
Upper left sternal border (ULSB)
Well localised, not radiating to back
When does a pulmonary outflow murmur increase?
Increases in supine position, with exercise
What kind of child does a pulmonary outflow murmur usually affect?
Narrow chested
What age does carotid/brachiocephal IC arterial bruits usually present?
2-10yrs
What are the characteristics of a carotid/brachiocephal IC arterial bruit?
1/6-2/6 systolic, harsh
Where is a carotid/brachiocephal IC arterial bruit heard best?
Supraclavicular
Radiates to neck
When does a carotid/brachiocephal IC arterial bruit increase?
Increases with exercise
Decreases on turning head or extending neck
What age does venous hum usually present?
3-8yrs
What are the characteristics of venous hum?
Soft, indistinct
Continuous murmur, sometimes with diastolic accentuation
Where is a venous hum heard best?
Supraclavicular
When can a venous hum be heard?
Only in upright position
Disappears on lying down/when turning head
What are the 3 main types of VSD?
Subaortic
Perimembranous
Muscular
What is the shunt in a VSD?
L to R shunt
What is the clinical presentation of VSD?
Pansystolic murmur lower left sternal edge
Sometimes thrill
What is the clinical presentation of a very small VSD?
Early systolic murmur
What is the clinical presentation of a very large VSD?
Diastolic rumble due to relative mitral stenosis
What is Eisenmenger syndrome?
Any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, reversal of flow, and cyanosis
How are VSD’s closed?
Amplatzer occlusion device
Patch closure - open heart surgery
How are atrial septal defects sometimes detected in adulthood?
AF
Heart failure
Pulmonary hypertension
What are the clinical signs of atrial septal defects?
Few clinical signs
Usually spontaneous closure
What are the features of an atrial septal defect on auscultation?
Wide fixed splitting of 2nd heart sound
Pulmonary flow murmur
Which chromosomal abnormality is an atrioventricular-septal defect associated with?
Trisomy 21
What are the clinical signs of pulmonary stenosis?
Asymptomatic in mild stenosis
Moderate and severe: dyspnoea and fatigue
What are the features of pulmonary stenosis on auscultation?
Ejection systolic murmur, ULSB
Radiation to back
What is a balloon valvoplasty for?
Balloon valvuloplasty is a procedure to repair a heart valve that has a narrowed opening
What are the clinical features of aortic stenosis?
Mostly asymptomatic
Severe: reduced exercise tolerance, exertional chest pain, syncope
What are the features of aortic stenosis on auscultation?
Ejection systolic murmur URSB
Radiation into carotids
What are the changes in fatal circulation at birth?
Pulmonary vascular resistance falls Pulmonary blood flow rises Systemic vascular resistance increases Ductus arteriosus closes Foramen vale closes Ductus venosus closes
How is patent ductus arteriosus treated?
Fluid restriction/diuretics
Prostaglandin inhibitors
Surgical ligation
What is coarctation of the aorta?
Narrowing of the aorta
What are the investigations for coarctation of the aorta?
MRI (3D)
What are the options for management of coarctation of the aorta?
Re-open DA with prostaglandin
Resection with end-to-end anastomosis
Subclavian patch repaird
Balloon aortoplasty
What is transposition the great arteries?
The two main blood vessels leaving the heart, the pulmonary artery and the aorta are swapped over
What are the surgical options for transposition of the great arteries?
Atrial septostomy
Switch procedure
What is Tetralogy of Fallot?
Defect affecting structure of heart, usually four:
- Pulmonary stenosis
- VSD
- Right ventricular hypertrophy
- Overriding aorta
How many defects are there normally in ToF?
4
What are the 4 defects normally seen in ToF?
- Pulmonary stenosis
- VSD
- Right ventricular hypertrophy
- Overriding aorta
What is the treatment for ToF?
Open heart surgery in first year of birth
What is a sign of ToF?
Blue-tinged skin
