Cardiology Flashcards
What are the eight commonest congenital heart conditions?
Ventricular Septal Defect Patent Ductus Arteriosus Atrial Septal Defect Pulmonary Stenosis Aortic Stenosis Coarctation of the Aorta Transposition of Great Arteries Tetralogy of Fallot (VSD, pulmonary valve stenosis, a misplaced aorta and a right ventricular hypertrophy)
What are the causes of heart defects in children?
DRUGS - Alcohol, Amphetamines, Cocaine, Ecstasy, Phenytoin, Lithium
INFECTIONS - TORCH and others (Toxoplasma, Rubella, CMV, Herpes)
MATERNAL - Diabetes Mellitus, Systemic Lupus Erythematosus
Chromosomal conditions (esp trisomy 13, 18 and 21)
Genetics
Teratogens in the first trimester
What is Still’s murmur?
LV outflow murmur
Age 2-7 years
Soft systolic; vibratory, musical,”twangy”
Apex, left sternal border
Increases in supine position and with exercise
Benign and usually gone by adolescence
What is a pulmonary outflow murmur?
Age 8-10 years
Soft systolic; vibratory
Upper left sternal border, well localised, not radiating to back
Increases in supine position, with exercise
Often children with narrow chest
Benign
What is a carotid bruit?
Age 2-10 years 1/6-2/6 systolic; harsh Supraclavicular, radiates to neck Increases with exercise, decreases on turning head or extending neck Benign
What is a venous hum?
Age 3-8 years
Soft, indistinct
Continuous murmur, sometimes with diastolic accentuation
Supraclavicular
Only in upright position, disappears on lying down or when turning head
Benign
What are the three types of VSD?
Subaortic
Perimembranous
Muscular
What is the presentation of VSD?
Pansystolic murmur lower left sternal edge, sometimes with thrill
In very small VSDs, early systolic murmur
In very large VSDs diastolic rumble due to relative mitral stenosis
Signs of cardiac failure in large VSDs, eventually leading to biventricular hypertrophy and pulmonary hypertension
What is Eisenmenger syndrome?
Eisenmenger syndrome occurs when the pressure in the pulmonary arteries becomes so high that it causes oxygen-poor (blue) blood to flow from the right to left ventricle and then to the body, causing cyanosis. The high pressure also causes the wall of your heart’s right ventricle to thicken (hypertrophy).
How is a VSD closed?
Amplatzer or other occlusion device, trans-catheter
Patch closure, open heart surgery
What is the presentation of ASD?
Few clinical signs in early childhood, good chance of spontaneous closure
Sometimes detected in adulthood with atrial fibrillation, heart failure or pulmonary hypertension
Wide fixed splitting of 2nd heart sound, pulmonary flow murmur
What condition is Atrioventriculo-septal defect associated with?
Trisomy 21
What is the presentation of pulmonary stenosis?
Asymptomatic in mild stenosis, in moderate and severe exertional dyspnoea and fatigue
Ejection systolic murmur upper left sternal border with radiation to back
How can pulmonary stenosis be managed?
Balloon valvuloplasty
What is the presentation of aortic stenosis?
Mostly asymptomatic; if severe, reduced exercise tolerance, exertional chest pain, syncope
Ejection systolic murmur upper right sternal border, radiation into carotids
