Cardiology Flashcards
What are the 8 common lesions that cause congenital heart disease?
Ventricular Septal Defect (VSD) Patent Ductus atreriosus (PDA) Atrial Septal Defect (ASD) Pulmonary stenosis Aortic stenosis Coarctation of the Aorta Transposition of great arteries Tetralogy of Fallot
What are some risk factors for congenital heart disease?
- Genetic susceptibility
- Environmental hazard; drugs, infections, maternal DM/SLE
- Teratogenic insult (18-60 days post conception)
What are some chromosomal abnormalities associated with CHD?
Trisomy 13 90%
Trisomy 18 80%
Trisomy 21 40% - specifically AVSD.
What congenital defect is Turner’s syndrome associated with?
Co-arctation of the Aorta
What congenital defect is Noonan syndrome associated with?
Pulmonary stenosis
What congenital defect is William’s syndrome associated with?
Supravalvular aortic stenosis.
How does CHD typically present?
Feeding, weight and development reduced. Cyanosis Tachypnoea Dyspnoea Decreased exercise tolerance Chest pain Syncope Palpitations Joint problems
What is seen on examination of someone with CHD?
Weight and height abnormalities Dysmorphic features Cyanosis Clubbing Tachy/dyspnoea Additional heart sounds Murmurs Abnormal pulses/apex beat.
What are some investigations for CHD?
Blood pressure O2 saturation Arterial Blood gases ECG CXR ECHO Catheter Angiography MRI Exercise testing
How can murmurs be characterised?
Timing in cycle - systole, diastole, continuous.
Duration - earl/mid/late, ejection/Holo- or pan systolic.
Pitch/quality - turbulence, soft or indeterminate, vibratory (laminar flow)
What are some common features of innocent murmurs?
Systolic murmur (continuous venous hum) No other signs of cardiac disease. Vibratory, musical Localised Varies with position, respiration and exercise.
What is Still’s murmur?
2-7yrs Left Ventricular outflow murmur. Soft systolic, vibratory, musical. Located at apex on left sternal border. Increased in supine position/exercise.
What are some features of Pulmonary Outflow Murmur?
8-10yrs Soft systolic, vibratory Upper left sternal border, well localised. Increases in supine and exercise. Often children with narrow chest.
What are some features of Carotid/brachiocephal IC arterial bruits?
2-10yrs
1/6-2/6 systolic, harsh.
Supraclavicular that radiates to neck.
Increased with exercise, decreased in turning head/neck extension.
What are some features of Venous hum?
3-8yrs
Soft, indistinct
Continuous murmur, sometimes with diastolic accentuation.
Supraclavicular
Only in upright position, disappears lying down/turning head.
What are the 3 types of Ventricular Septal defects?
Subaortic
Perimembranous
Muscular
What is the clinical presentation of Ventricular Septal Defects?
Pansystolic murmur lower left sternal edge, sometimes with thrill.
In small VSDs early systolic murmur.
In large VSDs diastolic rumbles due to relative mitral stenosis.
Signs of cardiac failure.
What is Eisenmenger Syndrome?
Pressure in the pulmonary arteries becomes so high that it causes oxygen-poor blood to flow from the right to left ventricle and then to the body, causing cyanosis.
Blood in wrong direction.
Ventricular septal defect.
How is a VSD closed?
Amplatzer
Transcatheter
Patch closure
Open heart surgery
What are some features of Atrial Septal defects?
Few clinical signs in early childhood.
Good chance of spontaneous closure.
Sometimes detected n adulthood with AF, heart failure or pulmonary hypertension.
Wide fixed splitting of 2nd heart sound, pulmonary flow murmur.
What are some features of pulmonary stenosis?
Asymptomatic in mild.
Exertional dyspnoea and fatigue in moderate/severe.
Ejection systolic murmur upper left sternal border with radiation to back.
What is a balloon valvoplasty?
Procedure to repair a heart valve that has a narrowed opening.
What are the features of aortic stenosis?
Mostly asymptomatic
Severe - reduced exercise tolerance, external chest pain, syncope.
Ejection systolic murmur upper right sternal border, radiation to carotids.
What happens to foetal circulation at birth?
Pulmonary vascular resistance falls and pulmonary blood flow rises. Systemic vascular resistance increases. Ductus arteriosus closes Foramen ovale closes Ductus venosus closes
What are some treatment options for patent ductus arteriosus?
Fluid restriction
diuretics
Prostaglandin inhibitors e.g. indomethacin, ibuprofen.
Surgical ligation.
Term babies good chance of spontaneous closure, not prostaglandin sensitive.
What is the management of Co-arctation of the Aorta?
Reopen Ductus arteriosus with prostaglandin E1 or E2.
Resection with end to end anastomoses.
Subclavian patch repair
Balloon Aortoplasty
What is transposition of the Great arteries?
The pulmonary and aortic arteries are swapped over. Aorta carries deoxygenated blood and Pulmonary carries oxygenated blood.
What is Fallot’s Tetralogy?
Combination of 4 congenital heart defects:
Ventricular septal defect (VSD)
Pulmonary valve stenosis, Misplaced aorta
Right ventricular hypertrophy.
