Cardiology Flashcards
Main causes of L to R shunts, and main presenting symptom…
L to R shunts (acyanotic heart disease):
- VSD (most common)
- PDA
- ASD
Main symptom = breathlessness
Main causes of R to L shunts, and main presenting symptom…
R to L shunts (cyanotic heart disease) 1-5:
- Truncus Arteriosus (vessel joins to make 1)
- Transposition of Great Arteries (2 major vessels switch)
- Tricuspid atresia (3=tri)
- Tetralogy of Fallot (4 defects)
- Total Anomolous Pulmonary Vascular Return (TAPVR = 5 letters)
Main symptom = cyanosis
What kind of heart defects cause breathlessnesss AND cyanosis ?
Common mixing defect = AVSD - combination of both types of mixing.
What are some common causes of congenital heart defects?
Maternal disorders: - Rubella infection - SLE - Diabetes Teratogens: - Warfarin - Alcohol Genetic syndromes: - Down Syndrome - Turner's Syndrome
What is an innocent murmur?
Benign, physiological murmur heard in up to 50% of children.
Key features:
- Soft, always well after first heart sound
- Always systolic
- Heard at L sternal edge
- Heart sounds are normal
What is the pathophysiology of hypoplastic left heart syndrome?
- Left ventricle is very underdeveloped
- LV is not able to pump blood adequately around the heart
- This causes increased afterload for the L atrium as very little blood can be transported via LV
- Hypertension of L atrium occurs leading to back up of pressure in the pulmonary veins into the pulmonary vasculature causing pulmonary hypertension and so pulmonary oedema
What are the different causes of heart failure in children?
Neonates - caused by obstruction:
- Hypoplastic left heart
- Aortic stenosis
Infants - high pulmonary bloodflow :
- VSD
- ASD
- PDA
Children:
- Esenmenger syndrome
- Cardiomyopathy
What is Eisenmenger’s Syndrome and how is it treated?
Reversal of a L to R shunt in a congenital heart defect due to compensatory increase in pulmonary vascular resistance causing significant pulmonary hypertension leading to later development of a R to L shunt.
Only definitive treatment = heart and lung transplant
How does a VSD present?
Symptoms:
- Breathlessness = key symptom
- Failure to thrive (due to breathlessness cannot feed)
- Recurrent respiratory infections
Signs:
- Pansystolic murmur - heard near L sternal edge- the smaller the VSD, the harsher the murmur
- Signs of heart failure in large VSD: gallop rhythm, cardiomegaly, hepatomegaly
Management of VSD…
- 50% will close spontaneously Medical management up to 3-4 months age: - Diuretics - Fluid restriction - ACEi
Surgery at 3-4 months if no response to medications:
- PA banding (band around pulmonary artery to increase RV pressure therefore decrease shunt flow)
Presentation of ASD…
- Most likely heart defect to be found in adulthood
- Breathlessness
Signs:
- Ejection systolic murmur - fixed splitting of S2
Investigation findings of ASD…
- ECG: RBBB
- CXR: cardiomegaly
Management of ASD…
Surgical repair at 3 - 5 years’ old - via cardiac catheterisation
How is the ductus arteriosus closed in neoneates?
When neonates take their first breaths, this causes an increase in pulmonary blood flow leading to increased clearance of prostaglandins.
Prostaglandins normally act as smooth muscle dilators which keeps the DA patent - but when they are removed, this allows the DA to close.
What is a PDA?
An acyanotic congenital heart defect where the DA remains patent after birth which allows blood to flow from the high pressure descending aorta into the lower pressure pulmonary artery.
