Cardiology Flashcards
Red flags signs/symptoms for cardio/resp
Breathing difficulty, cough, wheeze, cyanosis, lethargy, murmur
Top 5 features of an innocent murmur
Asymptomatic No thrill/no haeve Soft systolic murmur Varies with position Localised to one area
Top 5 facts about congenital heart disease
Incidence is 1 in 150 Most common congenital anomaly Approx 15% have another cardiac lesion Approx 15% have another congenital anomaly Classify into acyanotic and cyanotic
Top 5 acyanotic congenital heart lesions
Ventricular septal defect (VSD) Pulmonary stenosis Atrial septal defect (ASD) Coarctation of the aorta Patent ductus arteriosus (PDA)
Top 4 cyanotic congenital heart lesions
Tetralogy of Fallot
Transposition of the great arteries
Tricuspid atresia
Pulmonary atresia
5 causes of cyanosis
Respiratory disease Cardiac: - Neonatal - transposition of great arteries (TGA), persistent pulmonary hypertension of the newborn, pulmonry atresia, hypoplastic left heart syndrome - Infancy - teratology of fallot - Child - pulmonary hypertension
During a seizure
Stress - infection, hypoglycaemia, adrenal crisis
CNS depression - drugs, trauma, asphyxia
Common causes of cardiac failure
Cardiac:
Neonatal: PDA, hypoplastic left heart syndrome, coarctation of aorta, cardiomyopathy, critical aortic stenosis
Infant: VSD, AVSD, cardiomyopathy
Child: Cardiomyopathy, failing complex congenital heart disease
Stress: fever, hypoxia, infection, acidosis
Anaemia
Fluid overload
Cardiac associations with chromosomal abnormalities
Downs syndrome (trisomy 21) - atrioventricular septal defect, VSD, tetralogy of fallot, ASD
Edwards syndrome (trisomy 18) - complex
Pataus syndrome (trisomy 13) - complex
Turners syndrome (45XO) - aortic stenosis, cparctation of aorta, bicuspid aortic valve
DiGeorge syndrome (22q.11 microdeletion) - conotruncal abnormalities
Features of atrial septal defect
Secundum defect, in the centre of the atrial septum
Primium defect (partial AVSD), at the crux oof the heart
USually asymptomatic in childhood
Incidental murmur
Later in lide may present with breathless and arrhythmias
Transcatheter device closure (secundum only)
Surgical repair (secundum and primium)
Good long term outlook
Features of ventricular septal defect
2/1000 births
Membranous or musuclar part of the septum - may be smal, moderate or large
If small, usually asymptomatic and around 80% closes spontaneoulsy
Large/haemodynamically significant VSDs repaired in the 1st six months of life
If larger, the main effects are LV overload and inc pulmonary blood flow leading to cardiac faiure
If evidence of heart failure - diuretics, ACEi and maximising nutrition, often with NG feeds
Earlier surgery is indicated if infants continue to fail to thrive
Features of patent ductus arteriosus
Associated with prematurity and maternal rubella
Clinically bounding femoral pulses
Continuous murmur under left clavicle (subclavicular)
Complications include HF and failure to thrive
Tx in preterm infants includes
NSAIDs and surgical ligation if medical management fails
In older children - device occlusion by cardiac catheterisation
Features of coarctation of aorta
Presents in neonates as collapse, cardiac failure or weak/absent femoral pulses
Presnets in older children/adults with raised BP/absent femoral pulses or radio-femoral delay
CXR may show cardiomegaly/rib notching (in late stages)
Tx - surgery in infants, balloon dilatation/stenting more common in adults
Features of transposition of the great arteries (TGA)
Commonest neonatal cyanotic condition
2 separate circulations - mixing occurs at atrial level and arterial duct
Effortless tachypnoea and acidotic when duct closes
May not have a murmur
CXR may represent ‘egg on side’
Prostaglandin commenced to open arterial duct
May need urgent balloon atrial septostomy (BAS) to increase mixing at atrial level
Definitive surgery - arterial switch with good long-term outcome
Features of tetralogy of fallot
Combination of: VSD, RV outflow tract obstruction (RVOTO), ortic override of VSD, right ventricular hypertrophy
Can be pink if minimal RVOT obstruction, may be come progressively cyanosed due o fixed obstruction
Hypercyanotic spells occur due to dynamis RVOTO
Squatting in response to hypercyanotic spells rarely reported in the UK now as defects repaired in the first year of life
Polycythaemia (haemtocrit of 55-80%) is characteristic
CXR may resemble a ‘boot shaped heart’ with an upturned apex
Associated with Di George Syndrome (22q.11 microdeletion)
Top 5 infective endocarditis facts
Increased risk if underlying congenital cardiac lesion
Most likely infective agent: strep viridans
May present with fever, malaise, weight loss, arthralgia, haematuria, splenomegaly, splinter haemorrhages (rare)
Diagnoss made with multiple blood cultures - echo may show macroscopic vegetations but a negative echo does not exclude IE.
Tx with IV Abx for at least 6 weeks
Significant morbidity and mortality associated with bacterial endocarditis
