Cardiology Flashcards
What are the septal defects?
- Atrial septal defects
- Atrioventricular septal defect
- Coarctation of the aorta
- Pulmonary atresia
- Tetralogy of Fallot
- Tricuspid atresia
- Truncus arteriosis
- Ventricular septal defect
What is an atrial septal defect?
An atrial septal defect is a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart
What is the cause of an atrial septal defect?
Genetic and potentially environmental factors
What are the symptoms of atrial septal defects?
Ejection systolic murmur, fixed splitting of S2
Embolism may pass from venous system to left side of heart causing a stroke
How is an atrial septal defect diagnosed?
An atrial septal defect may be diagnosed during pregnancy or after the baby is born. In many cases, it may not be diagnosed until adulthood. Can be picked up in prenatal tests
What is the treatment of atrial septal defect?
Sometimes surgery
Medications
What is transposition of the great arteries?
A form of cyanotic congenital heart disease
- Aorta leaves the right ventricle
- Pulmonary trunk leaves the left ventricle
What is the cause of transposition of the great arteries?
Who is at increased risk of TGA?
It is caused by the failure of the aorticopulmonary septum to spiral during septation.
Children of diabetic mothers are at an increased risk of TGA.
What are the basic anatomical changes in transposition of the great arteries?
Aorta leaves the right ventricle
Pulmonary trunk leaves the left ventricle
What are the symptoms of transposition of the great arteries?
- Cyanosis
- Tachypnoea
- Loud single S2
- Prominent right ventricular impulse
- ‘Egg-on-side’ appearance on chest x-ray
How do you diagnose transposition of the great arteries?
- Loud single S2
- Prominent right ventricular impulse
- ‘Egg-on-side’ appearance on chest x-ray
What is the treatment of transposition of the great arteries?
Maintenance of the ductus arteriosus with prostaglandins
Surgical correction is the definite treatment.
What is the nitrogen washout test?
May be used to differentiate cardiac from non-cardiac causes
How is the nitrogen washout test carried out?
The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken.
A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
What are the causes of cyanotic congenital heart disease?
3 T’s
Tetralogy of Fallot (TOF)
Transposition of the great arteries (TGA)
Tricuspid atresia
What are the causes of acyanotic congenital heart disease?
- Ventricular septal defects (VSD) - most common, accounts for 30%
- Atrial septal defect (ASD)
- Patent ductus arteriosus (PDA)
- Coarctation of the aorta
- Aortic valve stenosis
What is patent ductus arteriosus?
Connection between the pulmonary trunk and descending aorta
What are the signs of patent ductus arteriosus?
- Left subclavicular thrill
- Continuous ‘machinery’ murmur
- Large volume, bounding, collapsing pulse
- Wide pulse pressure
- Heaving apex beat
https: //www.youtube.com/watch?v=Fm5xgS1xOOc
https: //www.youtube.com/watch?v=ZTTN3PIIeQ4
What is the treatment for patent ductus arteriosus?
Indomethacin or ibupofen
Promote closure
Can also do surgery
What is Ebstein’s anomaly?
Ebstein’s anomaly is a congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart.
What is the cause of Ebstein’s anomaly?
Lithium use in pregnancy
What are the symptoms of Ebstein’s anomaly?
- Cyanosis
- Prominent ‘a’ wave in the distended jugular venous pulse,
- Hepatomegaly
- Tricuspid regurgitation (pan-systolic murmur)
- Pansystolic murmur, worse on inspiration
- Tricuspid stenosis (mid-diastolic murmur).
- Right bundle branch block → widely split S1 and S2
- Enlargement of the right atrium.
Ventricular septal defects present with a pan-systolic but not diastolic murmur.
What is the treatment of Ebstein’s anomaly?
-
Surgery
- Repair of the tricuspid valve
WHAT ARE THE CAUSES OF HEART FAILURE IN NEONATES?
Causes can be grouped into:
-
Hyperdynamic flow, usually as a result of a shunt:
- Large ventricular septal defect
- Patent ductus arteriosus, especially when associated with overload and respiratory distress syndrome
-
Obstructed outflow from the left heart:
- Hypoplastic left heart
- Aortic stenosis
- Coarctation of the aorta or interupted aortic arch
-
Multiple major heart defects:
- Truncus arteriosus
- Atrioventricular canal
- Single ventricle
What are the clinical features of heart failure in neonates?
-
General features include:
- Poor feeding, during which the infant becomes tired
- Weight gain which may exceed 30 grams per day, despite the poor feeding
- Tachypnoea
- Tachycardia
-
Left sided failure may cause:
- Cough
- Sweating
- Fine crackles on auscultation
-
Right sided failure may cause:
- Hepatomegaly
- Sacral oedema
What is the management for heart failure in neonates?
- Diuretics - combination loop and potassium sparing diuretic
- Nsogastric feeding with high calorie content
- Digoxin may be helpful
In the seriously unwell child the following may be needed:
- Hypotension - treat with dopamine infusion
- Apnoeas may require ventilation
WHAT ARE THE COMPLICATIONS OF A VENTRAL SEPTAL DEFECT?
-
Aortic regurgitation
- aortic regurgitation is due to a poorly supported right coronary cusp resulting in cusp prolapse
- Infective endocarditis
-
Eisenmenger’s complex
- Due to prolonged pulmonary hypertension from the left-to-right shunt
- Results in right ventricular hypertrophy and increased right ventricular pressure. This eventually exceeds the left centricular pressure resulting in reversal of blood flow
- This is turn results in cyanosis and clubbing
- Eisenmenger’s complex is an indication for a heart-lung transplant
- Right heart failure
-
Pulmonary hypertension
- Pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality
