Cardiology Flashcards
what congenital heart condition is associated with trisomy 21
VSD and AVSD
what congenital heart condition is associated with trisomy 18 and 13
VSD
DORV = double outlet RV
what congenital heart condition is associated with Turner’s syndrome
coarctation of the aorta
bicuspid aortic valve - aortic stenosis
what congenital heart condition is associated with DiGeorges syndrome
truncus arteriosus
interrupted Aortic arch
tetralogy of fallot
VSD
structure to history taking for paed cardiology
baby well/unwell
symptoms of cardiac disease: breathlessness, difficulty feeding, sweating with feeding, cyanosis
additional RF: premature, other anomalies/syndrome, FH of CHD
approach to CVS exam
inspection: work of breathing, tachypnoea, cyanosis, scars
palpation: apex, heaves, thrills
auscultation: HS I+II, murmurs
additional: peripheral pulses, saturations, growth
what is acrocyanosis
acral = extremities
blue hands and feet
blue around your mouth, NOT in your mouth
perioral blueness is a sign of cardiac disease, true or false
false - may be acrocyanosis
intermittent central cyanosis is a feature of which congenital heart condition
tetralogy of fallot
what is the SCRIPT mnemonic for describing murmurs
Site - ULSE/URSE/LLSE/apex Character Radiation - carotids, axilla Intensity - grade 1-6 Pitch Positional changes Timing - systolic/diastolic/continuous
features of innocent murmurs
very common in children 'flow murmur' - blood is whooshing from fast HR physiological <3/6 short systolic - NEVER diastolic or associated with a thrill asymptomatic - baby is fine variable with position loudest at LLSE
how can congenital heart disease present
antenatal detection
newborn baby check
neonatal collapse
6 week check
in newborns, right ventricular pressure is equal to LV pressure but what happens over the next few weeks
RV pressure falls and becomes less than LV pressure
types of congenital heart disease
acyanotic
cyanotic
what are examples of acyanotic congenital heart disease
VSD ASD pulmonary stenosis AVSD PDA aortic stenosis coarctation of the aorta
what are examples of cyanotic congenital heart disease
TOF
TGA
causes of collapsed neonate when their duct shuts
systemic and cyanotic duct dependent lesions
dependent on ductus arteriosus
examples of systemic duct dependent lesions
hypoplastic left heart syndrome
critical aortic stenosis
interrupted aortic arch
examples of cyanotic duct dependent lesions
TGA
pulmonary atresia with intact septum
what is meant by systemic duct dependent lesion
severe obstruction of blood out of left side of the heart
systemic circulation os dependent on the PDA and so needs to be kept open until further management
what is meant by cyanotic duct dependent lesion
there is obstruction to pulmonary blood flow (blood going to lungs) OR lack of oxygenation of systemic blood
reliant on PDA - keep open
what is ASD
atrial septal defect
oxygenated blood from LA is shunted through hole into RA
this causes enlargement of both atria, RV and pulmonary artery
what is VSD
ventricular septal defect
oxygenated blood from LV is shunted through hole into RV
this causes enlargement of both ventricles, pulmonary artery, exposing them to abnormally high pressures
what is AVSD
atrioventricular septal defect
complete lack of AV septum
what is PDA
patent ductus arteriosus
blood from aorta is shunted through PDA into pulmonary artery resulting in L-R shunt and increased pulmonary blood flow
what is coarctation
severe narrowing of the aorta in the region of the ductus arteriosus
what are the features of Tetralogy of Fallot TOF
- pulmonary stenosis
- RVH
- VSD
- overriding aorta
what is transposition of the great arteries TGA
- aorta arising from RV instead of LV
unoxygenated blood is delivered to the body - pulmonary artery arising from LV instead of RV
well oxygenated blood is delivered back to the lungs
what is hypoplastic left heart syndrome HLHS
- hypoplastic ascending aorta and aortic arch
- hypoplastic LV
- large PDA (only source of blood to body with R=L shunt)
- ASD - allows blood returning from lungs to LA into RA then RV
what is the most common congenital heart defect
VSD
outcome of VSD
if small, close without intervention
if large, present with heart failure and may need surgery
symptoms of cardiac disease in neonates
breathlessness difficulty feeding and gaining weight pee and poo less sweating with feeding cyanosis
signs of increased work of breathing
tracheal tug nasal flare grunting intercostal recession subcostal recession
what is grunting
breathing against closed glottis
gives themselves CPAP
breath out against pressure to prevent atelectasis
periodic breathing
breath fast then slow
what is a heave
palpable impulse
acrocyanosis is different from central cyanosis, true or false
true
central cyanosis will have blueness IN the mouth as opposed to acrocyanosis which is a functional peripheral vascular disorder with mottled skin caused by vasospasm in response to the cold
what is a thrill
palpable murmur
vast majority of murmurs in kids >1 are likely to be innocent murmurs, true or false
true
what grade must a murmur be if you feel a thrill
grade 4 at least
cause of collapsed neonate when their duct shuts
duct dependent disease
What are the 5 ‘S’ you can use to describe an innocent murmur
Soft Short Systolic Symptomless Situation dependent
Give examples of pan systolic murmurs
mitral regurgitation
tricuspid regurgitation
VSD
give examples of ejection systolic murmurs
aortic stenosis
pulmonary stenosis
hypertrophic obstructive cardiomyopathy
what is splitting of the SII and why does it happen
this is when the pulmonary valve closes straight after the aortic valve making SII appear ‘split’
during inspiration, more venous blood enters the right side of the heart, and so takes longer to empty resulting in the pul valve closing slightly later
what types of murmur do you hear in ASD
mid systolic murmur loudest at left upper sternal edge
with FIXED splitting of SII i.e. does not vary with breathing
what murmur do you hear in PDA
continuous machine like murmur
what murmurs can you hear in TOF
pulmonary stenosis - ejection systolic at 2nd ICS left sternal edge
? pansystolic - VSD
what is cyanosis
when deoxygenated blood enter systemic circulation
what is PDA
patent ductus arteriosis
the DA fails to close after birth resulting in a L-R shunt as blood from the high pressure aorta goes into the pul artery
this can lead to pul HTN and RVH
RF for PDA
prematurity
rubella infection
symptoms and signs of PDA
asymptomatic
breathlessness
difficulty feeding and poor weight gain
continuous machine like murmur
ASD leads to which kind of shunt
L-R
may reverse and form R-L eventually (Eisenmengers)
what is Eisenmenger syndrome
can arise from ASD, VSD and PDA after initial L-R shunt.
The pulmonary pressure becomes greater than the systemic pressure and the shunt reverses to R-L leading to cyanosis as blood bypasses the pul circulation and lungs.
complications of ASD
Eisenmengers syndrome
RVH and pul HTN
AF / atrial flutter
stroke - paradoxical
how can you get a stroke from ASD
DVT develop in the venous circulation, if it comes off it becomes an embolus and travels to the right side of the heart. Instead of going through pul circulation to the lungs to form a PE, it can pass through the ASD to the left side of the heart and into the aorta to go to the brain
symptoms of ASD
asymptomatic if small
breathlessness
difficulty feeding and poor weight gain
adulthood: dyspnoea, HF, stroke
risk factors/associations for VSD
Down’s syndrome
Turner’s syndrome
idiopathic
TOF
symptoms and signs of VSD
asymptomatic
breathlessness
difficulty feeding and failure to thrive
tachypnoea
pan systolic murmur at 4th ICS left sternal edge +- systolic thrill on palpation
those with VSD are at increased risk of what
infective endocarditis
complications of Eisenmengers syndrome
^ RBC as a response to cyanosis –> polycythaemia
this can increase risk of clots
findings in Eisenmengers syndrome
RV parasternal heave loud P2 raised JVP peripheral oedema (RHF) murmur arrhythmia cyanosis clubbing dyspnoea plethoric - polycythaemia
What is coarctation of the aorta
congenital narrowing of the aorta typically at the arch near the ductus arteriosus
RF for coarctation of the aorta
Turner’s syndrome
in coarctation of the aorta, there is increased/decreased pressure proximal to the narrowing and increased/decreased pressure distal to the narrowing
increased pressure proximally
decreased pressure distally
symptoms and signs of coarctation of the aorta
weak femoral pulses
difference in blood pressure and SaO2 in upper and lower limbs
systolic murmur beneath left clavicle and scapula
tachypanoea
poor feeding
what can be given to keep the ductus arteriosus open
prostaglandins
explain the pathology behind TOF
Pulmonary stenosis means it is harder to pump blood through to the pul artery and so you consequently get RVH.
The VSD means that blood from the LV enters the RV further increasing that blood volume.
The overriding aorta sits more to the right above the VSD, this means that blood from the RV will follow the path of least resistance and enter the aorta which means it bypasses the lungs creating a R-L shunt which leads to cyanosis
What are ‘Tet’ spells
intermittent cyanotic episodes where R-L shunt is temporarily worsened as pul pressure > systemic pressure
triggers: crying, physical exertion, waking
older children tend to squat to increase the SVR and help blood to enter the pul artery
what is Ebsteins anomaly
congenital heart defect where the tricuspid valve is set lower in the right side of the heart leading to a bigger RA and smaller RV causing poorer flow from RV –> pul artery
what is a RF for Ebsteins anomaly
maternal use of lithium antenatally
what is Ebsteins anomaly associated with
ASD
WPW syndrome
what is TGA
transposition of the great arteries
attachments of the great vessels to the heart are swapped i.e. the RV connects to the aorta and LV connects to the pulmonary artery
the two separate circulations do not mix and they loop around the same circuit - deoxygenated round the body and oxygenate around the lungs
what is an immediate sign of TGA at birth
cyanosis
what pulse abnormality is associated with PDA
large volume, bounding, collapsing pulse
symptoms of heart failure in infants
breathlessness
difficulty feeding
sweating while feeding
recurrent chest infections
