Cardiology Flashcards
Describe foetal blood flow starting from the placenta
- umbilical vein
- most through ductus venosus and some to liver
- IVC
- right atrium
a) foramen oval, LA, LV
b) RV, pulmonary artery, ductus arteriosus - aorta
- circulation
- umbilical artery
In general, how may acyanotic congenital heart defects present?
Difficulty feeding Short of breath Failure to thrive Heart failure Respiratory infections
What are the acyanotic CHDs?
ASD
VSD
PDA
CoA
Compare ostium secundum and ostium primum ASDs.
Which is seen in Down Syndrome?
- ostium secundum if effectively a patent foramen ovale
- ostium primum is a patent foramen ovale and tricuspid valve incompetence. Seen in Down syndrome
What murmur is heard in ASD? Why do you get this murmur?
Ejection systolic heard best at the upper left sternal edge
Increased blood flow in the right outflow tract
What murmur is heard in VSD?
Pan systolic at the left lower sternal edge
Where is the most common location for narrowing in CoA?
just distal to the opening on the ductus arteriosus
What are the signs and investigation findings of CoA?
a) neonatal
b) childhood
c) adulthood
a) may just have weak femoral pulses
b) mid systolic murmur at upper left sternal edge radiating to back, BP higher in arms than legs, radio-femoral delay
c) notching of the inferior border of the ribs due to collateral vessels
What is CoA associated with?
Turner syndrome
Bicuspid aortic valve
What are the risk factors for PDA?
Prematurity
Maternal rubella infection
What murmur is heard in PDA? What other signs are there?
Continuous machinery like murmur at upper left sternal edge radiating all over the chest
+ wide pulse pressure
+ bounding, collapsing pulse
What are the defects of ToF?
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
VSD
When and how does ToF present?
First few months of life
- dyspnoea
- cyanotic
- HF
- clubbing
- Tett spells (on exertion, CO2 production leads to peripheral vasodilation, lower systemic vascular resistance means more deoxy blood goes from R-L as path of lower pressure)
What are the complications of ToF?
Cerebral thrombosis
Infective endocarditis
Brain abscess
What is seen on CXR in ToF?
Boot shaped heart
Describe the abnormality of TGA?
Aorta is connected to right heart and pulmonary artery to left heart leading to 2 separate circulations
How does TGA present?
Within first few hours of life with cyanosis and severe hypoxia
How should cyanotic CHDs be managed initially?
Prostaglandin infusions to keep any ducts they are depending on open
What is hypoplastic left heart syndrome?
Underdeveloped left heart means that the right heart is maintaining both pulmonary and systemic circulations via an ASD
What is Eisenmenger’s syndrome and how does it present?
Reversal of a L to R shunt due to pulmonary hypertension
- Original murmur disappears
- Dyspnoea
- Cyanosed
- Clubbing
What is Ebstein’s anomaly? What can cause it?
Low insertion of the tricuspid valve meaning you get a very large atrium and small ventricle
Maternal use of lithium
Where on the chest may an innocent murmur be heard?
Just below the clavicles - Venous hum
Lower left sternal edge - Stills murmur
Describe the features of venous hum
continuous soft blowing murmur heard when the child is standing
Describe the features of Stills murmur
short, systolic, musical low pitch murmur that intensifies with exercise and fever
What are your differentials for a cyanosed neonate?
- Transient peripheral cyanosis of the new-born (acrocyanosis)
- CHDs
- Transient tachypnoea of the newborn
- RDS
- Meconium aspiration
- Infection
- Seizures
What is the hyperoxia test?
Give 100% oxygen for 10 minutes, if the cyanosis and saturations do not improve the pathology cannot be respiratory and is likely CHD
