cardiovascular Flashcards
what an innocent systolic murmur
soft systolic murmur best heard in the 2nd and 4th intercostal spaces
what is an innocent venous murmur
- continuous murmur best head below the clavicles
- disappears when child lies down
- occurs due to turbulent flow in the head and neck veins
innocent murmur presentation
- asymptomatic, worse with fever
- no radiation or thrill, change with respiration and position (decreases when sitting up, increases when lying down)
what is a ventricular septal defect
- murmur is a loud pan-systolic murmur best heard at lower left sternal edge but radiates throughout precordium
- associated with thrills and sometimes symptoms of heart failure
ventricular septal defect causes
- chromosomal disorders (Down’s syndrome, Edward’s, Patau’s, cri-du-chat)
- congenital infections
- acquired (post MI)
ventricular septal defect diagnosis
may be detected in utero during routine 20 week scan
ventricular septal defect presentation
- failure to thrive
- heart failure features (hepatomegaly, tachypnoea, tachycardia, pallor)
- pan-systolic murmur (louder in smaller defects)
ventricular septal defect management
- small defects may be asymptomatic and close spontaneously but require monitoring
- moderate to large defects usually result in heart failure in first few months
- nutritional support
- medication for heart failure (diuretics)
- surgical closure of defect
ventricular septal defects complications
- aortic regurgitation
- infective endocarditis
- right heart failure
- Eisenmenger’s complex
what is Eisenmenger’s complex
- due to prolonged pulmonary hypertension from left to right shunt
- results in right ventricular hypertrophy and increased right ventricular pressure (this eventually exceeds the left ventricular pressure, resulting in reversal of blood flow)
- this results in cyanosis and clubbing
- indication for heart and lung transplant
atrial septal defect presentation
- soft ejection systolic murmur best heard at the upper left sternal edge with fixed splitting of S2
- embolism may pass from venous system to left side of heart causing stroke
atrial septal defect subtypes
- ostium secundum
- ostium primum
ostium secundum presentation
- more common
- associated with Holt-Oram syndrome
- ECG shows right bundle branch block and right axis deviation
ostium primum presentation
- presents earlier
- associated with abnormal AV valves
- ECG shows right bundle branch block with left axis deviation, and prolonged PR interval
coarctation of the aorta associations
- turner’s syndrome
- bicuspid aortic valve
- berry aneurysms
- neurofibromatosis
- men > women
what is coarctation of the aorta
congenital narrowing of the descending aorta
coarctation of the aorta presentation
- ejection systolic murmur heard between shoulder blades
- infancy: heart failure
- adult: hypertension
- radio-femoral delay
- mid-systolic murmur, maximal over back
- apical click from aortic valve
- notching of inferior border of ribs (due to collateral vessels), but this isn’t seen in young children
coarctation of the aorta management
- neonates: IV prostaglandins as this maintains patent ductus arteriosus before surgery
- surgery
patent ductus arteriosus risk factors
- premature babies
- born at high altitude
- mother’s that suffered from maternal rubella in the 1st trimester
patent ductus arteriosus presentation
- continuous machine-like murmur, best heard below the left clavicle
- left sub clavicular thrill
- large volume, bounding, collapsing pulse
- wide pulse pressure
- heaving apex beat
patent ductus arteriosus pathophysiology
- generally classed as acyanotic, however if uncorrected, can eventually result in late cyanosis in lower extremities (differential cyanosis)
- connection between the pulmonary trunk and descending aorta
- usually ductus arteriosus closes with first breathes due to increased pulmonary flow which enhances prostaglandin clearance
patent ductus arteriosus management
- indomethacin or ibuprofen
- if associated with other congenital heart disease and going for surgery, prostaglandin E1 is used to keep duct open until after surgical repair
tetralogy of fallot cause
anterior malalignment of the aorticopulmonary septum
tetralogy of fallot has characteristics from which 4 defects
- ventricular septal defect
- right ventricular hypertrophy
- right ventricular outflow
- overriding aorta
tetralogy of fallot presentation
- cyanosis
- right to left shunt
- ejection systolic murmur due to pulmonary stenosis
- right sided aortic arch
tetralogy of fallot diagnosis
- chest x-ray shows boot shaped heart
- ECG shows right ventricular hypertrophy
tetralogy of fallot management
- surgical repair in two parts
- cyanotic episode may be helped by beta blockers as this will reduce infundibular spasm
