Cardiovascular Flashcards
S+S of innocent murmur
Asymptomatic
Soft blowing murmur
Systolic only
Left sternal edge
Localised - no radiation
Congenital heart abnormalities with Downs, Turners + Marfans
Downs = ASD/ AVSD (only Downs get AVSD)
Turners = coarctation of aorta
Marfans = aortic aneurysm
What maternal factor can cause congenital heart disease?
Drugs: warfarin, phenytoin Alcohol DM SLE
What is the pathology of Fallots?
Right to left shunt Pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, overriding aorta
S+S Fallots
Cyanosis at rest + on exertion Cyanotic attacks - SOB + cyanosis
Management of Fallots
O2, beta blockers + analgesia Surgery
ASD pathology
Left to right shunt Can cause HF due to high pulmonary blood flow
ASD S+S
SOB Cyanosis Asymptomatic in childhood - symptoms in 20s + 30s Pulmonary hypertension, HF + atrial dysrhythmias
VSD murmur
Pansystolic murmur at left sternal edge
What is Eisenmenger’s syndrome?
Without surgery for VSD, pulmonary vascular disease worsens Shunt reverses Cyanosis + SOB
Patent ductus arteriosus S+S
Small PDAs – asymptomatic. Large PDAs = FTT, recurrent LRTIs
Continuous machinery murmur loudest in infraclavicular area or left sternal edge
Bounding pulse + systolic thrill
S+S coarctation
SOB, grey
Systolic murmur loudest in left infraclavicular area, radiating into back. Weak femoral pulses
Hepatomegaly, BP lower in legs than arms
Critical stenosis in neonates – cold + cyanotic legs, no femoral pulse
Management of coarctation
Prostaglandin E to reopen ductus Surgery
What is transposition of the great vessels?
Oxygenated blood = pulmonary artery Deoxygenated venous blood = aorta Right to left shunt
Signs of transposition
Cyanosis SOB Poor feeding
X ray signs of transposition
Heart has narrow pedicle like an egg
What is a flow murmur?
Type of innocent murmur
HR + blood flow increased due to response to increase O2 demand (ie illness)
Turbulent blood flow = audible murmur, loudest at left sternal edge
What is a venous hum?
Type of innocent murmur
drainage of blood through jugular veins causing vibration + hum of vessel walls
loudest beneath the clavicle
obliterated when lying flat
What investigations are required when a murmur is found?
Innocent - no investigations but follow up with GP when well
Echo if there are any red flags (cyanotic, FTT, difficulty breathing + feeding, HF)
When should a PDA close + what is the management?
PDA closes on day 1-2 of life, disappears by 3 weeks
Echo to confirm diagnosis
Wait up to a year to close if asymptomatic then catheter closure
Symptomatic pts:
- Ibuprofen (preterm), indomethacin, paracetamol
- Diuretics for HF
- Surgical ligation
RF for PDA
preterm, Downs, females, congenital rubella, maternal valproate exposure
Where is coarctation of the aorta + what are the complications?
Usually distal to subclavian artery, near ductus arteriosus.
Causes proximal hypertension, ventricular hypertrophy + HF
RF for coarcation
Turners, males, fam hx
Management of coarcation
prostaglandins, diuretics for HF, anti-hypertensives if needed. Surgery
What is the most common form of congenital heart disease?
VSD
RF for VSD
trisomies, maternal diabetes, turners, foetal alcohol syndrome
Where does a VSD occur + how does it progress?
Starts as a left ventricular hypertrophy + then leads to right ventricular hypertrophy
Usually in perimembranous area
S+S of mild, mod + severe VSD
Small VSD – asymptomatic, pansystolic murmur at LSE
Mod VSD – SOB on feeding from 5-6 weeks, increased WOB + FTT
Large VSD – irreversible pulmonary hypertension + cyanosis
Management of VSD
Most VSDs close by 2 years. If not closed by 5, surgically close
Management if symptomatic:
- Diuretics + high calorie feeds
- Surgical – open heart surgery or catheter closure – do it around 6 months
What are the congenital cyanotic defects?
TOF, transposition of arteries
What are the congenital acyanotic defects?
ASD + AVSD
When should TOF be fixed?
6 months
What are the acquired heart defects?
coronary artery aneurysms (Kawasakis),
carditis/ mitral valve disease (rheumatic fever)
What is a tet spell?
Occurs with TOF - child goes blue on exertion, squats to relieve it (knees to chest to help increase venous return to the heart)
