Cardiovascular Flashcards
How common are innocent murmurs in children?
Up to 30% will have them at some point
What features of a murmur make it likely to be innocent?
Soft Short Symptom-free Systolic only Site heard over is small Sitting and standing - disappears with change of position
What type are the vast majority of innocent murmurs?
Flow murmurs (80%) - Turbulent blood flow results in audible murmur, often best heard at left sternal edge Other 20% are venous shunts - vibration audible hum, loudest beneath clavicle, silent when lying flat
What is the most common congenital heart defect in Down’s syndrome?
Atrio-ventricular septal defect
What is the most common congenital heart defect in Turner’s syndrome?
Coarctation of the aorta
What is the most common congenital heart defect in Marfan’s syndrome?
Aortic aneurysms
What heart defects are classed as left to right shunts?
VSD, ASD, AVSD, PDA
What heart defects are classed as right to left (‘cyanotic’) shunts?
Tetralogy of Fallot, Transposition of the Great Arteries
Which heart defect is a ‘duct-dependent’ shunt?
Coarctation of the Aorta
Which congenital heart disease is most associated with DiGeorge syndrome?
Tetralogy of Fallot
What four things make up the Tetralogy of Fallot?
Pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, overriding aorta
What happens during a ‘Tet spell’?
To prevent cyanosis worsening, child squats to increase systemic vascular resistance and venous blood return
What is the most common congenital heart defect?
Ventricular septal defect - accounts for 30% of all CHDs
Which congenital heart defect may cause a widely split and fixed 2nd heart sound?
Atrial septal defect.
In VSD, which size defect will produce the most obvious murmur?
Small defects - loudest murmur but asymptomatic usually.
In contrast, large defects may have no murmur but most severe disease
When is the heart murmur heard in VSD?
Pansystolic murmur, best heard at LLSE
How is the murmur in Patent Ductus Arteriosus described?
Continuous machinery murmur - best heard under left clavicle
If a baby with PDA is symptomatic, what treatment should be given?
NSAIDs, indomethacin as a prostaglandin inhibitor - to encourage closure of the PDA. Diuretics if heart failure develops. If necessary, surgical ligation to close the duct.
What type of pulse is seen in PDA?
Bounding pulse
What is coarctation of the aorta dependent on to allow perfusion of the lower half of the body?
Requires a patent ductus arteriosus - allowing some blood to flow from pulmonary artery to aorta
What treatment is given to maintain patency of the ductus arteriosus in coarctation of the aorta?
Prostaglandin E. Definitive treatment is surgical correction, unless very mild coarctation
Where is the systolic murmur of coarctation of the aorta best heard?
Between the shoulder blades
Presence of which other defects can make transposition of the great arteries compatible with life?
Relies on some mixing of blood so
ASD, VSD, PDA.
Requires urgent surgical correction
