Cardiovascular Flashcards
Describe the foetal circulation.
Placenta -> umbilical vein -> IVC -> RV -> foramen ovale -> LA -> aorta -> umbilical arteries -> placenta. OR: … RV -> pulmonary artery -> ductus arteriosus -> aorta …
What is the function of the foramen ovale and the ductus arteriosus in the foetal circulation?
They are used to bypass the non-functioning lungs.
Name 4 congenital heart problems that can cause a L -> R shunt.
- VSD.
- ASD.
- AVSD.
- PDA.
Give 5 signs of a VSD.
Poor feeding and failure to thrive
Small VSD:
Pan-systolic murmur at LLSE
Large VSD: Active precordium Loud P2 Soft murmur Tachypnoea Hepatomegaly.
You request a CXR for a patient with a VSD. What would you expect to see?
- Cardiomegaly.
- Pulmonary oedema.
- Enlarged pulmonary arteries.
Why are ASD’s often asymptomatic?
ASD’s are often asymptomatic because the blood flow in the atria is low pressure and so breathlessness etc is uncommon.
Give 3 signs of an ASD secundum.
- Ejection systolic murmur at ULSE
2. Fixed split S2
AVSD is a common defect in people with which chromosomal abnormality?
Trisomy 21 (Down’s syndrome).
Give 5 signs of a PDA.
left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat
Describe the management for congenital health defects that cause a L->R shunt.
Diuretics and ACEi to prevent HF symptoms.
Surgical repair.
Name 3 congenital heart problems that can cause a R -> L shunt.
- Tetralogy of fallot.
- Transposition of the great arteries.
- Tricuspid atresia.
What 4 components make up Tetralogy of fallot?
- Pulmonary stenosis.
- RVH.
- Overriding aorta.
- VSD.
Give 3 signs of Tetralogy of fallot.
Cyanosis
Ejection systolic murmur due to pulmonary stenosis (the VSD doesn’t usually cause a murmur)
A right-sided aortic arch is seen in 25% of patients
Clubbing of fingers and toes (older)
Hypercyanotic spells
What do you see on on a TOF CXR?
Boot shaped heart
What do you see on a TOF ECG?
RVH
What is coarctation of the aorta?
a congenital narrowing of the descending aorta.
Give 3 signs of coarctation of the aorta.
radio-femoral delay
mid systolic murmur, maximal over back
apical click from the aortic valve
Give 3 signs of aortic stenosis.
- Palpable thrill.
- Ejection systolic murmur.
- LVH.
Name 3 congenital heart problems that are often associated with Down’s syndrome.
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)
Give 2 signs of pulmonary stenosis.
- Ejection systolic murmur, often radiates to the back.
2. RV heave if severe.
Name 2 congenital heart problems that are often associated with Turner syndrome.
Bicuspid aortic valve
Coarctation of the aorta
What is a possible consequence of persistent pulmonary hypertension, like that seen in CHD associated with a L->R shunt?
Eisenmenger syndrome: high pressure pulm. blood flow damages pulmonary vasculature -> increased resistance (pulm. hypertension) -> RV pressure increase -> shunt direction reverses -> CYANOSIS!
Giv 2 mx in ductal dependent cyanotic heart diseases.
- prostaglandin E1 (alprostadil) is infused to prevent closure of the patent ductus arteriosus until a surgical correction can be carried out. This will allow mixing of deoxygenated and oxygenated blood so as to provide adequate systemic circulation.
- Antibiotics- prophylaxis for bacterial endocarditis.
How is central cyanosis recognised?
Concentration of reduced haemoglobin in the blood exceeds 5g/dl
