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
How to differentiate cardiac from non-cardiac causes of cyanosis?
Nitrogen washout test. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
What is acrocyanosis?
- Seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities.
- It is caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition.
- Acrocyanosis is differentiated from other causes of peripheral cyanosis with significant pathology (eg, septic shock) as it occurs immediately after birth in healthy infants. It is a common finding and may persist for 24 to 48 hours.
List 3 signs of partial AVSD.
- ESM at ULSE
- Flixed split S2
- Pansystolic murmur at apex
List 2 features of TGA.
- Neonatal cyanosis
2. No murmur
List 2 mx of TGA.
- Prostaglandin infusion
2. Balloon atrial septostomy
List the mx of aortic stenosis.
Balloon dilatation
List the mx of pulmonary stenosis.
Balloon dilatation
List the mx of coarctation of the aorta.
Stent insertion/surgery
