Cardiovascular Flashcards
What are the two types of atrial septal defects?
Which is more common?
Secundum or Primium
Secundum - involves foramen ovale
What are they symptoms of an atrial septal defect?
can be none
recurrent chest infections/wheeze
arrthymias from 4th decade onwards
What are the signs of an ASD?
What are signs specific to ostium primum?
- Ejection systolic murmur - due to increased blood flow, best heard in upper sternal edge
- Fixed splitting of second heart sound (s2)
- Ostium primum: due to AV valve abnormalities causing regurg - pansystolic murmur
What is the investigations for SD and what do you expect to see?
Echocardiography - Gold standard
CXR- cardiomegaly, enlarged pulmonary arteries
ECG:
Secuncum: RBBB and RAD
primium: RBBB and LAD
What are risk factors for ASD?
- down syndrome
2. feotal alcohol syndrome
What is the management?
- small - can resolve on its own
- secudnum - cardiac cath and insertion of occlusion device
- primium - surgical
What is the presentation of a small VSD?
- Likely asymptomatic, will
What is the presentation of a large VSD?
- tachychardia
- tachypnoae
- failure to thrive
- recurrent chest infections
- can have enlarged liver due to HF
What sort of murmur can you hear in VSD?
- Pansystolic murmur, louder the smaller the defect
What investigations would you do and what do you expect to see in small and large VSD?
- echo
- CXE
- ECG
normal in small VSD
Large VSD
- CXR: cardiomegal, enlarged pulmonary arteries, pulmonary oedema
- ECG: biventricular hypertrophy
What is the management of VSD?
- drug therapy for HF - diuretics and captopril
- additional calorie intake
- surgery 3-6 months to avoid eisenmenger syndrome
What are complications of VSD?
- Eismenger syndrome - pressure in right becomes higher - reversal of blood flow R–>L causing deoxygenated blood to enter circulation = cynaosis (blue peripharies, pallor mouth)
- aortic regurg
- infective endocarditis
- RHF
- pulmonary HTN (pregnancy contraindicated)
Which conditions carry greater risk of VSD?
- Downs
- Patau
- Edwards
- fetal alcohol syndrome
What is a major risk with ASD?
- paradoxical embolism
- can reach brain and cause stroke
What causes Eisenmenger syndrome?
reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.
This occurs when an uncorrected left-to-right leads to remodeling of the pulmonary microvasculature,
eventually causing obstruction to pulmonary blood and pulmonary hypertension.
What is Eusengmenger syndrome associated with?
ventricular septal defect
atrial septal defect
patent ductus arteriosus
What are the features of Eisengmenger syndrome?
original murmur may disappear
cyanosis clubbing right ventricular failure haemoptysis, embolism
What is the management of eisengmenger syndrome?
- early intervention
- heart lung transplant
Who is Atrioventricular septal defect common in?
downs syndrome
What does a largeAVSD result in?
- pulmonary htn
- pulmonary vascular disease
What is the presentation of AVSD?
- presents on antenatal scan
- cyanosis at birth, HF at 2/3 weeks
- no murmur heard. detected on echo
- superior axis on ECG
- hepatomegaly, oedema, poor feeding, failure to thrive, tachypnoea
How is VSD managed?
- HF managed medically: diuretics + captopril
What pathogen causes rheumatic fever?
Which age range?
Group A beta haemolytic streptococcus
- streptococcus pyogenes
5-15 yrs. proceeds to chronic in 80%
What is the presentation?
- latent interval of 2-6 weeks
- followed by:
pharyngeal/skin infections, polyarthritis,
mild fever and malaise
What is the Jones diagnostic criteria for rheumatic fever?
2 major
or
1 major and 2 minor
What are major signs in Jones diagnostic criteria for rheumatic fever?
- Migratory Arthritis
- Carditis (endocarditis, myocarditis etc)
- Erythema marginatum
- Sydenham Chorea (2-6 months post infection, involuntary movements and emotional lability)
- subcutaneous nodules - rare
What are the minor signs of RF?
- fever
- polyarthralgia
- raised CRP, ESR, Leucocytes
- ECG PR interval increased
- previous episode of RF
What is the management of RF?
- bed rest, anti-inflammatory agents
- mycoarditis on echo - limit exercise and bed rest
- High dose aspirin
- Prednisolone if severe
- Infection: Benzylpenicillin
- HF: ACE-I (captopril) + diuretics
- Prophylaxis: Phenoxymethlpenicillin
What is the most common cause of Infective endocarditis?
- streptococcus aeurus
What are RFs for infective endocarditis?
- previous episode
- congential Heart defects
- prosthetic valves
What are the signs of infective endocarditis
- Fever
- clubbing
- splinter haemorrhages
- anaemia
- splenomegaly
6 HF, new murmur - microscopic haematuria
What investigations should you do for Infective Endocarditis
What is the management?
Prophylaxis?
- multiple blood cultures and multiple sites
- Echocardiogram
Management
Benzylpeniccilin + IV gentamicin
Prophylaxis - good dental hygiene, Abx not recommended
How common is tetralogy of fallot? What is a possible cause?
- most common cyanotic congenital heart disease
- chromosome 22 deletion
What are the 4 components of tetralogy of fallot?
- right ventricular outflow obstruction
- Right ventricular hypertrophy
- Large ventricular septal defect
- overarching aorta
What are the signs and symptoms of TOF?
How is it mostly diagnosed
Symptoms
- severe cyanosis
- hypercyanotic spells - squat
- feeding less
- failure to thrive
Signs
- clubbing
- loud harsh ejection systloc murmur - becomes shorter as cyanosis increases
What investgations would you do for TOF and what do you expect to see?
CXR- RVH (boot shape), small eart, right sided aortic arch
ECG - normal at birth, RVH after
Echo
What is the management of TOF?
- initial - medical, surgery at 6 months to close VSD and relieve ventricular outflow obstruction
- cyanosied in neonates - shunt to increase pulmonary outflow obstruction
- prolonged cyanotic spells
- sedation and pain relief (morphine)
- IV PROPANALOL - B-Blockers
- IV FLUIDS
- Bicarbonate to correct acidosis
- muscle paralysis and artifical ventilation
What occurs in transposition of great arteries?
What are possible risk factors
- when great arteries are switched so aorta is connected to the right ventricle and pulmonary artery is connected to the left
- maternal diabetes and rubella infection, alcohol, aged over40
When is TGA detected and why?
What are the symptoms?
What are the signs?
- on ductal closure around 2nd day of life
symptoms
- cyanosis, profound and lfie threatening
- acidosis
- if ASD present - less severe symptoms
signs
- lound and single heart beat
What investigations are done? for TGA
- CXR
- ECG
- Echo
What is the management of TGA?
- maintain patency of ducts - Prostoglandin E - short term
- surgery
What is tricuspid atresia
- when the tricuspid valve (between right atrium and ventricle) has not developed
What is the presentation of tricuspid atresia?
- may be well at birth but will quickly become cyanosed as a newborn, breathless
- mixing of systemic and pulmonary circulation in left atrium due to ASD
What is the management of tricuspid atresia?
- shunt insertion
- pulmonary artery banding to reduce pulmonary blood flow if breathless
What is persistent ductus arteriosis?
What does it result in?
when the connection between the pulmonary artery and the descending aorta does not close up as it should 1 month after birth
- results in left to right shunt - acyanotic
How does ductus arteriosis present?
- machinar constant murmur (through systolic and diastolic)
- left subclavicular thrill
- large volume collapsing/bounding pulse
- can be heart failure if the gap is large - hepatomegaly and splenomegaly
What is the management?
- Indomethacin - PE2 inhibitor
2. Surgery
What are causes of HF in neonates?
- obstructed systemic circulation (hypoplastic left heart syndrome, critical aortic valve stenosis, severe coarction of aorta)
What causes HF in infants?
- high pulmonary blood flow - VSD, AVSD, large persistant ductus arteriosis
What causes HF in older children and adolescents
- Eisenenmenger syndrome (RHF only)
- rheumatic heart disease
- cardiomyopathy
What are the symptoms of HF
- breathelessness
- sweating
- poor feeding
- recurrent chest infections
What are signs of HF
- failure to thrive
- tachypnoea
- tachycardia
- heart murmur - gallop rhythm
- enlarged heart
- hepatomgely
- cold peripheries
Management HF
- ACE-i
- Diuretics
