Cardiovascular System Flashcards
What is a heart murmur?
An extra or unusual sound made by the heart - in children, normally completely innocent caused by the blood negotiating its way around the tight bends of a young child’s heart
What kind of sound does a systolic ejection murmur make, and where is it best heard?
A short systolic murmur occurring during systole and head along the left sternal edge or at the apex. It sounds like the vibration of a tuning fork. It can also vary in intensity when the child changes from lying to sitting or can be intensified by exercise/excitement.
How does a pulmonary flow murmur present?
It is caused by rapid blood flow across a normal pulmonary valve, it is a brief, high-pitched blowing murmur, best heard in the second left intercostal space when the child is lying down.
How may a venous hum present?
It is caused by flow through the systemic great veins. It is a blowing, continuous murmur heard at the base of the heart just below the clavicles, sounding like a soft hum during systole and diastole. It disappears when the child lies down.
Name the three innocent murmurs that are common?
- Systolic ejection murmur
- Pulmonary flow murmur
- Venous hum
In an infant with a heart murmur, what symptoms would be a cause for concern? (7)
- Breathlessness
- Poor feeding
- Excessive sweating
- Cyanosis
- Generally unwell
- Not gaining weight
- Positive family history
In an older child with a heart murmur, what symptoms would be concerning? (6)
- Exercise intolerance
- Palpitations
- Chest pain
- Syncope
- Pedal oedema
- Positive family history
If a child has a small ventricular septal defect (VSD), what is the management?
The VSD should close within the first 10 years of life, with the majority closing before the age of 2, however some can remain open. So just monitoring using echocardiogram to determine if it is closing.
What is there a risk of in children with VSD - which infection?
Infective endocarditis
How may the heart sound in a child with VSD?
- Pan systolic murmur at the left sternal edge (turbulent L –> R flow)
- The murmur is often harsh, like the sound of wood being sawn
- The sound may become louder as the VSD closes due to greater turbulence
What is the treatment for VSD?
- Medical - control heart failure with ACE inhibitors, diuretics
- Surgical - closure using cardiopulmonary bypass
What is a PDA?
Patent ductus arteriosus, often seen in pre-term infants.
What are the signs on examination of a baby with PDA?
- Collapsing pulse due to sudden leak of blood from the aorta to the pulmonary artery
- Preterm infants may have tachycardia and bounding pulses
- Continuous (machinery) murmur - systolic and diastolic
What time of murmur can be heard with an ASD?
Ejection systolic murmur due to excessive blood flow through the normal pulmonary valve
How are murmurs generally classified in terms of systolic and diastolic?
Systolic: pan-systolic or ejection systolic
Diastolic: early diastolic, or mid-diastolic
If a murmur is present in the lower sternal edge, what can this signify?
VSD
Innocent heart murmur
What are the characteristics of pathological heart murmurs? (4)
- All diastolic murmurs
- All pan systolic murmurs
- Late systolic murmurs
- Loud murmurs
- Abnormal clinical features
What are the features of innocent heart murmurs? (5)
- Always systolic timing - never diastolic
- Short duration/low intensity
- Intensifies with increased cardiac output - e.g. exercise.fever
- No radiation
- Asymptomatic patient
What are the risk factors for congenital heart disease?
- Family history
- Maternal rubella (causes PDA and pulmonary stenosis)
- Maternal diabetes
4.
What are the characteristics of Ebstein’s anomaly?
Atrial septal defect
Small right ventricle with abnormal tricuspid valve
What is Eisgenmenger syndrome?
Shunt of blood right to left ventricle, causing cyanosis
What is Eisgenmenger syndrome?
Shunt of blood right to left ventricle, causing cyanosis, due to left to right shunt which causes right ventricular hypertrophy and pulmonary artery hypertrophy. Prevention of this involves putting an elastic band style device around the pulmonary artery to prevent it getting big. Surgery is not possible straight away as the baby needs to be big enough.
Which condition is associated with a boot shaped heart on X-ray?
Fallots tetralogy
