Congenital heart conditions Flashcards
Small VSD murmur
Loud pan systolic murmur at the lower left sternal edge Radiates to whole precordium
Management of small VSD
Lesion will close spontaneously Maintain good oral hygiene to prevent bacterial endocarditis whilst defect is present
Large VSD
small size or bigger than the aortic valve
Large VSD mumur
Soft pan systolic murmur or no murmur
Clinical features of large VSD
- Heart failure with breathlessness - Increased pulmonary oedema, vascular markings + Pulmonary hypertension 2. Failure to thrive 3. Recurrent chest infections
Ix of VSD
- Chest radiograph; - Cardiomegaly - Enlarged pulmonary arteries and markings 2. ECG - Biventricular hypertrophy
Management of VSD
- Medication - Diuretics/Captopril 2. Pulmonary artery band - to reduce pulmonary hypertension
4 x Features of Tetralogy of Fallot
- Large VSD
- Overriding aorta over the ventricular septum
- Pulmonary stenosis - RV obstruction
- Right ventricular hypertrophy
How and when are patients with VSD likely to present?
- 6 months with a failure to thrive
- Breathing - Increased effort, low O2 sats and crackles
- Circulation - Pansystolic murmur
- Cardiomegaly and Plethoric lung fields
CXR of Tetralogy of Fallot
Boot shaped heart due to RV hypertrophy
How does the tetralogy of Fallot present?
5 days and with cyanosis
Clinical features of Tetralogy of Fallot
Hypercyanotic spells features
Tetralogy of Fallot
- Behavior -
Limp & Lethargic
Inconsolable crying and irritabiity preceding recent D&V
Squating on exercise
- Breathing -
Increased effort and O2 sats 58% (severe cyanosis)
- Circulation -
Heart rate - 140
No mumur
Management of Hypercyanotic spells
- Medical emergency as severe cyanosis can cause MI, Stroke or death
- O2 sats
- Blood pressure
- Heart rate
Signs of Tetralogy of Fallot
- Harsh ejection systolic murmur at the left sternal edge from day 1
- Clubbing of fingers and toes will develop in older children
Patent ductus arteriosus
Persistent ductus arteriosus which connects the pulmonary artery to the descending aorta
Higher pressure in the orta, so oxygenated blood takes two turns round to the lungs
Mumur for PDA
Continous mumur below the left clavicle
- Mumur continues through to diastole because the pulmonary artery pressure is lower than aorta through out the whole of the cardiac cycle
Two major features of a PDA
- Collapsing / Bounding pulse and wide pulse pressure
- Continous murmur below the left clavicle
Management of PDA
- Closure via surgical ligation/coil closure
- closure is recommended to abolish lifetime risk of bacterial endocardiitis and pulmonary vascular disease
How does a patient with PDA present
- Tachypnoae
- Poor feeding and poor weight gain
- Reccurent LRTI
- Crackles on auscultation but normal O2 sats
- Chest X ray - Plethoric lung fields
- Echo - duct seen
Atrial septal defect
- Secumdum ASD - defect in the atrial septum involving the foramen ovale
- Partial AVSD - interatrial connection between the bottom end of the atrial septum and AV valves
Atrial septal defect murmur
- ejection systolic mumur in upper left sternal edge - due to increased flow across the pulmonary valve
- fixed and widely split second heart sound
Investigations of ASD
- Septum secumdum ASD -
- Partial right bundle branch block (common in young children)
- Right axis deviation due to right ventricular enlargement
Atrial septal defect presentation
- Commonly asysmptomatic
- Present at 5 years with incidental murmur
- Recuurent chest infections and arrythmias
Atrioventricular septal defect
non fusion of the endocardial cushion - abnormalities of the AV valves
Increased incidence in Trisomy 21
Presentation of AVSD
- Cyanosis at birth or heart failure within 2 -3 weeks of life
- Recurremt lower respiratory tract infections
- Increased effort of breathing and crackles on auscultation
- Cardiomegaly, plethoric lung fields and heart failure
Pulmonary stenosis clinical features
- Mainly assymptomatic unless critical stenosis
Physical signs of pulmonary stenosis
- Ejection systolic murmur at the left sternal edge
- Ejection click
- Clear on auscultation and low O2 sats
- Weak pulse
Pulonary stenosis murmur
Ejection systolic murmur at the upper left sternal edge
Radiates to the back
- Ix of Pulmonary stenosis
- Chest Xray - Oligaemic ( lacking blood because of stenosis in pulmonary valve )
- CBG - acidotic, hypoxic
- Echo - critical PS
- ECG - Right ventricular hypertrophy
Pulmonary stenosis - how does it present
2 days with cyanosis
Mx of pulmonary stenosis
- Most children are assymptomatic
- Transcatheter balloon dilatation
Transposition of the great arteries -
- when does it present
- signs on examination
- Presents within 12 hours with cyanosis as closure of duct leads to reduction of blood mixing and cyanosis
- Tachypnea
- Clear on auscultation
- Tachycardia
Murmur in transposition of arteries
No murmur
Ix in Transposition of Arteries
Chest radiograph
- Increased pulmonary marking due to increased pulmonary vascular flow
- Egg on side appearance of heart
CBG - acidotic + hypoxic
Coarctation of the Aorta symptoms
- constriction of the aorta, severe obstruction of the left ventricular outflow
Breathing -
increased effort and clear on auscultation
Circulation -
- Low blood pressure
- Weak femorals
- Brachiofemoral delay
* Severe heart failure*
Ix of Coarctation of Aorta
- Chest Xray
- Cardiomegaly and congestion - CBG - acidotic
- 4 limb BP - lower limbs have sign weaker bp
- Echo - Coarctation
Presentation of the coarctation of Aorta
- Presents at 6 weeks
- Increased work of breathing
- Heart failure
Aortic stenosis - what are the symptoms and appearance
Def : restricts exit from the left ventricle
Breathing :
effort is increased and clear on auscultation
Sats unable to be read
Circulation :
- Pulses thready and weak
- Bp unrecordable
Appearance :
- MOTTLED NOT BLUE
Main clinical presentation of Aortic stenosis and when does it present
- Presents 4 hours
- Pulses thready and weak
- Blood pressure unrecordable
- MOTTLED NOT BLUE
Ix of aortic stenosis
CXR - Cardiomegaly and congestion
CBG - severe acidosis
4 limb bp - unobtainable
Echo - Critical stenosis
TOF murmur
- systolic murmur
- left sternal edge
Atrial secumdum defect - murmur
upper left sternal edge
soft systolic mumur
splitting of S2 sound
Coarcatation of the aorta mumur
Ejection systolic
Left sternal edge
radiates to the back
Aortic stenosis mumur
- Ejection systolic
- Maximum in aortic space radiating to the enck and carotids
Mumurs causing mild cardimegaly and increased pulmonary markings
( Right ventricular hypertrophy)
- VSD
- ASD
Mumur causing left ventricular hypertrophy
Aortic stenosis
Mumur which causing rib notching
Coarctation of the aorta
Small boot shaped heart and oligemic lung fields caused by
ToF
- Narrow mediastinum and egg on side appearance and increased pulmonary markings
TGA
Ft of innocent mumurs (6)
- Soft
- Single
- Small - no radiation
- Assymptomatic
- Systolic - early ejection systolic
- Left Sternal edge
Assymptomatic mumurs
- small ASD
- small VSD
Cyanotic mumurs
1 . TGA
- ToF
Mumurs with potential to cause cardiac failure
- VSD
- PDA
Difference in paediatric ecg vs adult
- HR much faster
- Marked sinus arrythmia due to variations in breathing
- Right axis deviation
- Partial bundle branch block
- T wave inversion in leads v1 - v4
Mx of SVT
- Antiarrythmia medication - beta blcokers, digocix and amiadorone
- Catheter ablation
Ix paediatric palpitations
- Holter monitor - 24 hour ECG
- Cardiacmemo - ECG during episode of fast heart rate
- Reveal implant device -loop recorder through the skin
Main investigations to do in paediatric cardiology
- ECG
- CHEST XRAY
- ECHO
