Congenital heart defects Flashcards
Murmur associated with PDA
Continuous ‘machinery’ murmur
Crescendo-descrendo
Give 4 other features of a PDA
-Left subclavicular thrill
-Large volume, bounding, collapsing pulse
-Wide pulse pressure
-Heaving apex beat
give 3 RF for PDA
-Premature
-Maternal rubella in first trimester
-Born at high altitude
what is a PDA
Connection between pulmonary artery and aorta
Give 4 signs of PDA
SOB
Difficulty feeding
Poor weight gain
LRTI
How is PDA managed ?
-Indomethacin/ibuprofen can be given as a neonate to inhibit prostaglandin synthesis
-Monitor to 1 year - trans-catheter or surgical closure if it looks like it won’t close on its own
what is the most common type of ASD
Ostium secundum
What is seen on ECG in on ostium secundum ASD
RBBB with RAD
What is seen on ECG in an ostium primum ASD
RBBB with LAD, prolonged PR interval
Give 4 complications of an ASD
-Eisenmenger syndrome
-Stroke in the context of a VTE
-AF or atrial flutter
-Pulmonary HTN and right sided heart failure
What murmur is seen in ASD
-Mid systolic murmur crescendo-descendo loudest at upper left sternal border
-Fixed splitting of S2
what is the most common cause of congenital heart disease
VSD
What murmur is hear in a VSD
Pan systolic murmur heard at the left LOWER sternal border in the third and fourth intercostal space
what are people with a VSD at increased risk of ?
-Infective endocarditis
Give 3 causes of a pan systolic murmur
VSD
Mitral regurg
Tricuspid regurg
what is coarctation of the aorta
Congenital narrowing of the aorta
12 week old infant
Ejection systolic murmur
Sat on right arm : 99%
Sat on left foot : 90%
Coarctation of the aorta
How may coarctation of the aorta present in a neonate
-Neonate : weak femoral pulses , differing BP/O2 sats in arms and legs. Ejection sytstolic mumur
Where would the murmur be heard in coarctation of the aorta
Left infraclavicular area and below the left scapula
How would coarctation of the aorta present in infancy
Infancy : heart failure -> tachypnoea, poor feeding, grey and floppy
What additional signs may develop over time in coarctation of the aorta
-Left ventricular heave
-Underdeveloped left arm in reduced subclavian artery blood flow
-Underdevelopment of the legs
How is severe coarctation of the aorta managed
Prostaglandin E to keep ductus arteriosus open while awaiting surgery
What are the signs of more significant aortic valve stenosis
Fatigue
SOB
Dizziness
Fainting
All worse on exertion
what murmur is heard on aortic valve stenosis
Ejection systolic
Loudest at second intercostal space, right sternal border
Crescendo decrescendo
Radiates to carotids
What are 4 other signs of aortic valve stenosis
Ejection click before murmur
Palpable thrill in systole
Slow rising pulse
Narrow pulse pressure
How can aortic valve stenosis be managed
Percutaneous balloon aortic valvuloplasty
Surgical aortic valvotomy
Valve replacement
Give 5 complications of aortic valve stenosis
Left ventricular outflow tract obstruction
HF
Ventricular arrhythmia
Bacterial endocarditis
Sudden death on exertion
Give 4 associations with pulmonary valve stenosis
TOF
Williams
Noonan’s
Congenital rubella syndrome
what murmur is heard in pulmonary valve stenosis
Ejection systolic : second intercostal space left sternal border
What are 3 other signs of pulmonary valve stenosis
Palpable thrill in pulmonary area
Right ventricular heave
Raised JVP with giant a waves
How is mild pulmonary valve stenosis managed
‘watching and waiting’
How is symptomatic pulmonary valve stenosis managed
-> Balloon valvuloplasty
what 4 things make up the TOF
-> Pulmonary valve stenosis
-> Overriding aorta
-> Right ventricular hypertrophy
-> VSD
What determines the severity of TOF
- Degree of pulmonary valve stenosis
- The greater it is, the greater the resistance and more blood is pumped through the right -> left shunt -> cyanosis
Give 4 RF for TOF
Rubella infection
Increased maternal age
Alcohol in pregnancy
Diabetic mother
what would a chest x ray show in TOF
Boot shaped heart -> right ventricular thickening
what murmur is heard in TOF
Ejection systolic
Left
2nd intercostal space
Due to pulmonary value stenosis
Give 5 signs of TOF
Tet spells
Cyanosis
Clubbing
Poor feeding
Poor weight gain
what are tet spells
- Intermittent cyanotic episode when a child is exerting themselves (e.g. crying,exercise)
-Tacynpnoea
How is conservative management of a tet spells
Children - squat
Babies -position knees to chest
How can TOF be managed in neonates ?
Prostaglandin infusion to maintain ductus arteriosus
What medication can be used in cyanotic episodes in TOF
BB
what can be used in transposition of the great arteries to maintain until surgery
-> Prostaglandin : maintain ductus arteriosus
-> Balloon septostomy to create a large ASD through the foramen ovale
what is the definite management of transposition of the great arteries
Open heart surgery
what is ebstein’s anomaly
Tricuspid valve is set lower than the right
what can cause ebetein’s anomaly
Lithium in-utero
What is associated with ebstein’s anomaly
Wolff-Parkinson White syndrome
PFO or ASD
Give 5 features of ebstein’s anomaly
Cyanosis
Prominent ‘a’ wave in JVP
Hepatomegaly
Tricuspid regurg -> pansystolic murmur
RBBB -> widely split S1 and S2
- X-linked recessive
- progressive proximal muscle weakness from 5 yrs
- calf psuedohypertrophy
gower’s sign : use arms to stand up from squatted position - Raised creatining kinase
duchenne muscular dystrophy
