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3a > Congenital heart defects > Flashcards

Congenital heart defects Flashcards

1
Q

Murmur associated with PDA

A

Continuous ‘machinery’ murmur
Crescendo-descrendo

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2
Q

Give 4 other features of a PDA

A

-Left subclavicular thrill
-Large volume, bounding, collapsing pulse
-Wide pulse pressure
-Heaving apex beat

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3
Q

give 3 RF for PDA

A

-Premature
-Maternal rubella in first trimester
-Born at high altitude

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4
Q

what is a PDA

A

Connection between pulmonary artery and aorta

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5
Q

Give 4 signs of PDA

A

SOB
Difficulty feeding
Poor weight gain
LRTI

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6
Q

How is PDA managed ?

A

-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

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7
Q

what is the most common type of ASD

A

Ostium secundum

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8
Q

What is seen on ECG in on ostium secundum ASD

A

RBBB with RAD

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9
Q

What is seen on ECG in an ostium primum ASD

A

RBBB with LAD, prolonged PR interval

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10
Q

Give 4 complications of an ASD

A

-Eisenmenger syndrome
-Stroke in the context of a VTE
-AF or atrial flutter
-Pulmonary HTN and right sided heart failure

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11
Q

What murmur is seen in ASD

A

-Mid systolic murmur crescendo-descendo loudest at upper left sternal border
-Fixed splitting of S2

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12
Q

what is the most common cause of congenital heart disease

A

VSD

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13
Q

What murmur is hear in a VSD

A

Pan systolic murmur heard at the left LOWER sternal border in the third and fourth intercostal space

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14
Q

what are people with a VSD at increased risk of ?

A

-Infective endocarditis

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15
Q

Give 3 causes of a pan systolic murmur

A

VSD
Mitral regurg
Tricuspid regurg

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16
Q

what is coarctation of the aorta

A

Congenital narrowing of the aorta

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17
Q

12 week old infant
Ejection systolic murmur
Sat on right arm : 99%
Sat on left foot : 90%

A

Coarctation of the aorta

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18
Q

How may coarctation of the aorta present in a neonate

A

-Neonate : weak femoral pulses , differing BP/O2 sats in arms and legs. Ejection sytstolic mumur

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19
Q

Where would the murmur be heard in coarctation of the aorta

A

Left infraclavicular area and below the left scapula

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20
Q

How would coarctation of the aorta present in infancy

A

Infancy : heart failure -> tachypnoea, poor feeding, grey and floppy

21
Q

What additional signs may develop over time in coarctation of the aorta

A

-Left ventricular heave
-Underdeveloped left arm in reduced subclavian artery blood flow
-Underdevelopment of the legs

22
Q

How is severe coarctation of the aorta managed

A

Prostaglandin E to keep ductus arteriosus open while awaiting surgery

23
Q

What are the signs of more significant aortic valve stenosis

A

Fatigue
SOB
Dizziness
Fainting

All worse on exertion

24
Q

what murmur is heard on aortic valve stenosis

A

Ejection systolic
Loudest at second intercostal space, right sternal border
Crescendo decrescendo
Radiates to carotids

25
Q

What are 4 other signs of aortic valve stenosis

A

Ejection click before murmur
Palpable thrill in systole
Slow rising pulse
Narrow pulse pressure

26
Q

How can aortic valve stenosis be managed

A

Percutaneous balloon aortic valvuloplasty
Surgical aortic valvotomy
Valve replacement

27
Q

Give 5 complications of aortic valve stenosis

A

Left ventricular outflow tract obstruction
HF
Ventricular arrhythmia
Bacterial endocarditis
Sudden death on exertion

28
Q

Give 4 associations with pulmonary valve stenosis

A

TOF
Williams
Noonan’s
Congenital rubella syndrome

29
Q

what murmur is heard in pulmonary valve stenosis

A

Ejection systolic : second intercostal space left sternal border

30
Q

What are 3 other signs of pulmonary valve stenosis

A

Palpable thrill in pulmonary area
Right ventricular heave
Raised JVP with giant a waves

31
Q

How is mild pulmonary valve stenosis managed

A

‘watching and waiting’

32
Q

How is symptomatic pulmonary valve stenosis managed

A

-> Balloon valvuloplasty

33
Q

what 4 things make up the TOF

A

-> Pulmonary valve stenosis
-> Overriding aorta
-> Right ventricular hypertrophy
-> VSD

34
Q

What determines the severity of TOF

A
  • Degree of pulmonary valve stenosis
  • The greater it is, the greater the resistance and more blood is pumped through the right -> left shunt -> cyanosis
35
Q

Give 4 RF for TOF

A

Rubella infection
Increased maternal age
Alcohol in pregnancy
Diabetic mother

36
Q

what would a chest x ray show in TOF

A

Boot shaped heart -> right ventricular thickening

37
Q

what murmur is heard in TOF

A

Ejection systolic
Left
2nd intercostal space
Due to pulmonary value stenosis

38
Q

Give 5 signs of TOF

A

Tet spells
Cyanosis
Clubbing
Poor feeding
Poor weight gain

39
Q

what are tet spells

A
  • Intermittent cyanotic episode when a child is exerting themselves (e.g. crying,exercise)
    -Tacynpnoea
40
Q

How is conservative management of a tet spells

A

Children - squat
Babies -position knees to chest

41
Q

How can TOF be managed in neonates ?

A

Prostaglandin infusion to maintain ductus arteriosus

42
Q

What medication can be used in cyanotic episodes in TOF

A

BB

43
Q

what can be used in transposition of the great arteries to maintain until surgery

A

-> Prostaglandin : maintain ductus arteriosus
-> Balloon septostomy to create a large ASD through the foramen ovale

44
Q

what is the definite management of transposition of the great arteries

A

Open heart surgery

45
Q

what is ebstein’s anomaly

A

Tricuspid valve is set lower than the right

46
Q

what can cause ebetein’s anomaly

A

Lithium in-utero

47
Q

What is associated with ebstein’s anomaly

A

Wolff-Parkinson White syndrome
PFO or ASD

48
Q

Give 5 features of ebstein’s anomaly

A

Cyanosis
Prominent ‘a’ wave in JVP
Hepatomegaly
Tricuspid regurg -> pansystolic murmur
RBBB -> widely split S1 and S2

49
Q
  • 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
A

duchenne muscular dystrophy

3a (45 decks)

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