Heart Conditions Flashcards
What are the 4 types of asymptomatic heart murmurs?
- physiological: short, soft, diastolic murmur. Disappears during first few days of life. Due to flow through a PDA or across the tricuspid valve or increased flow through a normal pulmonary valve due to hyper dynamic circulation
- peripheral pulmonary stenosis/persistent PDA: systolic murmur heard over both sides of the chest
- small ventricular septal defect: systolic murmur best heard at the lower left eternal border. Becomes audible after day 2
- acyanotic tetralogy of fallot: loud harsh murmur. Adequate pulmonary flow prevents the appearance of obvious cyanosis
How does hear disease in a newborn infant usually present?
Presents with one or more of the following :
- asymptomatic heart murmur
- cyanosis
- gradual onset of respiratory distress and heart failure
- sudden catastrophic heart failure with shock
What is the cause of central cyanosis not responding to 100% oxygen (hyperoxia test)
It is usually due to persistent pulmonary hypertension or cyanotic congenital heart disease
How does persistent pulmonary hypertension cause central cyanosis?
There is a right to left shunt through the ductus arteriosus and foramen ovale.
What are two common congenital cyanotic heart diseases?
Transposition of the great arteries and severe tetralogy of fallot
What is the treatment for transposition of the great arteries?
Oral or intravenous prostaglandin therapy should be started to improve arterial oxygen saturation by reopening the ductus. Urgent referral is needed for possible atrial septostomy and wary corrective surgery
How can pulmonary flow be maintained in severe tetralogy of fallot?
Ductus is kept open with an infusion of prostaglandin E1 or oral E2. Urgent surgery is needed to establish shunting between the subclavian and pulmonary arteries
What are 4 less common congenital cyanotic heart diseases?
Tricuspid atresia
Ebsteins anomaly
Truncus arteriosus
Total anomalous pulmonary venous drainage
What are the clinical features of heart failure?
- signs of respiratory distress, especially fast breathing
- tiring with feeds and failure to thrive with or without oedema
- excessive sweating, especially of the forehead
- tachycardia or gallop rhythm
- hepatomegaly
What is the presentation of a large patent ductus arteriosus?
- flooded lungs become stiff and oedematous causing respiratory distress
- pulses are fast and very easily felt with a wide pulse volume
- systolic murmur over the left subclavicular area after day2
- on echocardiography: a large left atrium and reversed diastolic flow in the aorta indicate a significant shunt
- chest X-ray shows cardiomegaly and pulmonary plethora
What are the symptoms and signs of severe ventral septal defect?
- respiratory distress with poor feeding a few weeks after birth
- diastolic flow murmur may be heard
- failure to thrive and secondary pneumonia
What defect can a large vsd be a part of and what Syndrome is this common to?
Endocardial cushion defect and this is common in children with trisomy 21
What is usually the cause of catastrophic shock and early heart failure
Hypoplastic left heart syndrome
Severe aortic stenosis
Severe coarctation of the aorta
Interrupted aortic arch
What do infants with catastrophic shock and early heart failure present with
- early signs may be misdiagnosed as sepsis: poor perfusion, mottled skin, hypotensive, poor pulses and metabolic acidosis
- femoral pulses are Palpable until the ductus starts to close
- saturation difference of > 2 % between right hand and foot suggest the diagnosis
What are the causes of heart failure at birth?
- Severely anaemic infants
- Infants after severe intrapartum hypoxia
- Myocarditis
- Severe metabolic disturbance
- arrhythmias
