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Cardiac Disease - Paed's Maryam > Left to Right Shunts > Flashcards

Left to Right Shunts Flashcards

1
Q

What is ASD?

A

Atrial Septal Defect

Secundum ASD (80% of ASDs) – defect in atrial septum (foramen ovale does not close)

o Partial AVSD (or ‘primum ASD’) – defect of AV septu

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2
Q

Signs and symptoms of ASD?

A

Asymptomatic

o Recurrent chest infections / wheeze

o Arrhythmias (from 40yo+)

o Murmur:

Ejection-Systolic Murmur at ULSE

Fixed wide splitting of S2

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3
Q

Investigations of ASD?

A

CXR

ECG

Echoardiography

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4
Q

Management of ASD?

A

Secundum ASD -> cardiac catheterisation + insertion of occlusive device (percutaneous/endovascular closure)

Partial AVSD -> surgical correction

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5
Q

What is VSD?

A

Ventricular Septal Defect

this is based on size <3mm or >3mm

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6
Q

Symptoms of a small <3mm VSD?

A

Asymptomatic

Murmur = loud PAN-SYSTOLIC MURMUR

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7
Q

Investigations and Management of <3mm VSD?

A

Echocardiography

Self limiting - these close by themselves

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8
Q

Signs and symptoms of large VSD?

A

Heart Failure , SOB, recurrent chest infections, hepatomegaly

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9
Q

Investigations and management of a large VSD?

A

CXR
ECG
Echocardiography

Diuretics + captopril
additional calorie input
surgery is performed at 3-6 months to prevent permanent lung damage.

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10
Q

What is Patent Ductus Arteriosus?

A

Connects pulmonary artery to descending aorta (should close by 1 month postpartum)

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11
Q

Signs and symptoms of Patent Ductus Arterious?

A

Murmur = continuous ‘machine-like’ / Gibson’s murmur at ULSE

Left sub-clavicular thrill

Heaving apex beat

Wide pulse pressure

Large volume, bounding, collapsing pulses

Respiratory symptoms (increased work) à apnoea, bradycardia, high O2 need

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12
Q

Investigation and Management of Patent Ductus Arteriosus?

A

Medical: indomethacin (NSAID) à will promote duct closure

o Surgical: coil/device closure at cardiac catheter at 1yo, or Ligation

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13
Q

What is Cyanotic Heart Disease?

A

Present with cyanosis - hyperoxia nitrogen washout test

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14
Q

What is Tricuspid Atresia?

A

The most common form of complex cyanotic

heart disease (there are many others)

· Only left ventricle effective (right too small)

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15
Q

What are some signs and symptoms of Tricuspid Atresia?

A

Cyanosis and SoB

§ Presents very early (10mins)

§ Similar to ToF presentation but ToF presents at 1-6m of age

o ESM at left sternal edge

o Hypoplastic left heart

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16
Q

Management of Tricuspid Atresia?

A

1 - secure supply of blood to the lungs

2 - Glenn operation -> SVC to the pulmonary artery

3 - Fontan operation -> IVC to the pulmonary artery

17
Q

What is Transposition of the Great Arteries?

A

Two main vessels OUT of the heart are switched (Pulmonary Artery and Aorta)

  • Aorta is connected to the right atrium, PA to the left atrium.
  • Oxygenated blood goes to the lungs and deoxygenated blood is sent to the body.
18
Q

What are some signs and symptoms of TGA?

A

Cyanosis within a few hours

Loud S2 (but, no murmur)

19
Q

Investigations for TGA?

A

CXR - narrow upper mediastinum
increased pulmonary markings

Echocardiography

20
Q

Management of TGA?

A

immediate prostaglandin infusion (vasodilatory - mantains patency of the ductus arteriosus)

balloon atrial septoplasty - tears atrial septum down to enable mixing

21
Q

What is an atrioventricular septal defect? And what are the signs

A

Common in downs syndrome

Cyanosis at weeks 2-3 of life (no murmur) à found on routine echocardiography of Down’s

22
Q

What is Tetraology of Fallot?

Name some characteristics?

A

Most common cause of cyanotic heart disease

VSD

Overriding aorta (compresses pulmonary outflow -> stenosis -> RVH)

23
Q

What are some symptoms of TOF?

A

Clubbing

o Murmur = loud ESM at left lower sternal border

o Tet spells = crying à inc. pul. resistance à R-L shunt à cyanosis

24
Q

Investigations for TOF?

A

CXR (small heart, boot-shaped due to RVH)

Echocardiography

25
Q

Management of TOF?

A

1 - Prostaglandin to reverse severe cyanosis

  • morphine
  • propanolol - peripheral vasoconstriction
  • IV fluids
  • muscle paralysis and artificial ventilation

2 - surgery - post 6 months

26
Q

What is Eisenmenger Syndrome?

A

irreversibly raised pulmonary vascular resistance from chronically raised pulmonary arterial pressure and flow

At 10-15y, shunt reverses and teenager become blue + cyanotic with Eisenmenger syndrome à death by right-sided heart failure (40-50yo)

§ Cyanosis typically affects lower extremities in PDA-Eisenmenger

27
Q

Management of Eisenmenger Syndrome?

A

Early intervention for pulmonary blood flow

Heart transplantation not easy but can be done

Cardiac Disease - Paed's Maryam (3 decks)

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