Paediatric - Cardiology Flashcards
What are the four characteristic features of Tetralogy of Fallot?
- ventricular septal defect (VSD)
- right ventricular hypertrophy
- pulmonary stenosis - right ventricular outflow tract obstruction
- overriding aorta
What pulse abnormality on examination is most associated with Patent Ductus Arteriosus?
Collapsing pulse
What drug should be given to a neonate with Patent Ductus Arteriosus?
Indomethacin (inhibits prostaglandin synthesis and, in the majority of cases, closes the defect)
In ASD, blood moves from which atrium to the other?
What syndrome = reversal of this?
Blood moves from the left atrium to the right atrium because the pressure in the left atrium is higher than the pressure in the right atrium.
- Eisenmenger syndrome is where the pulmonary pressure is greater than the systemic pressure, the shunt reverses and forms a right to left shunt across the ASD, blood bypasses the lungs and the patient becomes cyanotic
What is Eisenmenger syndrome?
Eisenmenger syndrome. This is where the pulmonary pressure is greater than the systemic pressure, the shunt reverses and forms a right to left shunt across the ASD, blood bypasses the lungs and the patient becomes cyanotic
Name one of the 3 common Atrial Septal Defects
- Ostium secondum, where the septum secondum fails to fully close, leaving a hole in the wall.
- Patent foramen ovale, where the foramen ovale fails to close (although this not strictly classified as an ASD).
- Ostium primum, where the septum primum fails to fully close, leaving a hole in the wall. This tends to lead to atrioventricular valve defects making it an atrioventricular septal defect.
Name a complication of ASD’s
Stroke in the context of venous thromboembolism
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right sided heart failure
Eisenmenger syndrome
What murmur do ASD’s cause?
mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border
Which syndromes are VSD’s associated with?
Down’s and Turner’s
In VSD, blood moves from which ventricle to the other?
What syndrome = reversal of this?
Blood moves from the left ventricle to the right because the pressure in the left ventricle is higher than the pressure in the right ventricle.
- Eisenmenger syndrome is where the pulmonary pressure is greater than the systemic pressure, the shunt reverses and forms a right to left shunt across the ASD, blood bypasses the lungs and the patient becomes cyanotic
What murmur do VSD’s cause?
pan-systolic murmur more prominently heard at the left lower sternal border in the third and fourth intercostal spaces (systolic thrill)
Name a risk factor for heart failure
CHD, MI, valve disease, HT, palpitations, DM, meds like NSAIDs, Alcohol use, Sleep apnea, smoking, obesity, thiamine deficiency
What 2 proteins might be raised in heart failure?
BNP and NT-pro-BNP
What are 3 typical signs of Heart Failure?
breathlessness (dyspnoea on exertion / Orthopnea - lying down), fatigue, ankle swelling
Why might BNP be raised (other than HF) and why might it be reduced?
Raised: Left ventricular hypertrophy. Ischaemia. Tachycardia. Hypoxaemia. Renal dysfunction (eGFR <60). Age over 70. Liver cirrhosis. Sepsis. COPD. Diabetes.
Reduced:
Obesity.
African-Caribbean origin.
Medication - diuretics, ACE inhibitors, angiotensin-II receptor blockers, beta-blockers, mineralocorticoid receptor antagonists
What are the 4 stages of HF by NYHA
Class I: no symptoms on ordinary physical activity.
Class II: slight limitation of physical activity by symptoms.
Class III: less than ordinary activity leads to symptoms.
Class IV: inability to carry out any activity without symptoms.
Cyanotic vs Acyanotic congenital heart defects
Cyanotic:
- Tetralogy of Fallot.
- Transposition of the great vessels.
- Pulmonary atresia.
- Total anomalous pulmonary venous return.
- Truncus arteriosus.
- Hypoplastic left heart syndrome.
- Tricuspid valve abnormalities.
Acyanotic:
- Ventricular septal defect (VSD).
- Atrial septal defect (ASD).
- Atrioventricular septal defect.
- Patent ductus arteriosus (PDA).
- Pulmonary valve stenosis.
- Aortic valve stenosis.
- Coarctation of the aorta.
What heart murmur is heard for atrial septal defect?
mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border, with a fixed split second heart sound
Which heart defects might cause a pan-systolic murmur?
- Mitral regurgitation heard at the mitral area (fifth intercostal space, mid-clavicular line)
- Tricuspid regurgitation heard at the tricuspid area (fifth intercostal space, left sternal border)
- Ventricular septal defect heard at the left lower sternal border
What heart defect is a cause of stroke in patients with a previous DVT?
In patients with an ASD the clot is able to travel from the right atrium to the left atrium across the ASD. This means the clot can travel to the left ventricle, aorta and up to the brain, causing a large stroke
What procedure is used to correct a VSD?
transvenous catheter closure via the femoral vein or open heart surgery
What 3 lesions can result in Eisenmenger Syndrome?
Atrial septal defect, Ventricular septal defect, Patent ductus arteriosus
How might bone marrow react to Eisenmenger Syndrome / what haem condition is associated?
- Bone marrow will respond to low oxygen sats by producing more red blood cells and haemoglobin to increase oxygen carrying capacity of the blood.
- This leads to polycythaemia, which is a high concentration of haemoglobin in the blood. Polycythaemia gives patients a plethoric complexion
Examination findings associated with pulmonary hypertension?
- Right ventricular heave: contracts forcefully against increased pressure in the lungs
- Loud P2: loud second heart sound due to forceful shutting of the pulmonary valve
- Raised JVP
- Peripheral oedema
