Paediatric Cardiology Flashcards
What are the three fetal shunts?
Ductus venosus (umbilical vein to inferior vena cava)
Foramen ovale (right atrium to left atrium)
Ductus arteriosus (Pulmonary artery to aorta)
How can you keep the ductus arteriosus open and when might you want to keep it open?
Prostaglandin infusion
When there is a cardiac abnormality causing right->left shunt.
What are features of an innocent murmur?
Soft
Short
Systolic
Symptom-less
Situation dependent
What murmur is associated with an atrial septal defect?
Ejection systolic murmur, crescendo decrescendo
What murmur is associated with a PDA?
Machinery murmur of 2nd heart sound
What murmur is associated with Tetralogy of Fallot?
Ejection systolic murmur heard best at LUSE (pulmonary stenosis)
Which congenital heart conditions cause CYANOTIC heart disease?
Tetralogy of Fallot
Transposition of the great arteries
What murmur is associated with aortic stenosis? What other features are there?
Ejection systolic murmur, crescendo-decrescendo
Narrow pulse pressure
Slow rising pulse
Soft or absent S2
S4
How is aortic stenosis managed?
If asymptomatic -> observe
If symptomatic -> valve replacement
What is the most common complication of aortic stenosis?
Left ventricular outflow tract obstruction
What conditions are associated with pulmonary stenosis?
Tetralogy of Fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome
How does pulmonary stenosis present?
Ejection systolic murmur - louder on inspiration
Often found incidentally
Symptoms can be fatigue, SOB, failure to thrive
What murmur is associated with pulmonary stenosis? What other signs are there?
Ejection systolic murmur loudest in the pulmonary area
Palpable thrill
Right ventricular heave due to RV Hypertrophy
Raised JVP
What are causes of heart failure in: Neonates, infants, and older children?
Neonates = due to obstructed circulation (Hypoplastic left heart syndrome, aortic stenosis, coaractation of the aorta, interruption of aortic arch)
Infants = due to high pulmonary blood flow (ventricular septal defect, atrioventricular septal defect, large PDA_
Older children (Eisenmenger syndrome, Rheumatic heart Disease, Cardiomyopathy)
Which heart conditions cause a left to right shunt?
ASD
VSD
PDA
Which heart conditions cause a right to left shunt?
Tetralogy of Fallot
Transposition of the great arteries
Which type of shunt causes cyanosis?
Right to left
What are signs of heart failure in neonates/infants?
Breathlessness
Sweating
Poor feeding
Recurrent chest infections
Failure to thrive
What are symptoms and signs of atrial septal defect?
Symptoms = wheeze, may be often asymptomatic
Signs =
Ejection systolic murmur
Fixed, widely split S2
What is seen on CXR in atrial septal defect?
Cardiomegaly
Enlarged pulmonary arteries
Increased pulmonary vascular markings
How does a ventricular septal defect present?
If it’s smaller than the aortic valve (<3mm) = asymptomatic, LOUD pan systolic murmur at LLSE, quiet pulmonary S2, CXR = normal.
If larger than aortic valve = presents with heart failure, recurrent chest infections, SOFT pan systolic murmur, LOUD pulmonary S2. CXR shows signs of heart failure.
How is a ventricular septal defect managed?
Smaller asymptomatic VSD = close spontaneously
Larger symptomatic VSD = Surgical repair required
What are signs of a patent ductus arteriosus?
Continuous machinery murmur
Left subclavicular thrill
Bounding collapsing pulse
Wide pulse pressure
Heaving apex beat
How is a patent ductus arteriosus managed?
In preterm infants can give Indomethacin/Ibuprofen to help close the PDA
If asymptomatic - wait to see if it closes by 1 year
If symptomatic - needs closing
What is Eisenmenger syndrome and which conditions typically can cause it?
When a heart condition causing a L to R shunt, eventually causes pulmonary HTN and therefore it becomes a R to L shunt
This leads to cyanosis
Causes= ASD, VSD, PDA,TOF
How is Eisenmenger syndrome managed?
Complete heart-lung transplantation required
Which congenital heart condition is associated with Turner syndrome?
Coarctation of the aorta Aortic stenosis (due to bicuspid aortic valve)
How does coarctation of the aorta present?
Weak femoral pulses
Mid systolic murmur
Tachypnoea
Radio-femoral delay
Apical click
How is coarctation of the aorta managed?
If critical, need to keep ductus arteriosus open with prostaglandin infusion whilst awaiting surgery
What are the 4 features of Tetralogy of Fallot?
- Ventricular septal defect
- Right ventricular hypertrophy
- Pulmonary stenosis
- Overriding aorta
How does Tetralogy of Fallot cause cyanosis?
Pulmonary stenosis means that there is higher pressure on R side of heart, this means that there is a R to L shunt through the VSD
How does Tetralogy of Fallot present?
Ejection systolic murmur (due to pulmonary stenosis)
Cyanosis
“Tet spells” - cyanotic episodes, infant will typically squat
What is seen on CXR in Tetralogy of Fallot?
Boot shaped heart
How is Tetralogy of Fallot managed?
Surgical repair
What is Ebstein’s Anomaly?
A congenital heart defect where the tricuspid valve is set lower than usual, causing the RA to be larger than usual and the RV to be smaller than usual
What are signs of transposition of the great arteries?
Loud single S2
Prominent right ventricular impulse
What does a continuous machinery murmur indicate?
Patent ductus arteriosus
What can an ejection systolic murmur indicate?
Aortic stenosis - LLSE (crescendo-decrescendo)
Pulmonary stenosis - Pulmonary area
Atrial septal defect (crescendo-decrescendo)
Aortic stenosis vs. ASD?
Aortic stenosis = narrow pulse pressure, slow rising pulse, soft S2
ASD = fixed splitting of S2
What might be seen on an ECG in an ASD?
RBBB
Which condition can cause patients with a DVT to develop a stroke?
Atrial septal defect
