Paediatric Cardiology Flashcards
What are innocent mumurs?
Harmless sound made by the heart - noise sometime made when blood passes through a normal heart
Common infancy and children but disappears in adulthood
Becomes more obvious with fever, anaemia, anxiety and infections
What are the characteristics of an innocent murmur?
Soft 1-2/6, systolic (except venous hum which is a continuous murmur), varies with posture, no thrill, short durations and child is asymptomatic
What are some types of innocent murmur?
Still’s murmur, physiological pulmonary flow murmur neonate, venous hum, pulmonary flow murmur and carotid bruit
Where is the location of innocent murmur?
Venous hum - right upper sternal edge
Pulmonary artery murmur - left upper sternal edge
Still’s murmur - left lower sternal edge
Describe Still’s murmur
Most common in school age children
Best heart at LLSE
Systolic
Increased in supine/ decreased in standing, sitting and Valsalva
No known aetiology
Describe physiological pulmonary stenosis
Common in newborns may last up to 3-6 months of age
Localised to LUSE - radiation to back
Systolic murmur - sound like breath sounds
Due to turbulence and relative obstruction at PA bifurcation due to acute angle at birth
How is physiological pulmonary stenosis differentiated from ASD and PS?
ASD may be accompanied by wide split and may have right ventricular heave
PS murmur is harsh and associated with thrill or click
Describe cervical venous hum
Sound of blood flow returning normally through the veins above the heart
Common in young school age and hear when sitting
Disappears when lying down, slight pressure and turning neck to one side
Continuous soft, blowing murmur
Anterior neck to infraclavicular area R>L
How is cervical venous hum differentiated from PDA/ AV fistula?
PDA murmur radiates to back and best heard in left infraclavicular area
Not changed with position - also AV fistula
Describe pulmonary flow murmur
Common in older children and teenagers with think chest walls
Noise is the normal blood flow through the pulmonary valve which is close to the chest wall
Location is LUSE
Systolic in nature
How is pulmonary flow murmur differentiated from PDA/ PS?
Pulmonary stenosis murmur is harsh and can be associated with a thrill
PDA is a continuous murmur
Describe carotid bruit
Heard in children and young adults
Due to turbulence at take off of carotid or brachiocephalic vessels, heard in neck, suprasternal notch and below the clavicles
Systolic and decreases in intensity with hyperextension of shoulder
Louder in anxiety and anaemia
What investigations are used for innocent murmurs?
ECG, check pulses, check saturations and BP
Describe pulmonary stenosis
Asymptomatic in mild stenosis, in moderate and severe can have exertional dyspnoea and fatigue
Ejection systolic murmur in LUSE with radiation to back
What is the intervention for pulmonary stenosis?
Balloon valvoplasty
Delay valve replacement until after puberty
Describe aortic stenosis
Mostly asymptomatic, if severe then can get reduced exercise tolerance, exertional chest pain and syncope
Ejection systolic murmur in URSE and radiation into carotids
What is the treatment of aortic valve stenosis?
Balloon valvoplasty - can cause aortic regurgitation
Use the pulmonary valve to replace the aortic - Ross-Kono procedure
What are the changes in the foetal circulation at birth?
Pulmonary vascular resistance falls, pulmonary blood flow rises, systemic vascular resistance increases, ductus arteriosus + foramen ovale + ductus venosus closes
Describe patent ductus arteriosus
Very common in pre-term infants
Treatment with fluid restriction/ diuretics, prostaglandin inhibitors and surgical ligation
In term babies have good chance of spontaneous closure - not prostaglandin sensitive
What is the clinical presentation of coarctation of the aorta?
Weak or absent femoral pulses, radio-femoral delay, systolic murmur loudest at the back and sudden deterioration + collapse
What is the management of coarctation of the aorta?
Re-open PDA with prostaglandin E1 or E2, resection with end-to-end anastomosis, subclavian patch repair and balloon aortoplasty
What is the procedure for transposition?
Switch procedure
Describe Fallot’s tetralogy
Means 4 abnormalities
Main problem is narrowing of right ventricular outflow tract - infundibulum - leading to pulmonary valve
PV stenosis
Large ventricular septal defect
Overriding aorta
What is the affect of Fallot’s tetralogy?
Right ventricular hypertrophy and right ventricular pressure is high
Surpasses left ventricular pressure so left to right shunt over the large VSD
Baby will become centrally cyanosed
What is the management of tetralogy of Fallot?
Palliative measures - BB and Blalock-Taussig shunt
Full correction at 5kg body weight
Life long follow up due to recurring RVOT - right ventricular outflow tract obstruction
