Paediatric Cardiology Flashcards
where does the ductus venosus connect?
the umbilical vein to the IVC
What regulated the blood flow through the ductus venosus
a sphincter
Where does the ductus arteriosis connect?
the pulmonary arteries to the aorta
What is the foramen ovale?
A hole which diverts blood from the right atrium to the left atrium
What happens to faeotal circulation at birth?
ductus venosis and arteriosis, foramen ovale and the umbilical vessels close off ductus venosus sphincter constrics, diverting blood to the liver
what adult structure arises from the foramen ovale?
the fossa ovalis
what adult structure arises from the umbilical vein?
ligamentum teres (liver)
what adult structure arises from the ductus venosus?
ligamentum venosum
what adult structure arises from the ductus arteriosus
ligamentum arteriosis
What are the two mechanisms by which a new born can have an atrial septal defect?
Patent Foramen ovale Septum irregularity
In atrial septal defects What are the two types of septum irregularity ?
Primum and Secundum
Are atrial septal defects cyanotic or non-cyanotic?
non-cyanotic
What 2 symptoms can an adult present with who had an atrial septal defect?
cough or hypertensive episode
Which direction does the shunt go in a small atrial septal defect?
from L to R because of higher pressure on the left heart
In ASD why can the shunt change from L to R -> R to L? and what is this called?
blood initially moves from left to right because of the ASD, after long enough the right heart pressure becomes higher than the left heart pressure. Eissenmengers and is now cyanotic
What will you hear on auscultation of an ASD?
Fixed splitting of S2
What will you see on ECG in ASD?
prolonged PR
Right axis deviation
What disease are ventricular septal defects associated with
Down’s Syndrome
What three signs will be seen in an infant with a VSD?
breathlessness
poor feeding
failure to thrive
What condition can lead to a VSD in an adult?
MI
What will be heard on aiscultation of a child with a VSD?
Pansystolic murur
What will be seen on ECG of a child with a VSD?
Right axis deviation
What is the management of a VSD?
Conservative
Medical - Digoxin, diuretics
Surgery
What illness in pregnancy is assocciated with a patent ductus arteriosis?
Rubella during early pregnancy
What children are most likely to have a patent ductus arterisosis?
Pre-term infants due to hypoxia and immaturity
What murmur us associated with patent ductus arteriosis and where is it best heard?
machine like murmur best heart below the left clavicle
how are patent ductus artrisosis treated?
medical - fluid restrict and Prostaglandin synthase inhibitors (indomethacin) Surgical closure
What is corarctation of the aorta?
kinking of the aortic arch
Why might an aortic coarctation not be noticed for a while in pre-term infants?
Symptoms may not show until a patent ductus arteriosis closes, therefor synthetic prostaglandins may be given to prevent PDA closing
What two other cardiac birth defects may be present in a child with aortic coarctation?
VSD or bicuspid valve
What will be on auscultation in aortic coarctation?
ejection systolic murmur best heard between the shoulder blades
What will be seen on ECG in aortic coarctation?
Ventricular hypertrophy (first L then R) R wave progression
What is an interrupted aortic arch?
NO connection between the proximal and distal sides of the aorta. Must be a PDA to let blood flow to defending aorta?
What congenital condition is associated with an interrupted aortic arch?
Di George’s
What is Di Georges syndrome?
Di Georges syndrome is an autosomal dominant condition characterised by congenital heart defects such as interruption of aorta and tetrology of Fallot, no thymus, hypocalcaemia and palatal defects.
What are the There cyanotic heart defects?
Tetraology of Fallot Transposition Tricuspid atresia (eisenmenger’s)
What are the non-cyanotic heart defects? (5)
ASD VSD PDA aortic coarctation aortic interuptions
What are the 4 key abnormalities in tetralogy of Fallot?
VSD
Obstruction of blood flow from right ventricle to lungs
Aorta lies directly over the ventricular septal defect
Right ventricular hypertrophy
Describe tetraology of fallot
What does tetrology of fallot cause clinically?
Mixing of blood
Poor blood flow to lungs
Poor quality of blood to body
BLUE BABY
What is the characteristic sign on CXR in tetralogy of fallot?
Coeur-en-sabot (boot shaped heart)
What is the management of tetralogy of fallot?
B-blockers
adreneline
phone senior
may be palliative
surgical procedure (either shunt from PA to aorta or repair)
