Paediatric cardiology Flashcards
Commonest congenital heart defect
VSD
Small VSD symptoms
Asymptomatic
Small VSD physical examination findings
Pansystolic murmur
Where is a VSD best heard?
LLSB
Large VSD symptoms
Delayed growth
Decreased exercise tolerance
Large VSD physical examination findings
Pansystolic, loud harsh and high pitched murmur at LLSB
Hepatomegaly
CHF symptoms
What investigations are done for VSD? What would you expect on investigations?
Echocardiogram to estimate pressure gradient
ECG prominent L and R ventricular forces
CXR pulmonary plethora and cardiac enlargement
What is the Eisenmenger complex
irreversible pulmonary vascular disease due to lofnstading shunt with reversal of flow
What is chance of closure if VSD is muscular?
High chance of spontaneous closure
Difficult surgical closure
What is chance of closure if doubly committed VSD?
Low change spontaneous closure
Risk aortic valve regurgitation
Management of small VSD
close on their own
Management of large VSD
Surgical closure by 1 yo
When do symptoms of ASD develop?
Asymptomatic in childhood
Symptoms develop in 3rd, 4th decade
Murmur heard in ASD
Ejection systolic murmur
Fixed splitting of S2
Parasternal heave
Where is an ASD heard?
Pulmonary area
What percentage of murmurs are ASD?
8%
Where is the ASD defect?
ostium primum - common in Down syndrome
ostium secundum in region of fossa ovalis- commonest one
sinus venous in region of SVC or IVC
What are the complications of ASD?
Pulmonary HTN
HF
Arrhythmia
What is the natural history of ASD?
80-100% spontaneous closure rate if ASD diameter
how do you manage ASD that has not closed?
Surgical closure
Between 2-5 yo
When does the ductus arteriosus normally close?
After 10-15 hours of life
Up to when can a preme’s PDA close?
Can take up to 3 months
What are the symptoms and physical fundings in a small PDA?
No symptoms
Continuous murmur
When does a medium PDA develop?
2-6 months
