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Child Health > Paediatric Cardiology - Embryology and Acyanotic Heart Defects > Flashcards

Paediatric Cardiology - Embryology and Acyanotic Heart Defects Flashcards

1
Q

What are the five embryological origins of the heart?

A 
Truncus arteriosus
Bulbus cordis
Ventricle
Atrium
Sinus venosus
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2
Q

What does the truncus arteriosus form?

A

Aorta and Pulmonary trunk

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3
Q

What does the bulbis cordis form?

A

Ventricles - smooth part (with primitive ventricle)

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4
Q

What does the primitive ventricle become?

A

Ventricles - trabecular part of wall (with bulbis cordis)

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5
Q

What does sinus venosus become?

A

Smooth part of atria
SA Node
Coronary sinus

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6
Q

What shunts are present in the foetus?

A

Ductus arteriosus
Foramen vale
Ductus venosus

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7
Q

What is the function of ductus arteriosus and what does it become?

A

Bypass lungs to protect them

Ligamentum arteriosum

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8
Q

What is the function of foramen ovale and what does it become?

A

Bypass lungs to protect them

Fossa ovalis

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9
Q

What is the function of ductus venosus and what does it become?

A

Bypass liver as it is very metabolically active

Ligamentum venosum

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10
Q

How does ductus arteriosus shut?

A

When the baby takes its first breath, the ductus arteriosus contracts due to high O2 sats

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11
Q

How does foramen ovale shut?

A

The first breath opens the pulmonary circulation causing LA pressure > RA pressure which pushes the septum shut

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12
Q

How does ductus venosus shut?

A

When placental support is removed

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13
Q

What are the acyanotic heart defects?

A

Left to Right shunts

ASD
VSD
Coarctation of the Aorta
Patent Ductus Arteriosus
Pulmonary stenosis
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14
Q

How do acyanotic defects present?

A

Most are picked up on antenatal screening
Asymptomatic mostly

Possibly
Fail to thrive
Resp infections
Heart failure

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15
Q

Why can you see heart failure with acyanotic heart defects?

A

Increased pressure in pulmonary circulation

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16
Q

What is Eisenmenger’s syndrome?

A

L –> R shunt swap to R –> L if pulmonary pressure rise to exceed systemic pressure

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17
Q

How are acyanotic heart defects commonly investigated?

A

Echo - flow and anatomy
ECG - identity cardiomegaly or pulmonary hypertension
Cardiac catheter - if severe

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18
Q

How would you see cardiomegaly or pulmonary hypertension on ECG?

A

Commonly Left Ventricular hypertrophy - lead I increase, lead III invert

Right ventricular hypertrophy, right axis deviation, p pulmonale, tall R in V1, right ventricular strain

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19
Q

How are acyanotic heart defects managed in the general term?

A

Loop diuretics if heart failure

Surgical closure of defect

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20
Q

What are the risk factors for developing an acyanotic heart defect?

A

Family history
Maternal smoking/toxins/infection/diabetes
Genetic conditions - Down’s

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21
Q

What are the types of Atrial Septal Defect?

A

Ostium primum ASD

Ostium secundum ASD

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22
Q

What is a patent foramen ovale?

A

Isolated defect in the ostium secundum (more common)

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23
Q

What does a ostium primum Atrial Septal Defect leave?

A

Left to right shunt

+

Tricuspid incompetence

Seen in downs

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24
Q

What murmur would you hear with an Atrial Septal Defect?

A

Ejection systolic

Best heard at left sternal edge - increased blood flow in right ventricular outflow

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25
What clinical features can be suggest a patent foramen ovale?
Abnormal right ventricular pressure Widely split and fixed second sound Tricuspid flow murmur - mid diastolic rumble Pulmonary flow murmur - ejection systolic
26
What investigations are used to diagnose an Atrial Septal Defect?
CXR - pulmonary plethora ECG - right ventricular hypertrophy Echo
27
How are Atrial Septal Defect's managed?
Surgical - transcatheter closure
28
What is the most common type of congenital heart defect?
VSD
29
How common are Ventricular Septal Defect's?
Seen in 1/3 of children with heart defects 2-6 per 1000 births
30
What happens to 50% of Ventricular Septal Defect's?
Close spontaneously
31
What is the prognosis of a Ventricular Septal Defect dependent on?
Size and position of defect Development of changes due to blood shunting - pulmonary hypertension/narrowing of pulmonary arteries reduce left to right shunt
32
What chromosomal disorders are Ventricular Septal Defect's associated with?
Down's Edward's Patau
33
What examination features can be seen with a Ventricular Septal Defect?
Harsh pan systolic murmur at left lower sternal border Heard louder in smaller defects Parasternal thrill
34
What does a Ventricular Septal Defect cause?
Pulmonary congestion - more blood through pulmonary circulation High output cardiac failure - increased blood return from pulmonary circulation
35
What is a small Ventricular Septal Defect called and what is it its prognosis?
Maladie de Roger Spontaneous closure
36
What is warranted if a small Ventricular Septal Defect doesn't close within 12 months?
Echo to look for complications
37
How does a medium Ventricular Septal Defect present?
Infancy symptoms: Weight gain Difficulty feeding Recurrent chest infections
38
What can be heard if pulmonary blood flow is affected by a Ventricular Septal Defect?
Mid diastolic murmur
39
What investigations are done for a mid sized Ventricular Septal Defect and what will they show?
CXR - moderate cardiac enlargement Echo - position of defect Doppler - shunt
40
What are the complications of a Ventricular Septal Defect?
``` Aortic regurgitation Infective endocarditis Eisenmenger's syndrome Right heart failure Pulmonary hypertension ```
41
Why can you get aortic regurgitation with a Ventricular Septal Defect?
Poorly supported right coronary cusp lead to cusp prolapse
42
How is heart failure treated if present?
Diuretics | ACE-Inhibitor
43
What is the management plan for a mid sized Ventricular Septal Defect?
Spontaneous improvement in most Can do surgical correction - case by case
44
What is more likely to develop in a large Ventricular Septal Defect?
Heart failure develops early
45
What is the management plan for a large Ventricular Septal Defect?
Treat heart failure Surgical closure under cardiopulmonary bypass Banding of pulmonary artery in young infants for temporary respite until definitive surgery
46
What is coarctation of the aorta?
Narrowing of the aorta
47
Where can coarctation of the aorta occur?
Preductal or post ductal (ductus arteriosus) | 98% at level of ductus arteriosus
48
Who does coarctation of the aorta affect?
Males 2:1 Females If preductal - symptomatic infants If post ductal - asymptomatic children
49
How do preductal coarctations normally get picked up?
Antenatal diagnosis due to abnormal circulation Sick neonate with absent femoral pulses - MUST CHECK FEMORAL PULSE WHEN EXAMINING NEONATES
50
What happens in a preductal coarctation?
When ductus arteriosus is open, right ventricle adequately maintain CO When it closes heart failure occurs
51
How is preductal coarctation of the aorta managed?
Prostaglandin infusion to maintain ductal patency Transfer to cardiac centre for surgical intervention
52
How do post ductal coarctations present?
Asymptomatic usually Possible leg pains or headache Hypertension BP difference in arms and leg May have ejection click murmur due to biscupid aortic valve Systolic ejection murmur in left inter scapular area
53
How can coarctation of the aorta be managed surgically?
Catheter balloon dilatation | Resection of coarcted segment with end to end anastomosis
54
What is patent ductus arteriosus?
Failure of the ductus arteriosus to close following birth
55
How common is a Patent Ductus Arteriosus?
Very common in pre-term children
56
When does the ductus arteriosus close? (functionally and anatomically)
Functionally - 12-18 hours | Anatomically - 2-3 weeks
57
What are the risk factors for Patent Ductus Arteriosus?
Preterm Down's syndrome High altitudes
58
What clinical features are seen in a Patent Ductus Arteriosus?
Bounding pulses - wide pulse pressure | Systolic machinery type murmur at left sternal edge radiating to the back
59
How is a Patent Ductus Arteriosus diagnosed?
CXR can show increased pulmonary markings | ECG - left ventricular hypertrophy, prolong PR
60
How else can a Patent Ductus Arteriosus be visualised?
Echo | Doppler - shunt
61
How is a Patent Ductus Arteriosus managed?
Surgical closure - ligation, division or transvenous umbrella occlusion Pharmacological closure - indomethacin (not for term infants)
62
Why are Patent Ductus Arteriosus's closed?
Much higher risk of infective endocarditis or pulmonary vascular disease

Child Health (30 decks)

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