Paeds Cardiac Cases Flashcards
Case
A 2-day infant with trisomy 21 was reviewed on the post-natal ward with lethargy, diff feeding, and SOB. On exam, the pt is tachycardic, tachypnoeic, and has a wide pulse pressure. The baby has a loud continuous ‘machinery murmur’ that can be heard throughout the precordium and is loudest at the upper left sternal edge. A thrill may also be felt in the area.
What is the classification of murmur? 4 (loud with a thrill)
DDx? PDA ( character of the murmur - with continuous machinery murmur)
Large defect because the baby is symptomatic
Trisomy 21? ASD, VSD , AVSD, PDA
Case 3
4 yr old found to have a loud pan-systolic murmur, loudest at the left sternal border which disappears spontaneously by the age of 7 yrs old.
The most cause of this murmur? VSD
Why do you get a pan systolic murmur with VSD?
Because small lesions create loud murmurs due to an increase in turbulence of the blood flow. In systole blood flows from the left to right ventricle throughout the whole of systole, hence pansystolic.
What other signs might be seen on exam?
Thrill
Does VSD generally cause cyanosis ?
No
because the shunt is left to right. The only way this would happen was if the pressure in the right circulation exceeded that in the left causing reversal of the shunt( Eisenmenger’s syndrome )
Case 4
A 14 year old brought to the GP for sob on exercise and ejection systolic murmur is heard at the left upper sternal edge with wide fixed splitting sound ?
DDx? ASD
Which drugs commonly cause structural cardiac defects?
Which drugs commonly cause structural cardiac defects?
Alcohol VSD
Phenytoin ASD
Lithium Epstein’s anomaly
Warfarin VSD, TOF
What is the benefit of closing the ASD?
To improve prognosis/mortality and mortality.
Aims to reduce the risk of complications, failure, AF,Atrial flutter, pulmonary vascular disease
Narrowing of the aorta ?
Lead to arterial hypertension
aortic enlargement or aneurysms
HF
Accelerated atherosclerosis
This is usually during the first 3 weeks of life with poor feeding, lethargy, tachypnoea and present with cardiac failure
The problem starts when the ductus starts to close
Where is the systolic murmur heard?
Left interaclavicular area
Narrowing/Coarctation of the aorta can also lead to?
Delayed pulse between upper and lower limbs
BP would be higher in the upper limbs compared to the lower limbs
Coarctation of the aorta can be association with ?
genetic condition that affects girls and women, causing short stature, underdeveloped ovaries and distinctive features.
Treatment of Coarctation of the Aorta?
Surgical/balloon angioplasty
What should be done in order to keep the Ductus arteriosus open?
We use Prostaglandin in E1 infusion to open the ductus
also, consider if the pt needs prophylactic abx since this pt is a risk of HF.
Treatment for hf is diuretics and ionotropes
What is the ECG presentation of narrowing of the aorta?
Tall R in V6 & deep S in V1
