Paeds Cardiac conditions Flashcards
What are the classification of Heart Murmurs ?
Grande 1 to 6
Grade 1
Soft, barely audible
Grade 2
Soft, audible
Grade 3
Loud without a thrill
Grade 4
Loud with a thrill
Grade 5
very loud, audible with the stethoscope
placed lightly on the chest
Grade 6
extremely loud, audible with the stethoscope off
the chest
Palpable murmur
What is innocent murmurs ?
Asymptomatic and localised to the left sternal edge
When can the innocent murmur be seen ?
Occur due to changes in blood flow within the normal heart, often a child will get an innocent murmur when they get hyper-dynamic circulation following an infection
What is the timing of innocent murmur ?
Early Ejection systolic
What is the character of innocent murmur ?
Short, Soft
Vibrating, musical
No radiation, vary with posture and position
Sternal Edge
What is it associated with
No added sounds/Thrill/Ventricular lift
What is pathologic murmurs ?
Symptomatic
What is the timing of pathologic murmur ?
Diastolic
What is the character of pathologic murmur ?
- Long and Loud
Grade would be >3/6 - High-pitched, harsh
- Radiation over precordium
-
What is Pathologic murmur associated with ?
Loud / Fixed S2
Precordial thrill
What are the cardiac problems in children ?
Congenital Heart Disease
Acquired Heart Problems
Arrythmias
It can be either Structural or Functional
How is Fetal Circulation happens ?
involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta
What does congenital heart disease Contain ?
Cyanotic R-L Shunt
One of the most important reasons for congenital malformations, this cause more still birth
who tend to have problems with the septum of the heart ?
People with trisomy 21 and the babies could be present with atroventricular defect.
What is Edward’s syndrome ? also called as Trisomy 18
very severe genetic condition that affects how your child’s body develops and grows. Children diagnosed with trisomy 18 have a low birth weight, multiple birth defects and defining physical characteristic
The condition occurs when a person has an extra copy of chromosome 18,
How does the babies get oxygenated blood ?
Oxygenated blood is delivered to the baby from placenta through the Umbilical vein
How does the Fetal circulation works in Prenatal?
The Lungs don’t provide gas exchange, and the pulmonary vessels are vasoconstrictive, so the placenta plays a role here!
The placenta acts as a gas exchange unit to oxygenate fetal blood.
What are the 3 vascular structures most important in the transitional circulation ?
ductus venosus, foramen ovale, and ductus arteriosus
How does the Foetal blood vessel and circulation works ?
Once the main arteries and veins as well as the heart are developed, usually after the 8th week of fetal development, deoxygenated blood is returned from the fetal systemic circulation to the placenta via two umbilical arteries, which branch off the fetal internal iliac arteries.
What does the umbilical vein pass through ?
Highly oxygenated, nutrient-rich blood flows from the placenta to the fetus via the umbilical vein. Approximately half of the blood in the umbilical vein bypasses the liver to flow into the ductus venosus, a fetal vessel connecting the umbilical vein to the inferior vena cava.
What structure in the RA takes the oxygenated blood through a hole?
Foramen ovule , will then go to the LA and will be delivered to the body
whereas the poor blood go to the lungs
What does the Structure Ductus Arteriosus do?
This is in between the pulmonary artery the aortic arch which takes some blood back to the body instead of sending all the bloods to the lungs
What is Ventricular septal defect ?
Asynotic
Left to right shunt and get mixed and go to the lungs
Children with Down syndrome can develop this condition in common
Why type of murmur is heard in the Ventricular septal Defect ?
Systolic Murmur
What does the physical findings of the ventricular septal defect look like ?
Depends on the size of the defect as if it is small, the pt may be completely asymptomatic but if the defect is very large the pt could have HF
Investigation of VSD?
Echo with Doppler
This is to see the flow within the heart
How does the Small defect close?
Close by themselves
How does the Large defect close ?
Treatments for HF - surgically closing them
Diuretics, sometimes use inotropes like digoxin, ACE inhibitors to reduce afterload
What is Atrial Septal Defect?
30-50% of children with a congenital heart defect will have ASD.
Asymptomatic
Soft Systolic Ejection Murmur (Grade 2 to 3)
What is the Diagnosis of ASD?
Echo
What is the treatment of ASD?
If asymptomatic, wait till the child turns by 4-5 years of age, so that the surgery becomes easier
If symptomatic, treat the HF and then close it
What is Patent Ductus arteriosus ?
failure of the ductus arteriosus to close within the first 72 hours of life.
Why is the PDA present in Foetal life ?
When there is a higher pressure on the right side of the heart, therefore the blood flows from the pulmonary circulation into the systemic circulation.
When the baby is breathing air through the lungs, the pressure in the heart reverses but if the ductus stays open the flow of the blood reverses and goes from aorta back into the pulmonary circulation
PDA?
Acynotic as the mixed blood is going back to the lungs
if the defect is small, will close soon but if it’s large it can cause real problems such as poor growth, difficulty feeding, heart failure and a risk of endocarditis, and can get a resp infection
Where could you hear the PDA murmur?
grade 1 to 4/6 continuous
Machinery murmur
left infraclavicular area or upper left sternal border.
What investigation for PDA?
ECHO
cxr /ecg
What is the treatment of PDA? (asymptomatic) /if they’re well?
wait until 1 year for it to close, then regular ECHOs for spontaneous closure
Closure usually via cardiac catheterisation
What is the treatment of PDA for symptomatic ?
For Premature infants - ibuprofen or paracetamol
For Term infants - cardiac cath or surgery
meds works well in premature infants
Eisenmenger syndrome ?
Becomes Cyanotic
becuase it Cause reversible Vascular injury - which would make the right side of the heart to have more pressure than the left (hypertrophy on the right side of the heart) this will increase the pressure on right side of the heart even more pressure than the left side which will cause the shunt to reverse , then the child will become cyanotic as the blood is not delivered to the lungs but delivered to the body and the child will become hypoxic.
