Paeds revision lecture cardio Flashcards
History of murmur
- Known murmur?
- Previous investigations
- Red flags: FFT, breathlessness on exertion
Innocent murmur
Systolic
Soft (or musical)
Localised with no radiation
Alter with changes in position & respiration
No underlying cardiac abnormality
2 most common types of murmur
flow murmur
- HR ↑ = turbulence of blood flow
- Left sternal edge
Venous hum
- blood from jugular veins → heart
- makes hum
- near clavicle
Mgmt of innocent murmur
No investigation
Follow up in GP when child is well to review murmur
ECHO if any doubt or red flags
Patent Ductus Arteriosus - when should close and risk
Usually closes 1-2 days of life:
Risk factors: prematurity Downs Female Congenital rubella Maternal valproate exposure
CF
Small → asymptomatic
Large → FFT & recurrent LRTI in childhood
• Continuous machine murmur in intraclavicular area and L sternal edge
• Associated with bounding pulses
Mgmt
Preterm: ibuprofen, indomethacin
HF: diuretics
Surgical ligation
Asymptomatic: Regular ECHO review & catheter closer if still patent at 1 year
Co-arctation of the aorta
Narrowing of aortic arch
Usually distal to left subclavian artery
Results in hypertension in upper limbs but poor femoral pulses + risk of renal failure
Risk of ventricular hypertrophy + HF
Risk
Males
Turners
+ve family Hx
Inv co-arc
Investigation CXR: notch ECG: LVH ECHO U+E: renal complications MRI Cardiac catheter
Mgmt co-arc
Neonates: prostaglandins (keep duct open)
HF: Diueretics
Hypertension: anti-h
→ surgical repair
VSD
Risk
Most common form of congenital heart disease
1 + defect in septim
Most perimembranous
Trisomies
Maternal diabetes
Turners
FAS
CF
Presentation depends on:
- size of VSD
- R/L ventricular hypertensions
Small- asymptomatic, murmur on examination - pan systolic, loudest LSE
Moderate: SOB on feeding 5-6 weeks, ↑ WOB, poor weight gain
Large: as above + pulmonary hypertension & cynosis - once shunt reverses direction it is irreverisl
Invs VSD
ECHO
Mgmt VSD
Small close themselves < 2yrs
Symptomatic
medical: diuretics + high calorie feed
Surgical: open-heart surgery or catheter closure
Congenital rubella
Downs
PDA + small heads
Tetrolgy, ASD, AVSD
