Paeds Written - CARDIO Flashcards
How can Acyanotic defect cause cyanosis?
Cause pulmonnary HTN
If pulmonary pressure > systemic pressure –> reversal of blood flow ‘Eisenmenger syndrome’
Causes cyanosis
How does cyanosis occur in cyanotic heart defects?
Deoxygenated blood bypasses lungs & returns to body
Cyanotic heart conditions
Tetralogy of Fallot
Transposition of great vessels/arteries
Tricuspid atresia
(+ Truncus arteriosus, Total anomalous pulmonary venous return, Hypoplastic left heart)
Acyanotic heart conditions
Ventricular septal defect
Atrial septal defect
Patient ductus arteriosus
Coarctation (of aorta)
Aortic stenosis
Qualities of innocent murmurs
Soft blowing - pulmonary area Short buzzing - aortic area Vary with posture No radiation No diastolic component No thrill No added heart sounds Asymptomatic
What is Still’s murmur?
Innocent murmur
low pitched sound
heart at lower left sternal edge
Pathophysiology of PDA
Failure of ductus arteriosus to close as normal with first breaths
Remains patent –> too much blood delivered to lungs
Risk factors for PDA
Premature
Birth at high altitude
Maternal rubella (in 1st trimester)
Signs O/E with PDA
Left supraclavicular thrill? Continuous machinery murur Large volume bounding collapsing pulse Wide pulse pressure Heaving apex beat
Tx for PDA
Indomethacin or Ibuprofen 2nd line (or large duct) = open or keyhole surgery
EXCEPTION: if associated with another (duct-dependent) congenital cardiac defect, prostaglandin E1 given to keep open until after surgery
Main features of Tetralogy of Fallot
Ventricular septal defect
Right ventricular hypertrophy
Right ventricular outflow obstruction (pulmonary stenosis)
Overriding aorta
Associations with Tetralogy of Fallot
22q11.1 deletion syndrome (Di George)
Down’s syndrome
Presentation of Tetralogy of Fallot
Hypercyanotic ‘tet’ spells
- in 1st month of life
- may cause LOC
- Triggered by crying, breathing deeply/rapidly
Signs O/E in Tetralogy of Fallot
Mid systolic ejection murmur (from pulmonary stenosis)
Right parasternal heave (RV hypertrophy)
Ix findings in Tetralogy of Fallot
CXR –> boot shaped heart
ECG –> RV hypertrophy
Management of Tetralogy of Fallot
Prolonged hyper cyanotic spells:
- Propanolol
- Morphine
- Fluids
Definitive = surgical repair
- 2 stage repair if small pulmonary artery
Presentation of atrial septal defect
Mostly asymptomatic - many found in adulthood
SOB
Lethargy
Poor appetite & growth
Increases respiratory infections
Signs O/E in Atrial Septal Defect
Ejection systolic murmur over pulmonary area
Fixed (wide) splitting of 2nd heart sound
Signs O/E in ventricular septal defect
Mild = none
Larger: Holosystolic (pansystolic) murmur at lower left sternal edge Palpable thrill Mid-diastolic low pitched rumble at apex Parasternal heave Displaced apex beat
Signs of Heart failure
- peripheral oedema
- ascites
Complications/risks in child with VSD
Infective endocarditis
Pulmonary HTN
Aneurysm of ventricular septum