Pathophys and Clinical Pres of Heart Murmurs Flashcards
Aortic stenosis
crescendo decrescendo murmur after S1 and after an atrial kick
results from a stenotic aorta
Mitral regurgitation
mitral valve does not close during systole
holosystolic murmur after s1
aortic regurgitation
aortic valve does not close during
diastolic decrescendo murmur
mitral stenosis
follows opening snap during diastole
late diastolic murmur
secundum asd
most common asd
deficiency or perforation of septum primum
rarely signficant in infancy, but gets more symptomatic with age
L to right shunt–> right heart volume overload
wide fixed splitting of second heart sound
systolic ejection (crescendo-decrescendo) due to inc pulmonic flow
primum ASD
failure of fusion of septum primum to endocardial cushions
partial fusion of superior and inferior cushions with cleft in anterior mitral valve leaflet
holosystolic murmur with mitral regurg, otherwise similar presentation to secundum asd
sinus venosus asd
anomalous drainage of one or more right pulmonary veins- draining into right heart instead of left
presentation same as secundum asd
complete atrioventricular canal
lack of fusion of superior and inferior endocardial cushions
primum asd, inlet vsd , common av valve
infants present with chf symptoms- tachycardia, tachypnea, poor feeding, failure to thrive
loud s2, systolic ejection murmur at left sternal border due to inc pulmonic flow, holosystolic murmur due to av valve regurg if significant
surgical repair within 3-6 mos
vsd
31% of chd
depends on size of defect
tachypnea, feeding difficulties, failure to thrive, pulmonary htn
left to right shunt, so kids will not be cyanotic
vsd large defect m
large defect- systolic ejection murmur at left sternal border, mid diastolic murmur at apex
vsd restrictive defect
holosystolic murmur at left sternal border
pda
ductus arteriosus typically closes few days after birth due to inc oxygen tension after birth and removal of placental prostaglandin
pda is common in preterm infants
associated with rubella exposure in 1st trimester
moderate to large pda
chf, failure to thrive
wide pulse pressure, bounding pulses, continuous machine like murmur
untreated- rapid development of pulmonary vascular disease and pulmonary htn
tx- surgical ligation for large defects, transcatheter device placement with small defects
conotruncal formation
lefward shift of conotruncus to override muscular septum
septation of contruncus (persistent truncus arteriosus)
spiraling of outflow tracts (transposition of great arteries, tetralogy of fallot)
double outlet right ventricle
failure of leftward shift of conotruncus
aorta and pulm artery arise from right ventricle
vsd may be present
tetralogy of fallot
incomplete shifting of conotruncus results in anterior deviation of conotruncal septum and aorta overriding ventricular septum
pulmonary stenosis
thickened rv wall (right to left shunt)
vsd
aorta overrides septal defect
tetralogy of fallot presentation
harsh long systolic ejection murmur radiating to both axillae and back
cyanosis dependent on severity
hypercyanotic spells can result from obstruction from muscle in right ventricular outflow tract
transposition of great arteries
failure of spiraling of great vessels resulting in discordant ventriculo-arterial connection
severe cyanosis is present, survival dependent on patency of foramen ovale and ductus arteriosus to allow mixing of oxygenated and deoxygenated blood
transposition of great arteries tx
prostin infusion, balloon atrial septostomy followed by surgical repair
truncus arteriosus
failure of septation of truncus resulting in common arterial trunk exiting heart
large vsd, normal av connections
infants have severe chf
surgery required
coarctation of aorta
narrowing of aorta
high blood pressure in arms, low in legs leg pain, cramping tiring easily systolic murmur at right upper sternal border diminished femoral pulses lvh
