Presentations of cardiac disorders

Question 1

What circulatory changes occur at birth?

Answer 1

In a fetus left atrial pressure is low
Blood is shunted from the left atrium to the right atrium, the right atrium maintains a high pressure as it receives all systemic venous circulation.
With the first breaths, volume of blood through the lungs increases x6 and pulmonary blood flow resistance falls leading to increased pressure. The formaen ovale closes.
The ductus arteriosum (connects the pulnary artery and aorta) closes after a few hours/days

Question 2

How does congenital heart disease present?

Answer 2

antenatal cardiac ultrasound diagnoses
heart murmurs
cyanosis
heart failure
shock

Question 3

What is the difference between a normal heart murmur and innocent heart murmur?

Answer 3

An innocent heart murmur occurs from turbulent flow in the outflow tracts or great vessels on either side of the heart

Question 4

What are the two types of innocent heart murmurs?

Answer 4

Ejection- generated in the ventricle, outflow tracts or great vessels on either side by turbulent flow. There is no structural abnormality
Venous hum- occurs from turbulent flow in the head or neck veins. It is a continuous low pitch rumble heard beneath the clavicles. Increases with inspiration, louder after exercise, disappears after lying flat and compressing jugular vein

Question 5

what are the hallmarks of an innocent ejection murmur?

Answer 5

local to left sternal edge
soft blowing systolic murmur (right) or short buzzing (left side)
no diastolic component
no parasternal thrill
no radiation
asymptomatic patient
normal heart sounds with no additional sounds

Question 6

5 S’s of innocent murmurs

Answer 6

innoSent
Soft
Systolic
aSymptomatic
left Sternal edge

Question 7

What are the causes of cardiac cyanosis?

Answer 7

reduced pulmonary blood flow: infants can become severely cyanosed when the ductus arteriosus closes after birth if they have duct dependent circulation

Abnormal mixing of systemic venous and pulnoary venous blood

Question 8

What are the causes of heart failure? i.e. differentials

Answer 8

neonates: obstructed systemic circulation
-hypoplastic left heart syndrome
-critical aortic valve stenosis
-severe coarctation of the aorta
-interruption of the aortic arch
Infants:
-VSD
-ASD
-large persistent ductus arteriosus

Question 9

What are the symptoms of heart failure?

Answer 9

breathlessness
sweating
poor feeding
recurrent chest infections

Question 10

What are the signs of heart failure?

Answer 10

failure to thrive
tachypnoea
tachycardia
heart murmur, gallop rhythm
enlarged heart
hepatomegaly
cool peripheries

Question 11

Heart failure in neonatal period

Answer 11

usually left heart obstruction e.g. coarctation

duct dependent: closure can lead to acidosis, collapse and death

Question 12

Heart failure beyond neonates

Answer 12

usually progressive due to left to right shunts
symptoms increase up to about 3 months, they may improve if pulmonary vascular resistance rises
Eisenmengers syndrome: irreversibly raised pulmonary vascular resistance

Question 13

How are congenital heart defects diagnosed?

Answer 13

X ray- does not exclude CHD
ECG- does not exclude CHD
echocardiography plus doppler- most useful