Year 4 Cardiology Flashcards
what is a heave?
force pushes flat hand off the chest
what is a thrill?
palpable murmur
what is acrocyanosis?
hands and feet are blue
perioral blueness indicates peripheral cyanosis
what is intermittent central cyanosis a sign of?
tetralogy of Fallot
characteristics of murmurs?
timing location intensity radiation quality positional change
how is intensity of a murmur graded?
1-6
acyanotic heart disease causes
VSD ASD PDA pulmonary stenosis coarctation aortic stenosis
cyanotic heart disease causes
tetralogy of fallot
transposition of great arteries
pansystolic murmur causes
mitral regurgitation
tricuspid regurgitation
VSD
ejection systolic murmur causes
aortic stenosis
pulmonary stenosis
HOCM
what is an ASD?
hole between the left and right atria
what does an ASD cause?
oxygenated blood shunts from the left atrium into the right which causes enlargement of the atria, pulmonary artery and RV
classification of ASD
- secundum= middle of the wall
2. primum= lower part of the septum
ASD murmur presentation
EJECTION SYSTOLIC with FIXED SPLIT of 2nd HS
ASD presentation
recurrent resp infections fatigue post feed failure to thrive SOB syncope fatigue
diagnosis of ASD
ECG
CXR
ECHO is diagnostic
management of ASD
surgery
pulmonary vasodilators
complications of ASD
AF atrial flutter pulmonary hypertension right heart failure Eisenmenger
what is Eisenmenger’s syndrome
pulmonary pressure increases beyond systemic pressure so blood flows from right > left
why should Eisenmenger’s be avoided in pregnancy?
develops faster
what is a VSD?
interruption between interventricular septum
presentation of VSD
4-6 weeks with increased sweating (during feeding), failure to thrive, fatigue after feed and recurrent resp
murmur in VSD
pansystolic murmur in LLSE and diastolic murmur in mitral area
what does VSD have increased risk of?
IE so give prophylactic antibiotics in surgery
what is a complete AVSD?
hole between all 4 chambers of the heart (common valve due to failure to differentiate)
what is partial AVSD
both valves are usually present but one does not work
murmur AVSD
holosystolic murmur at LLSE and mid-diastolic rumble
what conditions are associated with AVSD?
T21
heterotaxy syndrome
Kartagner’s
what happens as a consequence of Eisenmenger’s sydnrome?
polycythaemia causing plethoric complexion and increased risk of thrombus formation
management in Eisenmenger’s
heart-lung transplant sildenaful for pulmonary hypertension venesection anticoagulation antibiotics
management of coarctation of the aorta
surgical repair
prostaglandin E to keep duct open
balloon dilation +/- stenting
four features in tetralogy of Fallot
overriding aorta (blood from right and left ventricles)
VSD
RV hypertrophy
pulmonary stenosis
what conditions is tetralogy of Fallot associated with?
T21
T18
T13
22q11 (DiGeorge)
presentation of tetralogy of Fallot
cyanosis
poor feeding
failure to thrive
tets spell
what is a tets spell?
sudden cyanosis as more blood goes right than left
what can precipitate a tets spell?
walking
physical exertion
crying
murmur in tetralogy of Fallot
ejection systolic 2nd left sternal border due to pulmonary stenosis
CXR of tetralogy of Fallot
boot heart
management of tets spell
squat/ bend babies legs to increase systemic vascular resistance morphine beta blockers adrenaline IV fluids oxygen
management of tetralogy of fallot
total surgical repair at 6 months
CXR in transposition of the great arteries
egg on side appearance of the heart
what is Ebstein’s anomaly?
congenital heart condition where the tricuspid valve is set lower in the right side of the heart causing a bigger RA and small RV leading to poor flow to the pulmonary vessels
presentation of Ebstein’s anomaly
gallop rhythm
cyanosis
SOB
PDA murmur
continuous crescendo-decrescendo machinery murmur
wide pulse pressure
bounding pulse
murmur between clavicles
how long is PDA monitored?
first year of life
management of PDA
fluid restriction
ibuprofen
indomethacin
surgery
what is Kawasaki’s disease?
type 2 hypersensitivity reaction that can affect the coronary arteries causing aneurysms
presentation of Kawasaki’s
high temp maculopapular rash (blanches) conjunctivitis strawberry tongue cracked lips lymphadenopathy desquamation of hands and feet
management of Kawasaki’s
immunoglobulin
high dose aspirin
why is aspirin normally avoided in children?
risk of Reye syndrome
diagnosis of Kawasaki’s
serial echos for coronary artery aneurysms
major criteria for rheumatic fever
carditis fever polyarthritis erythema marginatum sydenham's chorea subcutaneous nodules
management of rheumatic fever
penicillin
