what causes a Left to right shunt and presentation?
breathless, VSD, ASD, PDA
what causes a right to left shunt and presentation?
BLUE. tetralogy of Fallot, transposition of the great arteries.
what causes a common mixing with breathless and blue
atrioventricular septal defect
what causes outflow obstruction in a well child- asymptomatic with a murmur
pulmonary or aortic stenosis
what causes outflow obstruction in a sick neonate presenting with collapse and shock
coarctation of the aorta
what causes the flap of foramen ovale to close
change in pressure- left atrial pressure increases and resistance to pulmonary flow decreases so increase of blood through lungs increases by 6 times
how is congenital heart disease found (presentation)
antenatal cardiac diagnosis, detection of a murmur, cyanosis, shock, heart failure
what are the signs of an innocent murmur
asymptomatic, soft blowing murmur, systolic, left sternal edge. and normal heart sounds, no parasternal thrill, no radiation
what is the presentation of heart failure
breathless, sweaty, poor feeding, chest infections. faltering growth, tachypnoea, tachycardia, murmur (gallop), enlarged hart, hepatomegaly, cool peripheries
causes of heart failure
neonates- obstruction to left heart; infants- L->R shunt; older children- Eisenmenger, cardiomyopathy
what causes cyanosis in the newborn
cardiac- cyanotic congenital heart disease; resp- surfactant deficiency, meconium aspiration; persistent hypertension of the newborn; infection- septicaemia; metabolic acidosis and shock
diagnosis congenital heart disease
ECHO, doppler, ECG, chest radiograph
causes of congenital heart disease
maternal- diabetes mellitus, rubella, SLE; maternal drugs- warfarin, fetal alcohol syndrome; chromosomal abnormalities- downs, pataus, edwards etc
what is the most common type of ASD
ostium secundum
what is the less common type of ASD
partial atrioventricular septal defect- ostium primum
what murmur is heard in both types of ASD
secundum- ejection systolic, primum- pansystolic
how does ASD present
commonly no symptoms, recurrent chest infections/wheeze, arrhytmias
what does the ECG show in ASD
secundum- RBBB and RAD, primum- deflected QRS in AVF
what are the signs in ASD
ejection systolic (secundum), split S2 due to the right ventricular volume being the same in inspiration and expiration, pansystolic (primum)
management in ASD
secundum- cardiac catherisation and occlusion device. primum- surgery. do it by age 3-5 years
what is there a problem with in ostium secundum
foramen ovale
what does CXR show in ASD
cardiomegaly, enlarged pulmonary artery, increased pulmonary vasculature markings
what size is a small VSD
smaller than aorta- less than 3mm
symptoms of small VSD
asymptomatic, loud pansystolic murmur, quiet pulmomnary second sound
management of small VSD
close spontaneously
what size is a large VSD
same or bigger than aorta
symptoms of large VSD
heart failure- breathless and failure to thrive; recurrent chest infections; tachypnoea, tachycardia, hepatomegaly; SOFT pansystolic murmur, loud P2
CXR signs on large VSD
cardiomegaly, enlarged pulmonary arteries, increased pulmonary vasculature markings, pulmonary oedema
what is a complication of large VSD
pulmonary hypertension, L to R shunt
treatment of large VSD
diuretics, surgery at 3-6m to prevent Eisenmengers
what is PDA
where the ductus arteriosus fails to close by 1 month
when is PDA common
in pre term infants
where is the defect in PDA
between the aorta and pulmonary artery, the blood flows from aorta into pulmonary artery so causing L-R shunt
signs in PDA
continuous murmur beneath the left clavicle, collapsing/bounding pulse
management PDA
close by coil or occlusion device by 1 year
what happens to left ventricle in large left to right shunt
LVH
what are the four problems in T of F
overriding aorta, large VSD, pulmonary stenosis, RVH
what happens in transposition of the great arteries
aorta is connected to the right ventricle, pulmonary artery is connected to the left ventricle so blue blood goes to the body and pink blood goes back to the lungs
when is transposition compatible with life
when there is some mixing- ASD, VSD,PDA
symptoms transposition
cyanosis, usually presents day 2 when ductus arteriosus closes and leads to marked reduction in mixing of the blood, usually no murmur but may be a systolic murmur
CXR in transposition
egg on side appearance
management transposition
maintain patency of DA with prostaglandin. balloon atrial septostomy. surgery- transect pulmonary artery and aorta and switch them over
what is Eisenmengers
high pulmonary blood flow and pulmonary hypertension due to large L to R shunt. leads to increased resistance and shunt reversal and the child is blue
where is complete atrioventricular septal defect seen
children with Downs
what are the features of complete atrioventricular septal defect
cyanosis at birth, breathless at 2-3 weeks of life
what is the most common arrhythmia in childhood
SVT rapid HR of 250-300bpm
what does SVT lead to and how does it present
leads to poor cardiac output and pulmonary oedema. presents with heart failure symptoms in neonates and young infants and hydrops fetalis and intrauterine death.
why is SVT called re rentry tachycardia
circuit of conduction set up, premature activation of atrium via the accessory pathway
what is the treatment in SVT
IV adenosine bolus- induces atrioventricular block. electrical cardioversion if this is unsuccessful
mainenance therapy in SVT
fleicanide or sotalol. treatment stops at 1 year as more children wont have any further attacks
signs of venous hum
continuous low pitched rumble beneath clavicle, increases on inspiration and louder after exercise, disappears when lying flat or compression of jugular veins on ipsilateral side
