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What is the ductus arteriosus?

Connects the pulmonary artery to the aorta so that blood doesn't flow to the lungs, closes within first few hours or days


What % of congenital heart defects are picked up antenatally? And when?

70% at 18-20 week anomaly scan


What is the most common presentation of congenital heart disease - complication of presentation?

A heart murmur - however 30% of children will have an innocent murmur at some point which is present in a normal heart


What are the hallmarks of an innocent ejection murmur?

4 s's
aSymptomatic patient
Soft blowing murmur
Systolic murmur only - not diastolic
left Sternal edge - no radiation
Also - normal heart sounds with no added sounds and no parasternal thrill


What can be causes of innocent murmur

Anaemia or febrile illness due to increased cardiac output


Main cause of heart failure in first week of life

Coarctation of the aorta


What can be important in maintaining arterial perfusion in coarctation of the aorta

Right to left flow of blood via the arterial duct = duct dependant systemic circulation
If the duct closes then severe acidosis, collapse and death


Main cause of heart failure after first week of life - mechanism and symptoms (when?)

Left to right shunt. As weeks go on, pulmonary vascular resistance falls, progressive increase in left to right shunt and increase pulmonary blood flow
Causes pulmonary oedema and breathlessness - about 3 months of life


What will happen if left to right shunt goes untreated

Children will develop Eisenmenger syndrome - irreversibly raised pulmonary vascular resistance as resistance rises in response to the left right shunt
Shunt is now from right to left due to raised pulmonary pressure and TEENAGER is blue


Treatment of Eisenmenger syndrome

Only really heart lung transplant - medication is available to palliate symptoms


Causes of neonatal heart failure other than coarctation of the aorta x3

Hypoplastic left heart syndrome
Critical aortic valve stenosis
Interruption of the aortic arch


Causes of heart failure in infants

Due to high pulmonary flow therefore ventricular septal defect, atrioventricular septal defect and large persistent ductus arteriosus


Causes of heart failure in older children

Rheumatic heart disease and cardiomyopathy


When can peripheral cyanosis occur? X3

If child is cold, unwell from any cause or due to polycytheamia


When does central cyanosis occur? What level of reduction needs to be present for its identification

Due to fall in arterial blood oxygen tension
Can only be recognised if concentration of reduced haemoglobin in blood exceeds 5g/dl
Therefore less pronounced if child is anaemic


What is persistent cyanosis in an otherwise well child a sign of?

Structural heart disease


Presentation of right to left shunt symptom wise

Blue child


Presentation of left to right shunt symptom wise

Breathlessness or asymptomatic


3 causes of left to right shunt

ASD, VSD, or persistent ductus arteriosus


Two types of ASD and incidence

Secundum ASD (80%)
Partial atrioventricular septal defect


What is Secundum ASD

Defect in centre of atria where foramen ovale is


What is partial AVSD?

Defect of AV septum involving atrial septum and av valves
Also 3 leaflet defect in left av valve with regurgitant leak


Symptoms of ASD

Asymptomatic or recurrent lung infections/wheeze
Arrhythmias from 4th decade onward


Physical signs of ASD on auscultation

Ejection systolic murmur best heard at left Sternal edge because increase blood flow over pulmonary valve


Physical sign of partial AVSD on auscultation

Apical pan systolic murmur due to regurgitation through AV valve


Signs of ASD and AVSD on chest X-ray x3

Cardiomegaly, increased pulmonary vascular markings, enlarged pulmonary arteries


ECG signs with Secundum ASD

Partial right bundle branch block is common
Right axis deviation due to right ventricle enlargement


ECG in partial AVSD

Superior QRS complex - mainly negative in avF - because defect is near av node therefore displaced node conducts to the ventricles superiorly


Management of Secundum ASD

Cardiac catheterisation with insertion of occlusion device usually done 3-5 years of age


Management of partial AVSD

Surgical correction. - usually done 3 years of age