Cardiology Flashcards
(51 cards)
What is the most common cardiological problem / presenting feature in children?
A MURMUR
Are most murmurs concerning?
Most murmurs are completely innocent (30% of children will have an innocent murmer at some point)
What percentage of children will have an innocent murmur at some point during their childhood?
30% of children will have an innocent murmer at some point in their life
What are some features that will make a murmur REASSURING?
THE S FACTORS
- Systolic (commonly ejection systolic) - no diastolic murmur present
- Soft, blowing murmur
- aSymptomatic patient
- Left Sternal edge
***these are all factors that would reassure you to a murmur being innocent
Extra re-assuring factors:
- Normal heart sounds with no added sounds
- No parasternal thrill
- No radiation
What are some causes of innocent murmurs?
Mostly the murmurs are idiopathic and we don’t identify a cause. Organic causes include:
- FEBRILE ILLNESS
- ANAEMIA
***Any disease process that might mean that the cardiac output is increased could theoretically lead to the development of a murmur
What should you do if you hear a murmur?
Describe: Site Character (e.g. harsh, soft, blowing) Radiation Intensity Pitch Timing
-refer to PAEDIATRIC CARDIOLOGY if parents are concerned or worrying features
How do we investigate murmurs to rule out pathology?
Echocardiogram - gold standard
ECG
CXR
What are the four cardinal features of TOF?
PROV:
- Pulmonary stenosis (ejection systolic murmur)
- RVH (right side has to work harder because of stenosis)
- Overridng aorta (the aorta sits in front of the VSD-picking up blue blood from right side of heart)
- VSD (mix of red and blue blood)
How is TOF identified?
- Nowadays usually antenatally or following identification of a murmur in the first 2 months
- If not there might be severe CYANOSIS in the first few days of life
What symptomatic features of TOF can you see?
Severe CYANOSIS and breathlessness and pallor
worsened by: exercise/crying
relieved by: squatting
-Important to be able to identify the cyanotic spells as they may lead to an MI if not treated properly
What signs might you find o/e in TOF?
- Might find soft murmur during tet spell
- May have clubbing
- LOUD, HARSH EJECTION SYSTOLIC MURMUR at Left sternal edge
What investigations should you do if suspecting TOF?
CXR -uptilted apex (boot shaped-pulmonary artery bay)
ECG-might show RVH in older child
Echo -cardinaly features
How should a tet spell be managed?
Usually limited and followed by sleep. If 15mins+:
- oxygen
- sedation and pain relief (morphine)
- IV propanolol - perisperhal vasoconstrictor
- IV fluids
- Bicarbonate to correct respiratory acidosis
When will definitive surgery for TOF be offered and what will it involve?
-At 6 MONTHS
○ Close the VSD
○Pulmonary valve replacement
A surgery can be offered in the neonatal period as well in severe cyanotic cases - SHUNT between the subclavian and pulmonary arteries to improve blood flow to the lungs
What is transposition of the great arteries (TGA)?
- When the pulmonary artery connects to the LV and the aorta to the RV
- 2 closed circulations (red>red, blue>blue)
- INCOMPATIBLE WITH LIFE UNLESS there is a defect that stays open (VSD)
How and when does TGA present?
- Profound cyanosis
- Usually presents around day 2 of life when ductus arteriosus starts to close
What clinical signs might we be able to hear on TGA?
- Second heart sound often loud and single
- Usually no murmur but might be one associated with increased pressure through pulmonary artery (smaller than aorta)
What three investigations should be done for TGA?
CXR, Echo (anatomy) and ECG (usually normal)
What will the CXR show in TGA?
- Egg on its side
- There might also be some signs of pulmonary oedema due to the increased pressures through the pulmonary system
What is the initial management for TGA and what is the definitive management?
- Initial management is to preserve blood mixing and so PROSTAGLANDINS are given to keep the ducts arteriosis patent
- Sometimes a BALLOON ATRIAL SEPTOSOTOMY may be needed - rupture the foramen oval to improve blood mixing
- The definitive treatment - an operation to switch the arteries then ideally occurs in the second week of life
What are the two types of atrial septal defect?
Secundum (80%)
Primum / AVSD (Downs syndrome-involves AV valves)
What condition is assosiated with ASD?
Fetal alcohol syndrome
Downs syndrome
How are atrial septal defects detected clinically?
- Often ASx (sometimes chest infections, or arrhythmias in later life)
- Detected when a murmur is heard on routine examination (think about mum)
What will the murmur with a ASD sound like?
- Ejection systolic and at the upper left sternal edge (due to increased blood flow across the pulmonary valve due to L-R shunt-all the red blood taking another trip to lungs)
- Fixed and widely split second heart sound (increased volume in right side
