Cardiology Flashcards by Hannah Falconer

What are the 8 commonest lesions that account for most congenital heart diseases?

Ventricular septal defect (VSD)
Patent ductus arteriosus (PDA)
Atrial septal defect (ASD)
Pulmonary stenosis
Aortic stenosis
Coarctation of the aorta
Transposition of great arteries
Tetralogy of Fallot

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What is the aetiology of most congenital heart diseases?

Genetic susceptibility

Teratogenic insult

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What are the environmental factors that might cause congenital heart diseases?

Drugs: alcohol, amphetamines, cocaine, ecstasy, phenytoin, lithium
Infections: TORCH
Maternal: DM, SLE

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What are the TORCH infections?

Toxoplasma
Rubella
CMV
Herpes

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30% of what have CHD?

Chromosomal abnormalities

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Which chromosomal abnormalities in particular can have CHD?

Trisomy 13, 18 and 21

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What is trisomy 21 particularly associated with?

AVSD

ASD and VSD more common

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Which CHD is Turner syndrome associated with?

Co-arctation of aorta

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Which CHD is Noonan syndrome associated with?

Pulmonary stenosis

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Which CHD is Williams syndrome associated with?

Supravalvular aortic stenosis

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What do you ask in a history about CHD?

Feeding, weight, development
Cyanosis
Tachypnoea, dyspnoea
Exercise tolerance
Chest pain
Syncope
Palpitation
Joint problems

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What should you examine a child with CHD?

Weight/height
Dysmorphic features
Cyanosis
Clubbing
Tachy-/dyspnoea
Pulses/apex (femoral)
Heart sounds
Murmurs

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What investigations would you do in a child with potential CHD?

BP
O2 sats, ABG
ECG
CXR
ECHO
Catheter
Angiography
MRI/A
Exercise testing

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What can the timing of murmurs be in the cardiac cycle?

Systole
Diastole
Continuous

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What can the duration of murmurs be?

Early/mid/late

Ejection/holo- or pan systolic

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What can the pitch/quality of murmurs be?

Harsh or mixed frequency (turbulence)
Soft or indeterminate
Vibratory/pure frequency (laminar flow)

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What percentage of innocent murmurs are innocent?

70-80%

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What are the 4 types of innocent murmurs?

Still’s murmur (LV outflow murmur)
Pulmonary outflow murmur
Carotid/brachiocephal IC arterial bruits
Venous Hum

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What are common features of innocent murmurs?

Systolic murmur (cont. venous hum)
No other signs cardiac disease
Soft murmur
Vibratory/musical
Localised
Varies with position, respiration, exercise

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What age does Still’s murmur usually present?

2-7yrs

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What are the characteristics of Still’s murmur?

Soft systolic, vibratory/musical

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Where is Still’s murmur heard best?

Apex, left sternal border

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When does Still’s murmur increase?

Respiration

With exercise

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What age does pulmonary outflow murmur usually present?

8-10yrs

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What are the characteristics of a pulmonary outflow murmur?

Soft systolic, vibratory

Where is a pulmonary outflow murmur heard best?

Upper left sternal border (ULSB) | Well localised, not radiating to back

When does a pulmonary outflow murmur increase?

Increases in supine position, with exercise

What kind of child does a pulmonary outflow murmur usually affect?

Narrow chested

What age does carotid/brachiocephal IC arterial bruits usually present?

2-10yrs

What are the characteristics of a carotid/brachiocephal IC arterial bruit?

1/6-2/6 systolic, harsh

Where is a carotid/brachiocephal IC arterial bruit heard best?

Supraclavicular | Radiates to neck

When does a carotid/brachiocephal IC arterial bruit increase?

Increases with exercise | Decreases on turning head or extending neck

What age does venous hum usually present?

3-8yrs

What are the characteristics of venous hum?

Soft, indistinct | Continuous murmur, sometimes with diastolic accentuation

Where is a venous hum heard best?

Supraclavicular

When can a venous hum be heard?

Only in upright position | Disappears on lying down/when turning head

What are the 3 main types of VSD?

Subaortic Perimembranous Muscular

What is the shunt in a VSD?

L to R shunt

What is the clinical presentation of VSD?

Pansystolic murmur lower left sternal edge | Sometimes thrill

What is the clinical presentation of a very small VSD?

Early systolic murmur

What is the clinical presentation of a very large VSD?

Diastolic rumble due to relative mitral stenosis

What is Eisenmenger syndrome?

Any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, reversal of flow, and cyanosis

How are VSD's closed?

Amplatzer occlusion device | Patch closure - open heart surgery

How are atrial septal defects sometimes detected in adulthood?

AF Heart failure Pulmonary hypertension

What are the clinical signs of atrial septal defects?

Few clinical signs | Usually spontaneous closure

What are the features of an atrial septal defect on auscultation?

Wide fixed splitting of 2nd heart sound | Pulmonary flow murmur

Which chromosomal abnormality is an atrioventricular-septal defect associated with?

Trisomy 21

What are the clinical signs of pulmonary stenosis?

Asymptomatic in mild stenosis | Moderate and severe: dyspnoea and fatigue

What are the features of pulmonary stenosis on auscultation?

Ejection systolic murmur, ULSB | Radiation to back

What is a balloon valvoplasty for?

Balloon valvuloplasty is a procedure to repair a heart valve that has a narrowed opening

What are the clinical features of aortic stenosis?

Mostly asymptomatic | Severe: reduced exercise tolerance, exertional chest pain, syncope

What are the features of aortic stenosis on auscultation?

Ejection systolic murmur URSB | Radiation into carotids

What are the changes in fatal circulation at birth?

``` Pulmonary vascular resistance falls Pulmonary blood flow rises Systemic vascular resistance increases Ductus arteriosus closes Foramen vale closes Ductus venosus closes ```

How is patent ductus arteriosus treated?

Fluid restriction/diuretics Prostaglandin inhibitors Surgical ligation

What is coarctation of the aorta?

Narrowing of the aorta

What are the investigations for coarctation of the aorta?

MRI (3D)

What are the options for management of coarctation of the aorta?

Re-open DA with prostaglandin Resection with end-to-end anastomosis Subclavian patch repaird Balloon aortoplasty

What is transposition the great arteries?

The two main blood vessels leaving the heart, the pulmonary artery and the aorta are swapped over

What are the surgical options for transposition of the great arteries?

Atrial septostomy | Switch procedure

What is Tetralogy of Fallot?

Defect affecting structure of heart, usually four: 1. Pulmonary stenosis 2. VSD 3. Right ventricular hypertrophy 4. Overriding aorta

How many defects are there normally in ToF?

What are the 4 defects normally seen in ToF?

1. Pulmonary stenosis 2. VSD 3. Right ventricular hypertrophy 4. Overriding aorta

What is the treatment for ToF?

Open heart surgery in first year of birth

What is a sign of ToF?

Blue-tinged skin

Cardiology Flashcards

(64 cards)