Cardiovascular Flashcards
(48 cards)
What are the most common congenital heart lesions?
Ventricular septal defect (30%) Persistent arterial duct (12%) Atrial septal defect (7%) Pulmonary stenosis (7%) Tetralogy of Fallot (5%) Transposition of the great arteries (5%) Aortic stenosis (5%) Coarctation of the aorta (5%) Atrioventricular septal defect (2%)
What are the circulatory changes at birth?
Cutting umbilical vessels -> increased systemic vascular resistance
Crying -> decreased pulmonary vascular resistance and increased pulmonary blood flow
Closure of ductus arteriosus, foramen ovale and ductus venosus
What affects the ductus arteriosus?
Closed by:
- oxygen
- bradykinin/indomethacin (COX inhibitor)
Opened by:
- hypoxia
- prematurity
- prostaglandin E2
What are causes of heart disease?
Genetic
- familial
- chromosomal - Trisomy 21 -> AVSD
- syndromes - CHARGE, DiGeorge, Marfans
Maternal factors
- IU infections - rubella -> PDA
- medication - lithium, valproate, isoretinoin
- diseases - maternal diabetes, SLE -> heart block
- drugs - FAS -> ASD or VSD
Metabolic diseases
- cardiomyopathies
Infections
Childhood diseases
- Kawasaki’s
How do children with heart defect present?
Antenatal scans Newborn period - when duct closes Heart murmur on check Heart failure Palpitations Collapsing Fever and unwell
What are the duct dependent lesions?
Coarctation of the aorta Transposition of the great arteries Pulmonary stenosis/atresia Aortic stenosis/atresia Hypoplastic left heart syndrome
KEEP THE DUCTUS ARTERIOSUS OPEN
How does heart failure present in children?
Poor feeding FTT Lethargy Sweating Hepatomegaly Tachypnoea without recession
Pallor/cyanosis Poor perfusion Tachycardia Murmur Thrill Gallop rhythm
What is an innocent murmur?
Asymptomatic patient
Soft blowing sound
Systolic
Left sternal edge with no radiation
Heard during febrile illness or anaemia due to increased cardiac output
What are causes of congenital heart disease
3 holes (left->right) - BREATHLESS or ASYMPTOMATIC
- VSD
- PDA
- ASD
3 blocked pipes
- coarctation of the aorta
- pulmonary stenosis
- aortic stenosis
3 BLUE babies (right->left)
- tetralogy of Fallot
- transposition of the great arteries
What is ventricular septal defect?
Commonest CHD
Blood flows from left -> right ventricle
Pansystolic
Loudest over LLSE (tricuspid area)
If large, may have heart failure and recurrent chest infections
What are the two types of ASD?
Secundum ASD (most common) - involes FO
Partial atrioventricular septal defect (AVSD) (primum) - involves atrioventricular valves
How does ASD present?
Asymptomatic
Recurrent chest infections/wheeze
Ejection systolic murmur ULSE with split 2nd heart sound
What investigations are done for ASD?
CXR
- cardiomegaly
- enlarged PA
ECG
- secundum ASD - partial right bundle branch block
- AVSD - defect at AV node so abnormal axis
How is ASD managed?
Cardiac catherisation
Surgery at 3-5 years
How are large VSDs investigated and managed?
CXR
- cardiomegaly
- enlarged PA
- pulmonary oedema
Diuretics and captopril
Surgery at 3-6 months - prevent permanent lung damage from pulmonary hypertension
What is PDA?
Failure of ductus arteriosis to close after 1 month
Blood flows from aorta to pulmonary artery
Normal in prems
How does a PDA present and how is it managed?
Continuous murmur beneath left clavicle
Collapsing pulse
Coil or occlusion device at 1 year to prevent bacterial endocarditis and pulmonary vascular disease
What is pulmonary stenosis?
Pulmonary valve leaflets are partly fused so exit from right ventricle is restricted
How does pulmonary stenosis present?
Most asymptomatic
If critical then duct dependent and cyanotic
Ejection systolic murmur at ULSE
What is aortic stenosis?
Aortic leaflets are partly fused so left ventricular exit is partly restricted
Associated with mitral valve stenosis and coarctation of the aorta
How does aortic stenosis present?
Asymptomatic
If severe - reduced exercise tolerance, chest pain, syncope
In neonates with critical AS and duct dependent circulation - SHOCK
Carotid thrill
Ejection systolic murmur URSE -> neck
How is aortic stenosis treated?
Balloon valvotomy
If severe, then aortic valve replacement
How does coarctation of the aorta present?
Asymptomatic
Systemic hypertension in right arm
Ejection systolic murmur at USE
Radio-femoral delay
What investigations are done for coarctation of the aorta?
CXR
- rib notching - development of large collateral intercostal arteries
- visible notch in aorta
ECG
- left ventricular hypertrophy
