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Congenital heart defects Flashcards

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1
Q

Murmur associated with PDA

A

Continuous ‘machinery’ murmur
Crescendo-descrendo

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2
Q

Give 4 other features of a PDA

A

-Left subclavicular thrill
-Large volume, bounding, collapsing pulse
-Wide pulse pressure
-Heaving apex beat

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3
Q

give 3 RF for PDA

A

-Premature
-Maternal rubella in first trimester
-Born at high altitude

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4
Q

what is a PDA

A

Connection between pulmonary artery and aorta

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5
Q

Give 4 signs of PDA

A

SOB
Difficulty feeding
Poor weight gain
LRTI

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6
Q

How is PDA managed ?

A

-Indomethacin/ibuprofen can be given as a neonate to inhibit prostaglandin synthesis
-Monitor to 1 year - trans-catheter or surgical closure if it looks like it won’t close on its own

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7
Q

what is the most common type of ASD

A

Ostium secundum

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8
Q

What is seen on ECG in on ostium secundum ASD

A

RBBB with RAD

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9
Q

What is seen on ECG in an ostium primum ASD

A

RBBB with LAD, prolonged PR interval

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10
Q

Give 4 complications of an ASD

A

-Eisenmenger syndrome
-Stroke in the context of a VTE
-AF or atrial flutter
-Pulmonary HTN and right sided heart failure

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11
Q

What murmur is seen in ASD

A

-Mid systolic murmur crescendo-descendo loudest at upper left sternal border
-Fixed splitting of S2

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12
Q

what is the most common cause of congenital heart disease

A

VSD

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13
Q

What murmur is hear in a VSD

A

Pan systolic murmur heard at the left LOWER sternal border in the third and fourth intercostal space

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14
Q

what are people with a VSD at increased risk of ?

A

-Infective endocarditis

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15
Q

Give 3 causes of a pan systolic murmur

A

VSD
Mitral regurg
Tricuspid regurg

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16
Q

what is coarctation of the aorta

A

Congenital narrowing of the aorta

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17
Q

12 week old infant
Ejection systolic murmur
Sat on right arm : 99%
Sat on left foot : 90%

A

Coarctation of the aorta

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18
Q

How may coarctation of the aorta present in a neonate

A

-Neonate : weak femoral pulses , differing BP/O2 sats in arms and legs. Ejection sytstolic mumur

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19
Q

Where would the murmur be heard in coarctation of the aorta

A

Left infraclavicular area and below the left scapula

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20
Q

How would coarctation of the aorta present in infancy

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A

Infancy : heart failure -> tachypnoea, poor feeding, grey and floppy

21
Q

What additional signs may develop over time in coarctation of the aorta

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A

-Left ventricular heave
-Underdeveloped left arm in reduced subclavian artery blood flow
-Underdevelopment of the legs

22
Q

How is severe coarctation of the aorta managed

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A

Prostaglandin E to keep ductus arteriosus open while awaiting surgery

23
Q

What are the signs of more significant aortic valve stenosis

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A

Fatigue
SOB
Dizziness
Fainting

All worse on exertion

24
Q

what murmur is heard on aortic valve stenosis

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A

Ejection systolic
Loudest at second intercostal space, right sternal border
Crescendo decrescendo
Radiates to carotids

25
What are 4 other signs of aortic valve stenosis
Ejection click before murmur Palpable thrill in systole Slow rising pulse Narrow pulse pressure
26
How can aortic valve stenosis be managed
Percutaneous balloon aortic valvuloplasty Surgical aortic valvotomy Valve replacement
27
Give 5 complications of aortic valve stenosis
Left ventricular outflow tract obstruction HF Ventricular arrhythmia Bacterial endocarditis Sudden death on exertion
28
Give 4 associations with pulmonary valve stenosis
TOF Williams Noonan's Congenital rubella syndrome
29
what murmur is heard in pulmonary valve stenosis
Ejection systolic : second intercostal space left sternal border
30
What are 3 other signs of pulmonary valve stenosis
Palpable thrill in pulmonary area Right ventricular heave Raised JVP with giant a waves
31
How is mild pulmonary valve stenosis managed
'watching and waiting'
32
How is symptomatic pulmonary valve stenosis managed
-> Balloon valvuloplasty
33
what 4 things make up the TOF
-> Pulmonary valve stenosis -> Overriding aorta -> Right ventricular hypertrophy -> VSD
34
What determines the severity of TOF
- Degree of pulmonary valve stenosis - The greater it is, the greater the resistance and more blood is pumped through the right -> left shunt -> cyanosis
35
Give 4 RF for TOF
Rubella infection Increased maternal age Alcohol in pregnancy Diabetic mother
36
what would a chest x ray show in TOF
Boot shaped heart -> right ventricular thickening
37
what murmur is heard in TOF
Ejection systolic Left 2nd intercostal space Due to pulmonary value stenosis
38
Give 5 signs of TOF
Tet spells Cyanosis Clubbing Poor feeding Poor weight gain
39
what are tet spells
- Intermittent cyanotic episode when a child is exerting themselves (e.g. crying,exercise) -Tacynpnoea
40
How is conservative management of a tet spells
Children - squat Babies -position knees to chest
41
How can TOF be managed in neonates ?
Prostaglandin infusion to maintain ductus arteriosus
42
What medication can be used in cyanotic episodes in TOF
BB
43
what can be used in transposition of the great arteries to maintain until surgery
-> Prostaglandin : maintain ductus arteriosus -> Balloon septostomy to create a large ASD through the foramen ovale
44
what is the definite management of transposition of the great arteries
Open heart surgery
45
what is ebstein's anomaly
Tricuspid valve is set lower than the right
46
what can cause ebetein's anomaly
Lithium in-utero
47
What is associated with ebstein's anomaly
Wolff-Parkinson White syndrome PFO or ASD
48
Give 5 features of ebstein's anomaly
Cyanosis Prominent 'a' wave in JVP Hepatomegaly Tricuspid regurg -> pansystolic murmur RBBB -> widely split S1 and S2
49
- X-linked recessive - progressive proximal muscle weakness from 5 yrs - calf psuedohypertrophy gower's sign : use arms to stand up from squatted position - Raised creatining kinase
duchenne muscular dystrophy

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