Paediatric Cardiology Lecture Flashcards
(24 cards)
Saturations R side heart
73%
R vs L side heart
R:
* Low resistance
* Low pressure
* Low sats - blue
L:
* High resistance
* High pressure
* Red blood
Cause of congenital heart disease
- Genetics - eg trisomy (down syndrome, 13 and 18), cardiomyopathy gene, DiGeorge syndrome (22q11)
- Environment - teratogens eg lithium, alcohol, drugs
- Chance
Trisomy 21 heart defect that is common
- AVSD
Acyanotic heart disease
- Left to right shunts - ASD, VSD, PDA
- Obstructive lesions - aortic stenosis, pulmonary stenosis, coarctation of aorta, mitral stenosis
Cyanotic congenital heart disease
- Tetralogy of fallot
- Transposition of great arteries
- Total anomalous pulmonary venous drainage
- Univentricular heart
Haemodynamic effects of left to right shunt
- Overcirculation to lungs - too much blood (heart failure in children)
- = pulmonary oedema, hepatomegaly, tachypnoeic, vomitting, stop feeding
Management to overcirculation to lungs
- Diuretics
- ACEi
- Surgically - can fix hole with device via atria
When does left to right shunt present?
- 6 weeks post birth
- Pulmonary pressures are dropping and reach normal low levels by this time
- More blood going L to R
- = symptomatic
Haemodynamic effects of VSD
- Left to right shunt
- LV volume overload
- Pulmonary venous congestion
- Eventually pulmonary hypertension
What happens eventually after L to R ventricular shunt occurs for a while?
- Eventually switches direction
- Pulmonary vasculature narrows to make less blood go to lungs = pulmonary HTN
- When exceeds pressure of R, blood flows R to L = cyanotic
- = Eisenmengers syndrome
VSD below moderator band in RA or too small to operate
- Pulmonary artery bands - cause pulmonary stenosis
- = increases pressure on R side
- Protects lungs from these high pressures
Haemodynamic effects of ASDs
- Increased pulmonary blood flow
- RV volume overload
- Pulmonary hypertension is rare - lower flow
- Eventual right heart failure
Usually not cause problems until 50-60, in children, manage them at 5 yr
Murmur ventricular vs atria septal defect
- Ventricle = pansystolic murmur
- Atria = systolic murmur
- No murmur = large defect as no turbulant flow
Why does LV volume overload occur in ventricular septal defect but RV overload occur in atria septal defect?
Strongest valve
Mitral
Atrioventricular septal defects
- Present similar to VSD
- Abnormal AV valves
Patent ductus arteriorsus
- Pulmonary artery and aorta link
- Can manage in cath lab to close
Cause of aortic stenosis
Bicupsid aortic valve
Cause of coarctation of aorta
- PDA made of smooth muscle
- Prostaglandins reduce and duct closes
- Sometimes ductal tissue is around aorta
- Causes aorta to narrow severely
- If femoral pulses poorly felt in newly born baby (days old) start prostaglandins
Coarctation of aorta signs
- Radiofemoral delay - takes a while to reach collaterals
- Differences in blood pressure
- Differences in pre and post ductal sats
4 components of tetralogy of fallow
- Ventricular septal defect
- Overiding aorta
- Pulmonary stenosis
- Right ventricular hypertrophy
Cause of TOF
- Deviation of septum - moved upwards and towards head and to right???
