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Zero to finals- Cardio Flashcards

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1
Q

What are the 3 foetal shunts?

A

Ductus venosus
Foramen ovale
Ductus arteriosus

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2
Q

What is the ductus venosus

A

Shunt connects umbiliacal vein to IVC and allows bypass of liver

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3
Q

What is the foramen ovale?

A

Shunt connects RA to LA and allows blood to bypass the RV and pulmonary circulation

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4
Q

What is the ductus arteriosus

A

Connects pulmonary artery with aorta and allows blood to bypass the pulmonary circulation

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5
Q

How does the foramen ovale close?

A

First breath baby takes expans alveoli. Decreases pulmonary vascular resistance
This decrease causes a fall in pressure in RA
At this point LA pressure is greater than RA which squashes atrial septum to cause functional closure of foramen ovale

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6
Q

What does the foramen ovale become?

A

Fossa ovalis

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7
Q

What keeps the ductus arteriosus open?

A

Prostaglandins

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8
Q

What causes the closure of the ductus arteriosus?

A

Increased blood oxygenation causes a drop in circulating prostaglands. This causes closure of the ductus arteriosus which becomes the ligamentum arteriosum

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9
Q

What does the ductus venosus become?

A

Ligamentum venosum

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10
Q

What are innocent murmurs also called? What are they caused by?

A

Flow murmurs

Fast blow flow through various areas of the heart during systole

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11
Q

What are the features of innocent murmurs?

A 
Soft
Short
Systolic
Symptomless
Situation dependent
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12
Q

What investigations can rule out abnormalities in murmurs in children?

A

ECG
CXR
Echocardiography

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13
Q

What causes negative intra thoracic pressure?

A

During inspiration the chest wall and the diaphragm pull the lungs open. Also pulls the heart open

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14
Q

What does an atrial septal defect sound like?

A

Mid systolic, crescendo-decresendo murmur. Loudest at the upper left sternal border, with a fixed split second heart sound

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15
Q

What does fixed split mean?

A

Heart sound does not change with inspiration and expiration

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16
Q

What sound may be heard in PDA?

A

Small PDA may not cause any abnormal heart sounds
More significant PDAs cause a normal first heart sound with a continuous crescendo decresendo machine murmur that may continue during the second heart sound, making the second heart sound more difficult to hear

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17
Q

What does the murmur in teratology of the fallout sound like?

A

It arises from pulmonary stenosis giving an ejection systolic murmur loudest at the pulmonary area

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18
Q

What is cyanosis?

A

When deoxygenated blood enters the systemic circulation

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19
Q

When does cyantoic heart disease occur?

A

When blood is able to bypass the pulmonary circulation and the lungs
Allows a right to left shunt

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20
Q

Heart defects that can cause a right to left shunt:

A

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
Transposition of the great vessels

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21
Q

What is Eisenmenger syndrome?

A

If the pulmonary pressure increases beyond the systemic pressure, blood will start to flow from right to left across the defect causing cyanosis

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22
Q

What can having an asymptomatic PDA throguh childhood present with as in adulthood?

A

HF

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23
Q

PDA presenting symptoms

A 
Murmur may be pciked up
SOB
Difficulty feeding
Poor weight gain
LRTI
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24
Q

How can a diagnosis of PDA be confirmed

A

Echocardiogram

Doppler flow during ECHO can assess size and characteristics of left to right shunt

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25
What is the management of PDA?
Monitored until 1 year of age using echocardiograms | After 1 it is highly likely close spontaneously and transcatheter or surgical closure can be performed
26
What is an atrial septal defect?
A hole in the septum between the two atria
27
In ASD what way does the blood move?
From LA to RA as pressure higher in LA
28
What can ASD lead to?
Blood flows to lungs to patient not cyantoiv but increased flow and pressure in right side of heart leads to right sided overload and heart strain RHF and pulmonary hypertension
29
What is Eisenmenger syndrome?
Pulmonary pressure is greater than systemic. Shunt reverses and becomes right to left shunt. Blood bypasses lungs and becomes cyanotic
30
Examples of Atrial septal defects?
Ostium secundum Patent foramen ovale Ostium primum
31
Complications of ASD?
Stroke AF Pulmonary hypertension and RHF Eisenmenger syndrome
32
What is important to think about in relation to atrial septal defects and DVT?
Clot goes to RA then LA due to ASD instead of being a PE!
33
What are symptoms of ASD?
SOB Difficulty feeding Poor weight gain LRTI
34
What is the management of PDA?
Refered to paediatric cardiologist When it is small and asymptomatic watch and wait Corrected surgically using a transvenous catheter colusure. Anticoagulants such as aspirin, warfarin and NOACs reduce risk of clots and stroke in adults
35
what is VSD
Congeital hole in the septum between ventricles | Can occur by themselves but commonly associated with Down's syndrome and Turner's syndrome
36
What are symptoms of VSD>
Poor feeding Dysponea Tachynponea Failure to thirve
37
What is found in examination of a VSD
Pan systolic murmur more prominent over left lower sternal border in the third and fourth intercostal spaces Systolic thrill on palpation
38
What is the treatment of a VSD?
Watched if small Corrected surgically using a transvenous catheter closure via femoral vein or open heart surgery Risk of IE in patients with VSD. Abx prophylaxis should be considered during surgery to reduce risk of IE
39
What is Eisenmenger syndrome?
Blood flows from right tp left side of heart cross a structural lesion bypassing the lungs ASF, VSD, PDA Can develop 1-2 years with large shunts or in adulthood with small shunts
40
What is cyanosis?
Blue discolouration of skin relating to a low level of oxygen in blood
41
How does bone marrow respond to low oxygen saturation?
Produces more red cells and hameoglobin to increased oxygen carrying capacity in the blood Leads to polycythaemia which is a high concentration of haemoglobin in blood Gives patients a plethoric complexion High concentration of RBCs and haemoglobin make the blood more viscous making patients more prone to thrombus formation
42
Examinatin findings in pulmonary hypertension
Right ventricular heave Loud P2 Raised JVP Peripheral oedema
43
What are the findings related to right to left shunt and chronic hypoxia?
Cyanosis Clubbing Dysponea Plethroic complexion
44
What is the management of eisenmengers syndrome?
Once the pulmomnary pressure is high enough to cause the syndrome it cant be medically reversed. Only definitive treatment is a heart lung transplant Closely followed by a specialist Medical manegemtn involves: Oxygen can help manage symptoms Pulmonary hypertension: sildendail Arrhythmia treatment Treatment of polycythemia with venesection Prevention and treatment of thrombosis with anticoagulation Prevention of IE using prophylactic abx
45
What is coarctation of the aorta?
Congenitral condition where there is a narrowing of the aortic arch
46
What is the presentation of coarctation of the aorta?
Often the only indication is a weak femoral pulse Four limb bp- high bp in ones before narrowing and low bp in ones after May be a systolic murmur below the left clavicle and below the left scapula Tachyponea and increased work of breathing Poor feeding Grey and floppy baby Left ventricular heave Underdeveloped left arm where there is reduced flow to the subclavian artery Underdevelopment of the legs
47
What is the management of coarctation of the aorta
Mild- Ca live symtpom free until adulthood without requiring surgical input Severe-Patients will require emergency surgery shortly after birth Critical- Risk of HF and death. Prostanglandin E is used to keep ductus arteriosus opem while awaiting surgery. Then surgery asap
48
What is the presentation of aortic stenosis?
Mild- Asymptomatic. Incidental discovery More severe- Fatigue, SOB, dizziness and fainting Symptoms worse on exertion Severe- Present with HF within months of birth
49
Signs of aortic stenosis
``` Ejection systolic mumur in aortic area Crescendo-decrescendo Radiates to carotids Ejection click just before the murmure Palpable thrill during systole Slow rising pulse and narrow pulse pressure ```
50
Management of aortic stenosis?
Percutaneous baloon aortic valvoplasty Surgical aortic valvotomy Valve replacement
51
What are the complications of aortic stenosis?
``` Left ventricular outflow tract obstruction HF Ventricalr arrhythmias Bacterial endocarditis Sudden death ```
52
Congenital pulmonary valve stenosis is associated with what?
Teratology of fallot William syndrome Noonan syndrome Congenital rubella syndrome
53
What is the presentation of pulmonary valve stenosis
Asymptomatic More significant- Pulmonary valve stenosis Can present with symptoms of fatigue on exertion, SOB, dizziness and fainting
54
What is the management of pulmonary valve stenosis?
ECHO to investigate Mild- Symptoms patients generally do not require any interventions Symptomatic or significantly stenosed, balloon valvulopasty via a venous catheter Open heart surgery
55
What are the 4 coexisting patholgies of the teratology of fallout?
VSD Overriding aorta Pulmonary valve stenosis RVH
56
What are the risks factors of teratology of fallout?
Rubella infection Increased age of the mother Alcohol consumption in pregnancy Diabetic mother
57
Investigation of teratology of fallot?
ECHO Doppler flow study CXR- Boot shaped heart due to RV thickening
58
What is the presentation of teratology of the fallout?
Most cases are picked up before the child is born during the antenatal scans Ejection systolic murmur caused by the pulmonary stenosis may be heard on newborn check Severe cases will present with HF before one year of age In milder cases they can present as older children once they start to develop signs and symptoms of HF
59
What are signs and symptoms of HF?
``` Cyanosis Clubbing Poor feeding and poor weight gain Tet spells Ejection systolic murmur loudest in pulmonary area ```
60
What are Tet spells?
Intermittent symptomatic periods where the right to left shunt becomes temporarily worsened precipitating a cyanotic episode Pulmonary vascular resistant increases or systemic resistance decreases for example If child exerting get more CO2 CO2 is a vasodilatorand therefore reduces systemic vascular resistance Blood goes from RV to aorta rather than pulmonary vessels Episodes percipitated by waking, physical exertion or crying Child will become irritable, cyanotic and SOB Severe spells can lead to reduced consciousness, seizures and potentially death
61
Tet spell treatment options
Older children may squat Younger children can be positioned with their knees to chest These increase systemic vascular resistance Any medical management should involve an experience paediatrician as they can be potentially life threatening: Supplementary oxygen, beta blockers, IV fluid, morphine, sodium bicarbonate and phenylephrine infusion
62
What is the management of teratology of fallout?
In neonates, a prostaglandin infusion can be used to maintain the ductus arteriosus. Allows blood to flow from the aorta back to the pulmonary arteries Total surgical repair by open heart surgery is the definitive treatment however mortality from surgery is around 5% Prognosis depends on the severity, however it is poor without treatment. With corrective surgery 90% of patients will live into adulthood
63
What is ebstein's anomaly?
Congenital heart condition where the tricuspid valve is set lower in the right side of the heart causing a bigger RA and a smaller RV Leads to poor flow from RA to RV Poor flow to pulmonary vessels Often associated with a right to left shunt via an atrial septal defect Also associated with WPW
64
What is the presentation of Ebsteins anomaly
``` Evidence of hearth failure Gallop rhythm heard on auscultation Cyanosis SOB and tachyponea Poor feeding Collapse or cardiac arrest ```
65
What are the investigations for ebstein's anomaly?
ECG: Arrhythmias, right atrial enlargement, right bundle branch block, left axis deviation CXR: Cardiomegaly and right atrial enlargement Echocardiogram: Investigation of choice for confirming the diagnosis and assessing the severity
66
What is the management of ebstein's anomaly?
Treat arrhytmias and HF Prophylatic ABX may be used to prevent IE Defintive management is by surgical correction of the underlying defect
67
What is the transposition of great vessels?
Where the attachments of the aorta and the pulmonary trunk to the heart are swapped RV pumps blood into the aorta and LV pumps blood into the pulmonary vessels 2 separate circulations do not mix: one travelling through the systemic systems and right side of the heart and other travelling through the pulmonary system and left side of the heart
68
What is transposition of the great vessels associated with?
VSD Coarctation of the aorta Pulmonary stenosis
69
What is the presentation of transposition of the great vessels?
Often diagnosed during pregnancy with antenatal US scans If not detected in pregnancy it will present with cyanosis at or within a few days of birth ASD or VSD can initially compensated by allowing blood to mix between circulation but within a few weeks of the life they will develop respiratory distress, tachycardia, poor feeding, poor weight gain and sweating
70
What is the management of transposition of the great vessels?
When there is a VSD this will allow some mixing of blood Prostanglandin infusion can be used to maintain the ductus arteriosus. This allow blood from the aorta to flow to the pulmonary arteries for oxygenation Balloon septostomy involves inserting a catheter into the foramen ovale via the umbilicus and inflating a balloon to create a large ASD. Allows blood returning from the lungs to flow to the right side of the heart and out through to the aorta to the body Open heart surgery-Definitive management. Cardiopulmonary bypass machine is used to perform an arterial switch procedure within a few days of birth

Paediatrics (142 decks)

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