Class Notes (1,100,000)
CA (620,000)
McMaster (50,000)
PSYCH (6,000)
PSYCH 1XX3 (1,000)
Joe Kim (1,000)
Lecture 16

PSYCH 1XX3 Lecture Notes - Lecture 16: Bicuspid Aortic Valve, Infective Endocarditis, Right Bundle Branch Block

Course Code
Joe Kim

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Innocent murmur
Heard in up to 30% of all children
Ejection murmur
Generated in ventricles, outflow tracts or great vessels on either side of heart by turbulent blood flow
No structural abnormalities
Soft blowing syst murmur, localised to L-sternal edge, no diastolic component, no radiation
Venous hum
Turbulent blood flow in head and neck veins
Disappears when lying flat or compressing ipsilateral jug V
Acyanotic congenital heart lesions
o Sx: asymptomatic, heart failure, recurrent chest inf, cyanosis, endocarditis
o Signs: parasternal thrill, harsh loud passtoli loig urur, tahop, tachycardia, enlarged
o Ix: CXR=heart, pul A, pul vascular markings. ECG=ventricular hypertrophy, upright T wave=pul
o Course: 20% close in 9/12. Diuretics and ACE-Is. Surgery if pul HT as can cause pul vascular disease.
ABs to prevent bacterial endocarditis.
o Common in prem
o Left to right shunt (aortapul A)
o Signs: FTT, pneumonias, heart failure, collapsing pulse, thrill, S2, continuous murmur beneath L-
o Ix: CXR: vasc markings, enlarged aorta. ECG: usually N, LVH
o Rx: most close over time. Dex in preterm labour. If symptomatic, Rx with fluid restriction, diuretics,
indomethacin (a prostaglandin synthetase inhibitor). Surgical ligation or transvenous occlusion with
coil device.
o Speial for of VSD, ofte see i kids ith Dos s.
o Signs: widely split, fixed S2 and midsystolic murmur (2nd IC space of L sternal edge)
o Ix: CXR: cardiomegaly, globular heart (primum defects). ECG: RVH +/- incomplete RBBB
o Associated with other lesions e.g. bicuspid aortic valve and VSDs.
o Neonates present with duct-dependent circ
o Sx: circulatory collapse when duct closes, heart failure, murmur between shoulder blades.
o Signs: diff in feeling femoral pulses, BP in arms, BP in legs, no foot pulses
o Ix: CXR: rib notching (late), due to large collateral IC As running under ribs posteriorly to bypass
obstruction. ECG: RVH in neonate, LVH in older child
o Rx: surgical: resection and end to end anastomosis or balloon dilatation.
Cyanotic congenital heart lesions
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