PSYCH 1XX3 Lecture Notes - Lecture 16: Bicuspid Aortic Valve, Infective Endocarditis, Right Bundle Branch Block
19 May 2018
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CARDIOVASCULAR SYSTEM
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
• VSD:
o Sx: asymptomatic, heart failure, recurrent chest inf, cyanosis, endocarditis
o Signs: parasternal thrill, harsh loud passtoli loig urur, tahop, tachycardia, enlarged
liver
o Ix: CXR=heart, pul A, pul vascular markings. ECG=ventricular hypertrophy, upright T wave=pul
HT.
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.
• PDA:
o Common in prem
o Left to right shunt (aorta→pul A)
o Signs: FTT, pneumonias, heart failure, collapsing pulse, thrill, S2, continuous murmur beneath L-
clavicle
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.
• ASD:
o Speial for of VSD, ofte see i kids ith Dos 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
• Coarctation
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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Document Summary
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: vsd, sx: asymptomatic, heart failure, recurrent chest inf, cyanosis, endocarditis, signs: parasternal thrill, harsh loud pa(cid:374)s(cid:455)stoli(cid:272) (cid:858)(cid:271)lo(cid:449)i(cid:374)g (cid:373)ur(cid:373)ur(cid:859), ta(cid:272)h(cid:455)op, tachycardia, enlarged liver. Surgery if pul ht as can cause pul vascular disease. Abs to prevent bacterial endocarditis: pda, common in prem, left to right shunt (aorta pul a, signs: ftt, pneumonias, heart failure, collapsing pulse, thrill, s2, continuous murmur beneath l- clavicle. Ecg: usually n, lvh: rx: most close over time. If symptomatic, rx with fluid restriction, diuretics, indomethacin (a prostaglandin synthetase inhibitor).
