CVS PGMEE notes MV Flow murmur: DDM at mitral area

Congenital heart disease: Loud S-1

 Lt side of heart has higher pressure than Rt side  Symptomps (CHF: S3) at 6-10 weeks of age
 All L-R shunt have enlarged LA (L-R shunt   80% small : Spontneous closure
PAlungPul vein  LA) except ASD as it has  Max risk of IE
extra exit for blood in LA inform of ASD  CXR : Normal heart (small VSD) , cardiomegaly (Large
VSD)
Girls ASD,VSD,PDA,PS
Boys TGA, Left obst(AS,CoA) PDA:
 Physiological closure (muscular contraction by
bradykinin/low oxygen/low PGF2) : immediately after
ASD: few hrs of birth  anatomical closure (intimal
 osteum secundum (at/sup/post to fossa ovalis) > proliferation) at 10-21 days  obliterate to form
osteum primum (endocardial cushion defect-inf to ligamentum arteriosum
fossa ovalis :asso cleft in ant MV leaflet ± septal TV  MC site : just distal/below subclavian a.
cleft)  Hemodynamics :
 associated Ds: Aorta
o holt oram synd PDA Shunt thoughout cardiac cycle (systole + diastole) :
o down synd Continuous machinery murmur & thrill : after S1
-peak at S2-part of diastole : Lt ICS & lt Clavicle
o ellis van crevald synd
Pul a Also from Rt heart
o rubinstein taybi synd
Lung Pul Plethora  pulHT
o thrombocytopenia absent radius (TAR) synd
Pul v
o pierre robbin synd
LA LAH
o ehler danlos synd
MV Flow murmur : DDM & loud S1
o fetal alcohol synd
LV LVH
o lutembacher syndrome : ASD +MS AV High flow causes delayed closure : late A2 
 hemodynamics : narrow/Paradoxical Spliting of S2 (P2-A2)
LA Aortic Ejection click
ASD Low pr diff : no shunt murmur Aortic ESM (masked by cont murumur)
RA RAH Dilated ascending aorta
TV DDM at lower sternal border  D/D : Aortopul window defect (large : shunt only in
loud S-1(T1) systole / small mimic PDA)
RV RVH  parasternal heave  CHF(S3 at apex) at 6-8 weeks of age
PV Pulmonary ESM : systolic thrill at Lt 2nd ICS  MC cause of death in PDA : CHF >IE
delayed loud P2  widely split fixed S2  Preterm infant PDA (no structural abnormality but d/t
PA oxygen unresponsiveness) : spontaneous closure may
Lungs Pul plethora  Pul HT occur if not Indomethacin > ibuprofen usually works
 Asymptomatic > ex intolerance , chest infection in 90%
 CHF & IE is rare : no S3  Term infant PDA (structural abnormality) : cannot
 ECG : RAD in osteum secundum > LAD in osteum spontaneously close – give Indomethacin > ibuprofen 
primum (d/t asso lack of ant-sup LBB) fail usually  Sx ligation

VSD: Duct dependent condition :

 MC cong heart ds keep it open by PGE1 (Alprostadil ,rioprostil , misoprost)
 Memb > muscular > multiple For Pul flow TA , critical PS + intact septum , TOF
 Hemodynamics : For syst flow AS , CoA , HLHS , Interrupted aortic arch
LV For oxygen TGV
VSD Shunt murmur : PSM – systolic thrill at 3-4-5lt ICS Ductal independent But require immediate Sx :
masking S-1 &S-2 TAPVR , PTA , ALCAPA
Low blood flow thro aorta (early A2)
RV Normal size (shunting occurs during systole only) TOF:
PV Pul ESM (masked by PSM) in pul area  MC cyanotic Cong Heart ds : cyanosis NOT at Birth
Delayed loud P2 (&Early A2) : widely split S2  4 components
(usually masked by PSM except at pul area at upper 1. VSD
lt sterna border) 2. RVH
PA 3. RV out flow obst (Infundibular stenosis > both > PS
Lungs Pul plethora  pul HT >PA)
Pul v 4. Overriding of aorta
LA LAH  Hemodynamics :
Mild : no RVOT Mimic VSD (no cyanosis)
Severe : with RVOT (PS) Pul ESM
Delayed soft P2 = only A2 =
single S2
R-L shunt (low pr : no shunt
murmur)
Low PBF : soft P2
MC symp : dyspnea on exertion & Exercise intolerance