511551
Description
Mind Map by v.djabatey, updated more than 1 year ago
|
Created by v.djabatey
about 10 years ago
|
|
Outflow obstruction in well child
- aortic stenosis
- aortic valve leaflets
partly fused together
- giving a restrictive exit from
left ventricle
- may be 1-3 aortic leaflets
- giving a restrictive exit from
left ventricle
- may not be an isolated lesion
- often assoc w/ (& so must exclude)
- mitral valve stenosis
- coarctation of aorta
- mitral valve stenosis
- often assoc w/ (& so must exclude)
- clinical features
- asymptomatic murmur
- commonest presentation
- commonest presentation
- presentation of
severe stenosis
- reduced
exercise
tolerance
- chest pain on
exertion
- syncope
- reduced
exercise
tolerance
- presentation
in neonatal
period
- severe heart failure->shock
- presentation of
critical aortic stenosis
& duct dependent
circulation
- presentation of
critical aortic stenosis
& duct dependent
circulation
- severe heart failure->shock
- physical signs
- small vol, slow rising pulses
- carotid thrill (always)
- ejection systolic
murmur maximal
@ upper right
sternal edge
- delayed & soft aortic
S2
- apical ejection click
- small vol, slow rising pulses
- asymptomatic murmur
- Ix
- CXR
- normal
- prominent left ventricle w/ post
stenotic dilatation of asc aorta
- normal
- ECG
- left ventricular hypertrophy
- deep S wave
in V2 and tall R
wave in V6
- deep S wave
in V2 and tall R
wave in V6
- down going T wave
- suggests left
ventricular strain &
aortic stenosis
- suggests left
ventricular strain &
aortic stenosis
- left ventricular hypertrophy
- CXR
- congenital type
commoner in
boys
- Mx
- regular
assessment
- clincal
- echo
- clincal
- if symptomatic on
exercise or hihg
resting Pa gradient (>
64 mmHg) across
aortic valve
- balloon valvotomy
- generally safe in older kids
- more difficult
& dangerous
in neonates
- generally safe in older kids
- balloon valvotomy
- eventual aortic valve replacement
- neonates & kids w/ sig aortic stenosis requiring Rx in 1st few years of life
- neonates & kids w/ sig aortic stenosis requiring Rx in 1st few years of life
- early Rx
- palliative
- directed @ delaying valve replacement
- palliative
- avoid
competitive
sports if severe
aortic stenosis
- regular
assessment
- if severe,
risk of
sudden
death
- aortic valve leaflets
partly fused together
- pulmonary stenosis
- pulmonary
leaflets partly
fused together
- -> restrictive exit from right ventricle
- -> restrictive exit from right ventricle
- seen in Noonan's syn
- clinical features
- presentation
- asymptomatic
- mild-mod stenosis
- mild-mod stenosis
- poor exercise tolerance
- severe stenosis
- severe stenosis
- right ventricular failure/cyanosis
- critical stenosis
- critical stenosis
- asymptomatic
- clinical diag
- physical signs
- ejection sys murmur
- best heard at
upper left
sternal edge
- best heard at
upper left
sternal edge
- thrill
- ejection click
- best heard at upper left sternal edge
- best heard at upper left sternal edge
- prominent right ventricular heave
- when severe stenosis
- when severe stenosis
- ejection sys murmur
- presentation
- Ix
- CXR
- normal
- post stenotic dilatation of pul a
- normal
- ECG
- right ventricular hypertrophy
- upright T wave in V1
- upright T wave in V1
- right ventricular hypertrophy
- CXR
- Mx
- most kids are asymptomatic
- when Pa grad across pul valve gets sig increased ( > 64 mmHg)
- intervention needed
- trans-catheter balloon dilatation
- trans-catheter balloon dilatation
- intervention needed
- most kids are asymptomatic
- pulmonary
leaflets partly
fused together
- adult-type coarctation of aorta
- uncommon
- not duct dependent
- gradually gets more severe over many years
- usually occurs distal
to origin of left
subclavian a @ level of
ductus arteriosus
- commoner in boys than girls
- but more common in Turner's syn
- but more common in Turner's syn
- clinical features
- asymptomatic
- systemic hypertension in right arm
- ejection systolic murmur
- upper sternal edge
- or btw shoulder blades
- or btw shoulder blades
- upper sternal edge
- collaterals heard w/ continuous murmur at the back
- radio-femoral delay
- due to blood bypassing obstruction via collateral vessels in chest wall
- so pulse in legs delayed
- so pulse in legs delayed
- due to blood bypassing obstruction via collateral vessels in chest wall
- weak/absent femoral pulses
- asymptomatic
- Ix
- CXR
- rib notching
- due to development of large
collateral intercostal aa running
under ribs posteriorly to bypass
obstruction
- due to development of large
collateral intercostal aa running
under ribs posteriorly to bypass
obstruction
- 3 sign
- w/ visible notch in desc aorta @ site of coarctation
- w/ visible notch in desc aorta @ site of coarctation
- rib notching
- ECG
- left ventricular
hypertrophy
- deep S wave in V2, tall R wave in V6 and upright T wave
- deep S wave in V2, tall R wave in V6 and upright T wave
- downgoing T wave in V6
- suggest left ventricular strain and severe coarctation and/or HTN
- suggest left ventricular strain and severe coarctation and/or HTN
- left ventricular
hypertrophy
- CXR
- Mx
- when condition severe
- as assessed by echo
- stent insertion using cardiac catheter
- surgical repair
- as assessed by echo
- when condition severe
- complications
- premature coronary
heart disease
- congestive
cardiac
failure
- hypertensive
encephalopathy
- intracerebral haemorrhage
- premature coronary
heart disease
- uncommon
Want to create your own Mind Maps for free with GoConqr? Learn more.