Term
| presenting a patient with congenital pulmonary valve disease/tricuspid regurgitation |
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Definition
this patient has evidence of previous cardiac surgery and pulmonary valve disease and tricuspid regurgitation
She has a median sternotomy scar
SR with normal pulse pressure
Raised JVP with prominent CV waves
A systolic murmur loudest at the lower left sternal edge and louder on inspiration (TR)
A second systolic murmur loudest over pulmonary region.
A widely split S2 which varies with respiration (causes include pulmonary stenosis)
Normal apex beat
No RV heave and palpable thrills
She does not have a metallic heart valve and does not have RV heave. Given that she has a widely split S2 I would like to ix with ECHO looking for
Pulm HTN
Evaluate whether TR is new
Assess pulmonary valve in more detail. |
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Term
| How to explain the median sternotomy scar in this patient? |
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Definition
I think this patient had surgery for congenital heart disease; either valvular or structural heart disease.
Given that all of her signs are right sided, this patient may have had surgery for congenital pulmonary valve disease. |
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Term
| How does splitting of S2 vary with an ASD? |
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Definition
with an ASD you would not expect splitting to vary with respiration.
This is because in ASD there is a communication between the right and left atria which allows for equalisation of pressures and no change with inspiration.
Whereas the other causes vary with respiration. |
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Term
| This woman tells you she wants to start a family. What would be your advice? |
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Definition
Essential to guiding pre-pregnancy planning discussions she would need an ECHO
She would need a referral to a Cardiologist
A review of her medications
Close monitoring throughout her pregnancy. |
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Term
| An echo is performed which indicates she is developing pulmonary HTN. How would this alter your management? |
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Definition
An important thing would be looking for any possible concomitant shunts that have not previously been identified.
If left untreated pul HTN could lead to Eisenmenger's which is shunt reversal in the context of irreversible pul HTN and will lead to central cyanosis. |
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Term
| You mention this woman could have possible pulmonary valve disease. What would be the causes of this? |
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Definition
There are various congenital and acquired causes which can cause pulmonary valve disease.
Common one include
Rubella
Down syndrome
Noonan syndrome
Turner syndrome
Include whether your patient had any features of these in your examination. |
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Term
| A systolic murmur heard loudest at the left sternal edge accentuated by inspiration and accompanied by prominent CV waves is suggestive of? |
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Definition
TR
Systolic murmur
Louder on inspiration
location is lower left sternal edge
Accompanied by CV waves on JVP |
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Term
| When you suspect presence of congenital heart disease there are 3 things you need to qualify |
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Definition
1) Pink or blue? cyanotic or acyanotic congenital heart disease?
2) presence of scars indicating previous surgery. Look at front and back
3) associated conditions; presence of down's, turner or noonan's syndrome. |
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