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YR5 Specialties > Paeds CARDIO > Flashcards

Paeds CARDIO Flashcards

1
Q

What is Acrocyanosis?

A

peripheral cyanosis around the mouth + extremities
Often seen in healthy newborns, occurs immediately after birth

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2
Q

What causes acrocyanosis?

A

benign vasomotor changes resulting in peripheral vasoconstriction + increased tissue O2 extraction

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3
Q

What are the 6 features of innocent cardiac murmurs?

A

Sensitive to changes in position + breathing
Short duration (not pansystolic)
Single (no associated clicks/ gallops)
Small (in limited area + doesn’t radiate)
Soft (low amplitude)
Systolic

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4
Q

What is a ‘breathless baby’ presentation indicative of?

A

L-R shunt
Acyanotic heart defect

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5
Q

Recall the 3 types of L-R shunt from most frequent to least frequent

A

VSD
ASD
PDA

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6
Q

Give 3 risk factors for VSD

A

Maternal diabetes
Downs, Edwards, Patau syndrome
IUI- TORCH

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7
Q

Give 2 risk factors for ASD

A

Down syndrome
Fetal alcohol syndrome

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8
Q

Give 3 risk factors for PDA

A

Fetal alcohol syndrome
Congenital RUBELLA
Down syndrome

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9
Q

What murmur is heard in VSD?

A

Harsh pansystolic at lower LSB
Louder in smaller defects

MDM over cardiac apex

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10
Q

When can VSD be detected?

A

20w scan

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11
Q

What are the signs and symptoms of VSD?

A

Small: Asymptomatic

Med-large:
Heart failure by 2-3 months
failure to thrive
recurrent bronchopulmonary infections
Exercise intolerance

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12
Q

How are VSDs classified?

A

By size:
small <3mm
large >3mm

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13
Q

How should small VSDs be managed?

A

Self-limiting: they close over time

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14
Q

What is the medical management for large VSDs?

A

Diuretics for HF
ACEi to reduce afterload e.g. Captopril
High-energy feeds

(CDC: Calories, diuretics, Captopril)

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15
Q

What is the surgical management for large VSDs?

A

Patch repair

At 3-6 months to prevent permanent lung damage from pulmonary HTN + high blood flow

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16
Q

List 5 complications of VSD

A

Aortic regurgitation
Infective endocarditis
Eisenmenger’s complex
RHF
Pulmonary HTN

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17
Q

What is Eisenmenger syndrome?

A

Where a long-standing L-R shunt causes pulmonary HTN + eventual reversal of the shunt into a cyanotic R-L shunt

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18
Q

How should Eisenmenger be managed?

A

Early intervention for pulmonary blood flow
Heart transplantation not easy but can be done

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19
Q

What murmur is heard in ASD?

A

Ejection systolic
ULSE: 2nd ICS LSB
Widely split S2 (fixed- no change with respiration)

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20
Q

What are the types of ASD and which is more common?

A

Secundum (more common): defect in atrial septum (failure of closure of foramen ovale)

Primum/ Partial (AVSD): defect of AV septum

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21
Q

What are 3 signs and symptoms of ASD?

A

Asymptomatic (small)
Exertional dyspnoea
Recurrent bronchopulmonary infections

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22
Q

How will the different types of ASD appear on ECG?

A

Secundum: RBBB + RAD
Partial: superior QRS axis

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23
Q

How quickly after birth does AVSD present?

A

Typically 4-8w
May be earlier

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24
Q

How should the different types of ASD be managed?

A

Secundum: transcatheter device closure at 3-5y
Partial: surgical correction at 3-5y

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25
Q

What investigation is diagnostic of ASD or VSD?

A

Echo

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26
Q

Where is the ductus arteriosus?

A

Between the aorta + pulmonary artery

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27
Q

What connection allows underdeveloped lungs to be bypassed by the fetal circulation? What keeps this patent in utero?

A

Ductus Arteriosis
(R-L shunt)
Kept patent by PGE + low O2 tension

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28
Q

What happens to the ductus arteriosus after birth?

A

Pulmonary vascular resistance decreases + allows reversal of shunt from R-L to L-R

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29
Q

Give 5 features of PDA on examination

A

Continuous ‘machinery’ murmur

Left subclavicular thrill

Large volume, bounding, collapsing pulse

Wide pulse pressure

Heaving apex beat

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30
Q

What is the management of PDA in premature infants?

A

Indomethacin/ Ibuprofen infusion
Inhibits prostaglandin synthesis, induces closure

Surgical: Transcatheter closure or surgical ligation

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31
Q

If PDA associated with another CHD, what is the management?

A

Prostaglandin E1 infusion to keep the PDA open

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32
Q

When do cyanotic and acyanotic heart defects present generally?

A

Left-to-Right shunts = LateR cyanosis

Right-to-Left shunts = eaRLy cyanosis

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33
Q

Give 3 features of heart failure

A

Hepatomegaly
Tachypnoea
Pallor (low CO, low BP)

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34
Q

What is a ‘blue baby’ presentation a red flag for?

A

R-L shunt
Cyanotic heart defect

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35
Q

What are 5 causes of cyanotic congenital heart disease?

A

Tetralogy of Fallot (most common)
Transposition of the great vessels
Tricuspid valve atresia
Total anomalous pulmonary venous return
persistent Truncus arteriosis

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36
Q

What is the tetralogy of fallot?

A

VSD

Overarching aorta

Right outflow tract obstruction: pulmonary stenosis

RV hypertrophy

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37
Q

When does Tetralogy of fallot present?

A

~1-2 months,
May be later e.g. 6m

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38
Q

How does ToF present?

A

Tet spells: hypercyanotic hypoxic episodes (peak 2-4m)
a/w stress: crying, feeding, defecation

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39
Q

When does the ductus arteriosus close?

A

Functional closure within 24-48h if born at term
Complete by 2-3w

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40
Q

What would be heard on auscultation in tetralogy of fallot?

A

ESM at ULSE
due to pulmonary stenosis

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41
Q

What investigations should be done in suspected tetralogy of fallot?

A

Echo: confirmatory

CXR: Boot shaped heart

42
Q

How is tetralogy of fallot managed?

A

Medical: PGE1 infusion until surgery to maintain PDA

Surgical by 6m: VSD repair- patch closure

43
Q

How are acute tet spells managed in ToF?

A

100% FiO2 via NRB
Knee to chest position, squatting

44
Q

What palliative procedure may be performed for severe ToF in the first week of life?

A

Blalock Thomas Taussig shunt

45
Q

What determines the degree of cyanosis and clinical severity in ToF?

A

Severity of right outflow tract obstruction

46
Q

What is the basic anatomical pathology in ToGA?

A

Aorta leaves the right ventricle

Pulmonary trunk leaves the left ventricle

47
Q

When does ToGA present?

A

When ductus arteriosus closes at 2-4 days old

48
Q

Give 2 signs of ToGA

A

Tachypnoea
Postnatal cyanosis- not affected by supplemental O2

49
Q

What is heard upon auscultation in ToGA?

A

Single loud S2
Often NO MURMUR
Diminished femoral pulses

50
Q

What investigations are used for ToGA?

A

Echo: confirmatory

CXR: Egg on a string

51
Q

How can ToGA be managed?

A

PGE1 infusion to keep DA open
Balloon atrial septostomy
Urgent surgery (within 2w)

52
Q

What surgical procedures may be used for ToGA?

A

Arterial switch procedure
or
Rastelli procedure

53
Q

When do aortic problems (coarctation or stenosis) present?

A

First few weeks of life depending on presence of other abnormalities + patency of DA

54
Q

What test is used to diagnose heart disease in a cyanosed neonate, and how is it done?

A

Nitrogen washout test
Give 100% oxygen for 10 mins
Measure right radial artery blood gas oxygen
If it stays low (<15kPa) = positive for CHD

55
Q

What are the differentials for cardiac outflow obstruction and how can you clinically differentiate between them

A

If child is otherwise well: P or A stenosis
If child is also in CV collapse + shock: coarctation

56
Q

Recall the medical and surgical management of PDA

A

Medical: Indomethacin (NSAID): to prompt duct closure
Surgical: at 1 year

57
Q

How can cyanosis be tested for?

A

Hyperoxia nitrogen washout test

58
Q

How should cyanosis be immediately managed?

A

ABCs
Prostaglandin infusion (to maintain PDA patency)

59
Q

Recall the timeline of presentation of the different types of cyanotic heart disease after birth

A

<10 mins: Tricuspid atresia

Few hours: ToGA

Up to 3w: AVSD

Any age (at a few days, often): ToF

10-15y: Eisenmenger

60
Q

What is Ebstein’s abnormality?

A

Malformation of tricuspid valve leading to severe tricuspid regurgitation

61
Q

What maternal medication is associated with Ebstein’s abnormality?

A

Lithium

62
Q

What would be heard on auscultation in Ebstein’s abnormality?

A

split 1st + 2nd heart sounds

63
Q

What is Ebstein’s abnormality also referred to?

A

atrialisation of the right ventricle.

64
Q

How should Ebstein’s be managed?

A

Prostaglandin infusion
Tricuspid valve repair

65
Q

What is tricuspid atresia?

A

Complete absence of tricuspid valve:
No blood flow between RA + RV

66
Q

Describe the presentation of tricuspid atresia

A

Cyanosis + SOB within first 10 mins of life

67
Q

What is the murmur in tricuspid atresia?

A

ESM at LSE due to VSD

68
Q

Recall the management of tricuspid atresia

A

IV PGE1 infusion
Balloon atrial septostomy

Stage 1: to maintain a secure supply of blood to the lungs
Blalock-Taussig shunt insertion
or
pulmonary banding to reduce pulmonary blood flow

Stage 2: Bidirectional Glenn procedure

Stage 3: Fontan procedure

69
Q

Why is ToGA not instantly fatal?

A

Usually found alongside ASDs/ VSDs/ PDAs which aid mixing

70
Q

What is the most common association with AVSD?

A

Down’s syndrome

71
Q

How should AVSD be managed?

A

Treat heart failure medically + surgery at 3 months

72
Q

What is the cause of congenital aortic/ pulmonary stenosis?

A

Aortic: fusion of valve leaflets (2 instead of 3)
Pulmonary: fusion of valve leaflets

73
Q

What are the most likely co-existent conditions with aortic/ pulmonary stenosis?

A

Coarctation of aorta

74
Q

What are the signs and symptoms of aortic/ pulmonary stenosis?

A

NO CYANOSIS
AS: ESM. Palpable thrill. Ejection click
PS: ESM, split S2

75
Q

How should a/p stenosis be managed?

A

Transcatheter balloon dilatation

76
Q

When does coarctation of the aorta present?

A

3 days - a few weeks of life
Depends on severity

77
Q

Recall signs and symptoms of coarctation of the aorta depending on severity

A

Critical: shock + heart failure- dyspnoea, pale, irritable, poor femoral pulses, hepatomegaly

Less severe: Asymptomatic, weak femoral pulses, High BP in arms, low BP in legs

Ejection systolic murmur

78
Q

How should coarctation be managed?

A

Critical: ABC, PGE1 infusion + inotropes. Once stabilised surgical repair

Non-critical: surgical repair OR balloon angioplasty + stenting

79
Q

Recall 4 signs and symptoms of hypoplastic left heart syndrome

A

Cyanosis
Tachypnnoea
NO murmur

80
Q

How should hypoplastic left heart syndrome be managed?

A

1st = ABCs + PGE1

2nd = Blalock-Taussig (BK) shunt or Norwood Stage 1

3rd = BK shunt removal –> Glenn/ hemi-Fontan –> Fontan/ Total Cavo-Pulmonary Connection

81
Q

What is a BK shunt?

A

Arterficial ductus arteriosus

82
Q

What HR is expected in SVT?

A

250-300bpm

83
Q

Recall the main symptom of SVT in neonates

A

Hydrops fetalis

84
Q

What would be seen on an ECG in SVT?

A

Narrow complex tachycardia + T wave inversion due to ischaemia

85
Q

How should SVT be managed?

A
  1. Circulatory + respiratory support (correct any tissue acidosis)
  2. Vagal stimulating manoevres - 80% success
  3. IV adenosine
  4. Electrical cardioversion with synchronised DC shock if adenosine fails
86
Q

What is the common cause of rheumatic fever?

A

Group A beta-haemolytic streptococcal throat infection
Acute rheumatic fever presents 2-4w after

87
Q

What age child can get rheumatic fever?

A

5-17y

88
Q

What is the long term risk of rheumatic fever?

A

Mitral stenosis

89
Q

What are the 5 major Jones criterion for rheumatic fever?

A

CASES
Carditis
Arthritis (Polyarthritis)
Subcutaneous nodules
Erythema marginatum (map-like outlines)
Sydenham’s chorea

90
Q

What are the 5 minor criteria for rheumatic fever?

A

FRAPP:
Fever
Raised ESR >30 / CRP >3
Arthralgia
Prolonged PR
Previous RF

91
Q

What criteria are necessary to diagnose acute rheumatic fever?

A

2 Major or 1 Major + 2 minor
With evidence of preceding streptococcal infection e.g. elevated ASOT or +ve throat culture

92
Q

How should rheumatic fever be managed?

A

Bed rest
IV Benzylpenicillin STAT
PO Penicillin V for >,10d
High dose aspirin (suppresses inflammatory responses in heart + joints)
Corticosteroids (if not resolved rapidly/ signs of mod-severe carditis)

93
Q

What should be done following resolution of rheumatic fever?

A

Prophylatic monthly IM benzylpenicillin until age 21
May need surgical valve repair

94
Q

Recall the signs and symptoms of infective endocarditis in a child

A

Necrotic skin lesions: from infected emboli
Splinter haemorrhages
Changing cardiac signs
Fever, aneamia, pallor
Splenomegaly
Arthritis/ arthralgia
Clubbing

95
Q

How is infective endocarditis diagnosed in children?

A

Multiple blood cultures (before ABx) + echocardiography to identify vegetations

96
Q

What is the most common pathogen implicated in paediatric IE?

A

Streptococcus viridians

97
Q

How should infective endocarditis be managed in children?

A

6 weeks IV Abx
Strep viridians (native/prosthetic valve) = amoxicillin + gentamicin/vancomycin

Staph aureus (native valve): Amoxicillin/ vancomycin/ daptomycin

Staph aureus (prosthetic valve): nafcillin/ oxacillin

98
Q

How is the liver affected by cardiac failure?

A

May see hepatomegaly

99
Q

How is the respiratory system affected by cardiac failure?

A

Increased RR
Recurrent chest infections

100
Q

What basic investigations are necessary in cardiac failure?

A

O2 sats
BP
FBC
U+Es
calcium
BNP/ANP

101
Q

Recall systematically the management of paediatric cardiac failure

A

Decrease preload: diuretics (furosemide)/ GTN

Enhance contractility: eg digoxin, dopamine, dobutamine

Reduce afterload: ACE inhibitors

Improve oxygen delivery: B-blockers (eg carvedilol)

102
Q

How should cyanosis be managed?

A

Prostaglandin infusion

YR5 Specialties (27 decks)

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