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3rd Year - Paediatrics > 5. Paediatric Cardiology > Flashcards

5. Paediatric Cardiology Flashcards

1
Q

What are the 8 Commonest Congenital Heart Disease Lesions?

A
  1. Ventricular Septal Defect (VSD)
  2. Patent Ductus Arteriosus (PDA)
  3. Atrial Septal Defect (ASD)
  4. Pulmonary Stenosis
  5. Aortic Stenosis
  6. Coarcation of the Aorta
  7. Transposition of the Great Arteries
  8. Tetralogy of Fallot
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2
Q

What is the Aetiology of Congenital Heart Defects?

A
  1. Genetic Susceptibility (Chromosomal Abnormalities)

2. Teratogenic Insult (Environmental Factors)

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3
Q

What are the Genetic Susceptibility (Chromosomal Abnormalities) Factors which contribute to Congenital Heart Defects?

A
  1. a) Trisomy 13 (VSD & ASD)
  2. b) Trisomy 18 (VSD & PDA)
  3. c) Trisomy 21 (AVSD)
  4. Turner - Co-Arctation of the Aorta
  5. Noonan - Pulmonary Stenosis
  6. Williams - Supraventricular AS
  7. 22q11 Deletion Syndrome
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4
Q

What are the Teratogenic Insult (Environmental) Factors which contribute to Congenital Heart Defects?

A
  1. Drugs - Alcohol / Cocaine / Ecstacy / Lithium
  2. Infections - TORCH (Toxoplasmosis / Rubella / CMV / Herpes)
  3. Maternal - Diabetes / Systemic Lupus Erythomatous
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5
Q

What needs to be asked about in a Congenital Heart Defect History?

A
  1. Feeding / Weight / Development
  2. Cyanosis
  3. Tachypnoea / Dyspnoea
  4. Exercise Tolerance
  5. Chest Pain
  6. Syncope
  7. Palpitation
  8. Joint Problems
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6
Q

What needs to be looked for in a Congenital Heart Defect Examination?

A
  1. Weight / Height
  2. Dysmorphic Features
  3. Cyanosis
  4. Clubbing
  5. Tacypnoea / Dyspnoea
  6. (Femoral) Pulses / Apex Beat
  7. Heart Sounds / Murmurs
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7
Q

What Investigations should be done if a Congenital Heart Defect is suspected?

A
  1. Blood Pressure
  2. O2 Saturation / ABG
  3. ECG / Echocardiogram / Angiography
  4. MRI / Chest X-Ray
  5. Catheter
  6. Exercise Tolerance
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8
Q

What are the Different Classifications of Murmurs?

A
  1. Cardiac Cycle Timing - Systole / Diastole / Continuous
  2. Duration:
  3. a) Early / Mid / Late
  4. b) Ejection / Holo/ Pan Systolic
  5. Pitch / Quality:
  6. a) Harsh / Mixed Frequency (Turbulence)
  7. b) Soft / Intermittent
  8. c) Vibratory / Pure Frequency (Laminar Flow)
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9
Q

What are the Murmur Sites?

A
  1. Upper Right Sternal Border
  2. Upper Left Sternal Border
  3. Lower Left Sternal Border
  4. Apex
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10
Q

What are the 4 Types of Innocent Murmurs?

A
  1. Left Ventricular Outflow Murmur (Still’s Murmur)
  2. Pulmonary Outflow Murmur
  3. Carotid / Brachiocephalic Arterial Bruits
  4. Venous Hum
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11
Q

What are the Common Features of Innocent Murmurs?

A
  1. Systolic Murmur
  2. No other Signs of Cardiac Disease
  3. Soft Murmur - Grade 1/6 or 2/6
  4. Vibratory / Musical
  5. Localised
  6. Varies with Position / Respiration / Exercise
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12
Q

What are the Specific Features of a Left Ventricular Outflow Murmur (Still’s Murmur)?

A
  1. Common Presentation Age = 2-7 years old
  2. Described as Soft Systolic / Vibratory / “Twangy”
  3. Heard in the Apex / Left Sternal Border
  4. Increases in Supine Position and with Exercise
  5. Between S1 and S2
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13
Q

What are the Specific Features of a Pulmonary Outflow Murmur?

A
  1. Common Presentation Age = 8-10 years old
  2. Described as Soft Systolic / Vibratory
  3. Heard in the Upper Left Sternal Border - Well Localised / Not Radiating to the Back
  4. Increases in Supine Position with Exercise
  5. Heard Between S1 and S2
    Note - Often Children with a Narrow Chest
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14
Q

What are the Specific Features of a Carotid / Brachiocephalic Arterial Bruit?

A
  1. Common Presentation Age = 2-10 years old
  2. Described as 1/6-2/6 Systolic / Harsh
  3. Heard in Upper Supraclavicular - Radiating to Neck
  4. Increases with Exercise
  5. Decreases on Turning Head / Extending Neck
  6. Heard Between S1 and S2
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15
Q

What are the Specific Features of a Venous Hum?

A
  1. Common Presentation Age = 3-8 years old
  2. Described as Soft / Indistinct / Continuous Murmur (Sometimes with Diastolic Accentuation)
  3. Heard in Upper Supraclavicular
  4. Only heard in the Upright Position - Disappears on Lying Down
  5. Heard Between S2 and S1, and S1 and S2
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16
Q

What are the 3 Main Types of Ventricular Septal Defects?

A
  1. Subaortic
  2. Perimembranous
  3. Muscular
17
Q

What is the Clinical Presentation of a Ventricular Septal Defect?

A
  1. Pansystolic Murmur at the Lower Left Sternal Edge
  2. Early Systolic Murmur - in Very Small VSD’s
  3. Diastolic Rumble due to Relative Mitral Stenosis - in Very Large VSD’s
  4. Signs of Cardiac Failure - in Large VSD’s
  5. Bivertricular Hypertrophy - Eventually
  6. Pulmonary Hypertension - Eventually
18
Q

How is a Ventricular Septal Defect closed?

A
  1. Amplatzer Device

2. Patch Closure

19
Q

What are the Features of Atrial Septal Defects?

A
  1. Few Clinical Signs in Early Childhood
  2. May Spontaneously Close
  3. Sometimes detected in Adulthood - Atrial Fibrillation / Heart Failure / Pulmonary Hypertension
  4. Wide, Fixed, Splitting of 2nd Heart Sound
  5. Pulmonary Flow Murmur
20
Q

What is Atrioventriculo-Septal Defect?

And what is it associated with?

A

Singular AV Valve with Ostium Primium ASD and High VSD

Associated with Trisomy 21

21
Q

What are the Clinical Features of Pulmonary Stenosis?

A
  1. Asymptomatic in Mild Stenosis
  2. Exertional Dyspnoea in Moderate - Severe Stenosis
  3. Exertional Fatigue in Moderate - Severe Stenosis
  4. Ejection Systolic Murmur in the Upper Left Sternal Border, with Radiation to the Back
22
Q

What are the Clinical Features of Aortic Stenosis?

A
  1. Mostly Asymptomatic
  2. Reduced Exercise Tolerance (Exertional Chest Pain / Syncope) if Severe
  3. Ejection Systolic Murmur in the Upper Right Sternal Border, with Radiation into the Carotids
23
Q

What are the Changes in the Foetal Circulation at Birth?

A
  1. Pulmonary Vascular Resistance Falls
  2. Pulmonary Blood Flow Rises
  3. Systemic Vascular Resistance is Increased
  4. Ductus Arteriosus Closes
  5. Foramen Ovale Closes
  6. Ductus Venosus Closes
24
Q

What are the Features of Patent Ductus Arteriosus (Botalli)?

A
  1. Abnormal Blood Flow between the Aorta and the Pulmonary Artery
  2. Very Common in Pre-Term Infants
  3. In-Term Babies - good chance of Spontaneous Closure
  4. Treatment with Fluid Restriction / Diuretics / Prostaglandin Inhibitors (Ibuprofen) / Surgical Ligation
25
Q

What is the Management of Co-Arctation of the Aorta?

A
  1. Reopen Patent Ductus Arteriosus with Prostaglanding E1 / E2
  2. Resection with End-to-End Anastomosis
  3. Subclavian Patch Repair
  4. Balloon Aortoplasty

3rd Year - Paediatrics (40 decks)

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