29. Peadiatric Cardiology

Question 1

What are the main classes of disorders in paediatric cardiology

Answer 1

Genetic

Acquired

Arrhythmias (mostly supraventricular tachycardia’s)

Question 2

What are some congenital conditions?

Answer 2

Marfans
Long QT syndrome
Cardiomyopathy

Question 3

What are some examples of acquired heart disease?

Answer 3

Kawasaki
Rheumatic Fever
Bacterial endocarditis

Question 4

What are the common congenital conditions of the heart

Answer 4

Ventricular Septal Defect     (VSD) 
Patent Ductus Arteriosus      (PDA) 
Atrial Septal Defect              (ASD) 
Pulmonary Stenosis 
Aortic Stenosis 
Coarctation of the Aorta 
Transposition of Great Arteries 
Tetralogy of Fallot

Question 5

What cause a higher rate of developmental abnormalities of the heart?

Answer 5

Drugs/toxins- alcohol, amphetamines

Infections- rubella, herpes

Maternal pal- diabetes, SLE

Question 6

What are the common trisomy that cause heart defects?

Answer 6

Trisomy 13- Patau syndrome

Trisomy 18- Edwards

Trisomy 21- Down’s (atrio-ventricular septal defect)

Question 7

What genetic conditions cause heart defects

Answer 7

Turner’s- co-arctation of aorta

Noonan- pulmonary stenosis

Williams- supravalvular aprtic stenosis

22q11 deletion syndrome

Question 8

What do you look for on the history of the disease

Answer 8

Cyanosis
Feeding weight and developmental 
Tachypnoea, dyspnoea
Exercise tolerance
Chest pain
Syncope
Palpitation
Joint problems 
Chest pain (usually MSK not heart)

Question 9

How does heart failure present in children?

Answer 9

Shortness of breath
Hepatomegaly
Tachycardia

Question 10

What are the most common referrals to the cardiology clinic?

Answer 10

Murmurs

Question 11

How do you examine a child with a suspected heart problem

Answer 11

Weight and height
Dysmorphic
Cyanosis
Clubbing- May also be IBD, respiratory problems 
Tachy/dyspnoea
Pulses/apex- femoral pulses
Heart sounds
Murmurs

Question 12

How do you investigate a child with a cardiac defect?

Answer 12

BP, ECG
CXR
ECHO
Angiography 
Holster monitoring
MRI angiogram
Exercise testing

Question 13

What are the treatment principles of peadiatric cardiology?

Answer 13

Can we fix it?- yes! Well fix it then

Can we fix it?- no- well make it better then (medication, palliative surgery)

Can we fix it?- no- we can’t make it better either, replace it

Question 14

What are the common features of innocent peadiatric heart murmurs?

Answer 14

Systolic murmurs
No other signs of cardiac disease
Soft murmurs
Musical quality (buzz, hmmmm)
Localised
Varies with position, respiration, exercise

Question 15

What is a still’s murmur?

Answer 15

2-7 year’s
Soft systolic vibratory musical murmur
Apex, left sternal border
Increases in supine position and with exercise

Question 16

What is a pulmonary outflow murmur?

Answer 16

8-10 years
Soft systolic, vibratory
Upper left sternal border. Well localised, no radiating to back
Increases in supine exercise

Question 17

What is a carotid/brachiocephalic arterial bruits?

Answer 17

Occurs at age 2-10 years
Radiates to neck
Increased with exercise
Decreases when yiu turn neck to the side

Question 18

What is the venous hum?

Answer 18

3-8 years
Soft indistinct
Supraclavicular
Occurs upright, disappears lying down

Question 19

What are the different types of ventricular septal defects?

Answer 19

Subaortic
Perimembranous
Muscular

Closer to the apex the more worrying it is

Shunts are L->R

Question 20

What are the clinical presentations of ventrosepticular defects

Answer 20

Pansystolic murmer
LL sternal edge
Early systolic murmurs
Diastolic rumble due to relative mitral stenosis
Signs of cardiac failure in large VSD’s- leads to hypertrophy and pulmonary hypertension