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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How can congenital heart defects be classified?

A

Acyanotic vs. cyanotic…

Acyanotic:

  • Ventricular septal defect (VSD)
  • Atrial septal defect (ASD)
  • Persistent ductus arteriosus (PDA)

Cyanotic:

  • Tetralogy of Fallot (ToF)
  • Transposition of the great arteries (TGA)
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2
Q

Which congenital heart defects are associated with outflow obstruction in a well child?

A
  • Pulmonary stenosis

- Aortic stenosis

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3
Q

Which congenital heart defect is associated with outflow obstruction in a sick neonate?

A

Coarctation of the aorta

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4
Q

Which chromosomal disorders are associated with which specific congenital heart defects?

A
  • Down’s syndrome = AVSD
  • Turner’s syndrome = bicuspid aortic valve, CoA
  • William’s syndrome = supravalvular aortic stenosis
  • Noonan syndrome = pulmonary stenosis
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5
Q

How are congenital heart defects picked up?

A
  • Antenatal ultrasound diagnosis
  • Asymptomatic murmur
  • Symptoms of heart failure, cyanosis or shock
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6
Q

What are the features of an innocent murmur?

A

Hallmarks of an innocent murmur are (all have an S, innoSent):

  • aSymptomatic
  • Soft blowing murmur
  • Systolic murmur only, not diastolic
  • left Sternal edge
  • poSture (varies with change in posture)
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7
Q

What is an ASD?

A

An ASD is a condition where there is a hole in the atrial septum

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8
Q

Which murmur is associated with ASD?

A

Ejection systolic murmur (plus fixed split S2)

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9
Q

Describe the management of ASD

A
  • Small = close spontaneously

- Large = catheter device closure/surgery

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10
Q

Describe the epidemiology of VSDs

A

VSDs are the most common type of congenital heart defect - they account for around 30% of all congenital heart defects

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11
Q

Which murmur is associated with VSD?

A

Pansystolic murmur

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12
Q

Describe the management of VSDs

A
  • Small = close spontaneously

- Large = catheter device closure/surgery

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13
Q

What is the ductus arteriosus?

Describe the pathophysiology of PDA

A

The ductus arteriosus connects the pulmonary artery to the descending aorta (it is an essential part of the foetal circulation)

In term infants, the DA normally closes shortly after birth; in PDA, it has failed to close by 1 month after expected date of delivery

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14
Q

Which murmur is associated with PDA?

A

Continuous “machinery” murmur

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15
Q

Describe the medical and interventional management of PDA

A

Medical:
- Indomethacin or ibuprofen

Interventional:
- Catheter device closure

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16
Q

What are the four cardinal features of Tetralogy of Fallot?

A
  • Large VSD
  • Overriding aorta
  • Pulmonary stenosis (causing RV outflow obstruction)
  • and RV hypertrophy as a result
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17
Q

What are the symptoms and signs of Tetralogy of Fallot?

A

Symptoms:
- Severe cyanosis/hypercyanotic spells

Signs:

  • Ejection systolic murmur
  • Clubbing in older children
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18
Q

Describe the immediate and definitive management of Tetralogy of Fallot

A

Immediate:

  • In the sick, cyanosed neonate the key is to improve mixing of blood by maintaining patency of ductus arteriosus
  • This is done using a prostaglandin infusion

Definitive:
- Surgery to correct VSD/pulmonary stenosis

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19
Q

Describe the pathophysiology of transposition of the great arteries (TGA)

A

In TGA, the aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle

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20
Q

What are the symptoms and signs of TGA?

A

Symptoms:
- Cyanosis

Signs:
- Usually no murmur

21
Q

Describe the immediate and definitive management of TGA

A

Immediate:

  • In the sick, cyanosed neonate the key is to improve mixing by maintaining the patency of the ductus arteriosus
  • This is done using a prostaglandin infusion

Definitive:
- Arterial switch procedure

22
Q

Describe the pathophysiology of AVSD

Which group of patients is this defect most commonly seen in?

A
  • A complete AVSD is a hole in the middle of the heart with a single five-leaflet valve between the atria and ventricles, which stretches across the entire atrioventricular junction
  • This defect is most commonly seen in children with Down’s syndrome
23
Q

How is AVSD usually detected?

A

Either:

  • Detected on antenatal USS
  • Detected on routine echocardiography screening in a newborn baby with Down’s syndrome
24
Q

Describe the management of AVSD

A

Surgery to correct defect

25
Q

Describe the pathophysiology of aortic stenosis

A

Narrowing of the left ventricular outflow tract due to partial fusion of the aortic valve leaflets

26
Q

Which murmur is associated with aortic stenosis?

A

Ejection systolic murmur

27
Q

Describe the management of aortic stenosis

A

Balloon dilatation

28
Q

Describe the pathophysiology of pulmonary stenosis

A

Narrowing of the right ventricular outflow tract due to partial fusion of the pulmonary valve leaflets

29
Q

Which murmur is associated with pulmonary stenosis?

A

Ejection systolic murmur

30
Q

Describe the management of pulmonary stenosis

A

Balloon dilatation

31
Q

Describe the pathophysiology of coarctation of the aorta

A
  • Coarctation of the aorta is due to arterial duct tissue encircling the aorta just at the point of insertion of the ductus arteriosus
  • When the duct closes, the aorta constricts, causing severe left ventricular outflow obstruction
32
Q

What are the symptoms and signs of coarctation of the aorta?

A

Symptoms:
- Acute circulatory collapse, heart failure and shock in the first few days of life

Signs:
- Absent femoral pulses

33
Q

Describe the management of coarctation of the aorta

A
  • Maintain ABC
  • Maintain patency of ductus arteriosus with prostaglandin infusion
  • Surgical repair in neonatal period
34
Q

What causes rheumatic fever?

A
  • Rheumatic fever can develop following infection with group A beta haemolytic streptococcus, e.g. streptococcus pyogenes
  • The most common manifestation of this infection is streptococcal pharyngitis (strep throat)
35
Q

Describe the pathophysiology of rheumatic fever

A

Type II hypersensitivity reaction: antibodies produced against streptococcus also attack host cells (skin, joints, heart, brain)

36
Q

Which criteria can be used to describe the symptoms/signs of rheumatic fever

A

Jones criteria…

Major criteria:

  • Carditis
  • Migratory arthritis
  • Sydenham chorea
  • Erythema marginatum
  • Subcutaneous nodules

Minor criteria:

  • Fever
  • Polyarthralgia
  • Raised CRP/ESR
  • Prolonged P-R interval on ECG
37
Q

What are the potential complications of recurrent rheumatic fever?

A
  • Rheumatic HD, leading to fibrosis of the mitral valve

- This can lead to mitral stenosis/regurgitation and increased risk of infective endocarditis

38
Q

Describe the prophylactic treatment of rheumatic fever

A
  • Recurrence should be prevented once the acute episode of rheumatic fever is resolved, in order to prevent chronic rheumatic heart disease
  • Prophylactic treatment is with monthly injections of benzathine penicillin (continued for 10 years)
39
Q

Which group of patients is most at risk of infective endocarditis?

A

All patients with congenital heart disease

40
Q

What are the signs of infective endocarditis?

A

FROM JANE

  • Fever
  • Roth spots (retinal haemorrhages)
  • Osler’s nodes (nodules on finger and toe tips)
  • Murmur
  • Janeway lesions (macules on palms and soles)
  • Anaemia
  • Nail haemorrhage (splinter haemorrhage), necrotic skin lesions
  • Emboli
41
Q

What is the most common causative organism of infective endocarditis?

A

Alpha haemolytic streptococcus (streptococcus viridans)

42
Q

Describe the investigation of infective endocarditis

A
  • Blood cultures

- Echocardiography (characteristic vegetations)

43
Q

Describe the management of infective endocarditis

A
  • High dose penicillin + gentamicin (6 weeks of IV therapy)
  • If prosthetic material, e.g. valves, are present these may require surgical removal in order to fully eradicate the infection
44
Q

What advice is given to help prevent infective endocarditis?

A
  • Practise good dental hygiene

- Avoid piercings/tattoos

45
Q

What is Kawasaki disease?

A

Kawasaki disease is a systemic vasculitis

46
Q

Describe the aetiology of Kawasaki disease

A

Unknown

47
Q

Describe the clinical presentation of Kawasaki disease

A

Diagnosis of Kawasaki disease is based on the clinical features present. These clinical features include a high-grade fever persisting for at least 5 days, PLUS 4 of the following:

  • Conjunctivitis
  • Cervical lymphadenopathy (usually unilateral)
  • Polymorphous rash affecting trunk and limbs
  • Painful, red, oedematous, peeling palms and soles
  • Strawberry tongue (+/- cracked lips)
48
Q

Describe the management of Kawasaki disease

A
  • Aspirin

- IVIG

49
Q

What investigations must be undertaken in a case of suspected Kawasaki disease?

A
  • Echocardiography at baseline and repeat echo at 6 weeks

- This is important to check for coronary artery aneurysm, which is a complication of Kawasaki disease

Paediatrics (17 decks)

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