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Cardiac Flashcards

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1
Q

Signs of acute decompensation of heart disease

A
  • Difficulty feeding
  • Brady (imminenet arrest)
  • Hepatomegaly
  • Acidosis
  • Cyanosis
  • Dyspnoea
  • Tachycardia
  • Cool peripheries
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2
Q

What is the management of heart failure in a child

A
  • Sit up right
  • O2
  • NGT
  • Furesomide
  • +/- spironalactonr
  • ACEi
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3
Q

Examples of cyanotic heart disease

A
  • AV septal defect
  • Tetralogy of Fallot
  • Pulmonary/tricuspid atresia
  • transposition of the great vessels
  • total anomalous pulmonary venous return
  • truncus arteriosus
  • hypoplastic left heart
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4
Q

What are the key features of tetralogy of Fallot

A
  • Large VSD
  • Overriding aorta
  • Pulmonary stenosis
  • Right ventricular hypertrophy
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5
Q

Signs and symptoms of tetralogy of Fallot

A
  • Early systolic murmur left lower sternal edge
  • hypoxia: distress and pallor
  • Hypercyanotic episodes
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6
Q

Management of tetralogy of fallot

A
  • Corrective surgery at 6 months old
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7
Q

Examples of acyanotic heart disease

A
  • Patent ductus arteriosis
  • VSD
  • ASD
  • Coarctation
  • Aortic/Pulmonary stenosis
  • Mitral/tricuspid stenosis
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8
Q

What is the most common presentation of HF in children

A

poor weight gain
tachypnoea/wheeze
clear lung fields

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9
Q

What is the most common heart defect assoc with trisomy 21

A

atrio-ventricular septal defect

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10
Q

What is the most common benign murmur heard in infants

A

Short, systolic murmur over lower left sternal border and child is otherwise well

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11
Q

What is the most common type of heart defect assoc with William’s Syndrome

A

Supravalvular aortic stenosis

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12
Q

What is the most common type of heart defect assoc with Noonan’s syndrome

A

dysplastic pulmonary valve

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13
Q

What is the most common type of heart defect assoc with 22 q deletion

A

truncus arteriosis and tetralogy of fallot

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14
Q

What is the most common type of heart defect assoc with Holt Oram syndrome

A

atrial septal defects

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15
Q

Systolic murmur heard best at the cardiac apex

A

mitral regurgitation

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16
Q

Diastolic murmur heard best at the cardiac apex

A

mitral stenosis

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17
Q

Systolic murmur heard best at the lower left sternal border

A

Ventricular septa defect
tricuspid regurgitation
Common atrioventricular valve with regurgitation

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18
Q

Systolic murmur heard best at the upper left sternal border

A

pulmonary stenosis
patent ductus arteriosus
aortic stenosis
atrial septal defect

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19
Q

diastolic murmur heard best at the upper left sternal border

A

pulmonary regurgitation

aortic regurgitation

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20
Q

continuous murmur heard best at the upper left sternal border

A

Patent ductus arteriosus

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21
Q

Systolic murmur heard best at the neck/aortic area

A

aortic stenosis

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22
Q

Systolic murmur heard best at the back

A

coarctation of the aorta

pulmonary stenosis

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23
Q

Which congenital heart defects manifest symptoms of HF

A

Large VSD
AVSD
patent ductus arteriosus

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24
Q

Which congenital heart defects tend to be asymptomatic unless severe

A

Pulmonary stenosis
ASD
Aortic stenosis

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25
What do you have to worry about in children with congenital heart defects
Prone to bacterial growths - look for signs of endocarditis - splinter haemorrhages - persistent fever - Oslo's nodes - splenomegaly - microscopic haematuria
26
What advice should be given to individuals at risk of endocarditis
- avoid tattoos and piercings - regular dental hygiene - prompt attention to dental issues - prophylactic antibiotics are no longer recommended following dental procedures.
27
Mitral regurgitation
systolic murmur cardiac apex
28
Mitral stenosis
diastolic murmur cardiac apex
29
VSD
systolic murmur lower left sternal border
30
tricuspid regurgitation
systolic murmur lower left sternal border
31
common atrioventricuoar valve with regurgitation
systolic murmur lower left sternal border
32
Pulmonary stenosis
systolic murmur upper left sternal border
33
patent ductus arteriosus
systolic/continuous murmur upper left sternal border
34
ASD
systolic murmur upper left sternal border
35
aortic stenosis
systolic murmur upper left sternal border Into the carotid/aortic area often assoc with a thrill
36
pulmonary regurgitation
diastolic murmur upper left sternal border
37
aortic regurgitation
diastolic murmur upper left sternal border
38
Coarctation of the aorta
systolic/continuous murmur heard best at the back Systolic pressure higher in upper extremities Absent/weak femoral pulses
39
What may causes central cyanosis
congenital heard disease pulmonary disease abnormal haemoglobins (methemoglobins/sulhaemoglobin)
40
What are the clinical features of central cyanosis
affects whole body skin and mucosa blue pulse oximetry abnormal
41
What may cause peripheral cyanosis
``` sluggish circulation HF Shock exposure to cold temperatures Arterial obstruction - Raynaud venous obstruction (DVT) ```
42
What are the clinical features of peripheral cyanosis
localised to peripheries skin blue but mucosa pink pulse ox generally normal.
43
What is the most common site for coarctation of the aorta
segment of aorta adjacent to ductus arteriosus
44
What is the management of coarctation of the aorta
- surgical interventino to prevent LV dysfunction - angioplasty (re-coarctation can occur) - Rx of HTN
45
what are the x ray findings in coarctation of the aorta
rib notching - doesn't really occur in infancy
46
what is the outcome of persistent L to r shunting
increase pulmonary resistance & severe pulmonary htn resulting in a R to L shunting causing cyanosis anf sometimes clubbing
47
what is the pathophysiology of asd
oxygenated bloods passes from left to right atrium mixing with deoxygenated blood most common CHD to be missed until adulthood
48
what is the most common asd
ostium secundum- centre of the septum
49
What is a patent ductus arteriosus
- persistence of fetal vessel which connects aorta with pulmonary artery - Normailly closes in 1st week of life - 10% of all CHD - FEMALE>MALE - often assoc with coarctation and VSD
50
What is thr pathophysiology of a patent ductus arteriosus
higher aortic pressure causes blood to shunt through to the pulmonary artery.
51
What other clinical features other than a murmur may a patient have with a PDA
- if severe, symptoms of HF - widened pulse pressure - bounding arterial pulse - enlarged heart with prominent apical pulse
52
What is the treatment of PDA
usually done by ligation and division or intravascular coil in catheterisation lab. Needed to prevent HF and pulmonary disease
53
What is truncus arteriosus
- failure of septum formation in truncus arteriosus to form pulmonary artery and aortic artery - controlled only with 1 valve - Most patients have a VSD
54
What is a transposition of the great vessels
aortic artery and pulmonary artery are swapped. | Requires at least 1 shunt - ASD or VSD or PDA
55
What is tricuspid atresia
Tricuspid valve never formed which means a patient requires both a VSD and an ASD to allow blood to go to the lungs to become oxygenated
56
What is an over-riding aorta
the aorta takes blood from both the right and left ventricles
57
What is total anomalous pulmonary venous connection
``` Both pulmonary veins and SVC + IVC all terminate in the right atria causing mix of oxygenated and deoxygenated blood. Needs ASD ( Or PDA) to move blood from right atria to left atria to ensure it goes into the peripheral circulation. ```
58
What is the role prostaglandin E
Keep PDA open in conditions such as transposition of the great arteries or total anomalous pulmonary venous connetion
59
What are the risk factors associated with transposition of the great arteries
mother is: - diabetic - >40 - alcohol use - poor nutrition - having rubella
60
What is the most common cyanotic hear disease
tetralogy of fallot
61
what may you classically see on cxr in a pt with tetralogy of fallot
boot shaped heart
62
What heart defect MUST you have to survive truncus arteriosus
VSD
63
What cxr findings may you seen in a patient with transposition of the great arteries?
egg on a string
64
How long before symptoms of tricuspid atresia occur
immediately - surgery is required at birth
65
How do you manage tricuspid atresia
3 stage operation 1. Blalock–Thomas–Taussig shunt 2. hemi-fontan procedure 3. IVC then drains into pulmonary artery
66
What is the Blalock–Thomas–Taussig shunt
like a PDA which allows mixing to happen
67
What is a hemi-fontan procedure
some of the blood drains into pulmonary artery from SVC
68
Where is the most common location for pulmonary veins to drain in total anomolous venous return
Most are supracardiac - into SVC (50%) IVC 20% right atrium 20% mixed 10%
69
What arrhythmia are children with WPW prone to
SVT
70
What is the management of WPW
radiofrequency ablation of the accessory pathway
71
What are the ECG findings of WPW
- Shortened PR - Prolonged QRS - slurring of upstroke of QRS
72
What drug is used to maintain patency of ductus arteriosus
prostaglandin infusion
73
Duct dependent lesions associated with pulmonary flow
``` pulmonary atresia critical pulmonary htn tetralogy of fallot tricuspid atresia Severe TR Severe Epsteins anomalie ```
74
Duct dependent lesions associated with systemic blood flow
critical aortic stenosis coarctation of the aorta Interruption of the aortic arch left hypoplastic heart syndrome
75
What is coarctation of the aorta
Narrowing of descending aorta adjacent to the point where the ductus arteriosus joins
76
What us hypoplastic left heart syndrome
characterised by - hypoplasia of left ventricle - atresia/critical stenosis of aortic valve +/or mitral valve - hypoplasia of the ascending aorta and aortic arch - Coarctation of aorta often associated
77
What is the management of hypoplastic left heart
- IV prostglandin to keep duct open - univentricular circulation where one ventricle supports both pulmonary and systemic circulation - needs a staged surgical approach
78
Physiological causes of palpitations
exercise excitement fever
79
Psychogenic causes of palpitations
stress anxiety panic attacks
80
Cardiac causes of palpitations
``` arrythmias congenital heart disease post surgical cardiomyopathies cardiac tumours or infiltrative conditions ```
81
Other medical causes of palpitations
anaemia thyrotoxicosis hypoglycaemia
82
What is the most common abnormal cardiac ryhtm disturbance in children which requires treatment
SVT
83
What is the recomended management of SVT
- vagal manouveres: ice cold water on the fact, carotid sinus massage, valsalva - adenosine bolus
84
What is the udnerlying mechanism of SVT in children
accessory pathway
85
What are the ECG features of wolf parkinson white
short PR interval delta wave prolongation of QRS (secondary to early take off)
86
What can be used to prevent SVT in children
beta blockers | - children who can't verbalise their symptoms and have less cardiac reserve
87
What is the difinitive treatment of accessory pathways
radio-frequency ablation
88
what type of cardiomyopathy are you at risk of with maternal diabetes?
hypertrophic obstructive
89
Who can't have indomethacin for closure of PDA
- renal impairment - NEC - intraventricular haemorrhage

Paediatrics (21 decks)

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