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Y5 Paediatrics > Cardiac > Flashcards

Cardiac Flashcards

(75 cards)

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1
Q

What kind of shunts cause breathlessness?

A

left to right shunts

They drive oxygenated blood into lungs > less oxygenated blood to body > dyspnoea to attempt to compensatw

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2
Q

What are the left to right shunts?

A

VSD
ASD
PDA
AVSD

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3
Q

What kind of shunts cause cyanosis

A

right to left shunts

they drive deoxygenated blood from the R side of heart into the L side of circulation > into body

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4
Q

What are the right to left shunts?

A

Tetralogy of fallot

Transposition of great arteries

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5
Q

What is the function of the foramen ovale

A

allow blood to flow from R atrium to L A > systemic circulation

This is useful in a foetus because blood in R atrium comes from umbilical vein: it is oxygenated

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6
Q

Why does the foramen ovale shut

A

Due to changes in pressure
After birth
When resistance to pulmonary blood flow falls (due to breathing)
And volume of blood returning to right atrium falls (due to placenta being excluded)

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7
Q

What does the ductus arteriosus connect?

A

Pulmonary artery to aorta

Allows pulmonary blood to bypass the lungs

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8
Q

What are features of an innocent ejection murmur

A

InnoSSSSent

aSymptomatic
Soft blowing
Systolic only (not diastolic)
left Sternal ege

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9
Q

How do you manage heart failure

A

Reduce preload - DIURETICS e.g furosemide
Enhance contractility e.g. dopamine, digoxin
Reduce afterload e.g. ACe inhibitors, hydralazine

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10
Q

WHat does central cyanosis present as

A

Tongue is slate blue

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11
Q

What does peripheral cyanosis present as

A

Child is cold / unwell or with polycythaemia

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12
Q

What investigations must you get for chanosis

A

CXR, ECG
Echo with doppler
Specialist opinion

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13
Q

What are complications of heart disease in children?

A

Heart failure, SOB
Faltering growth
Recurrent chest infections
Infective endocaridtis

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14
Q

What are the two types of atrial septal defect

A

Secundum ASD

Partial AVSD

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15
Q

What is secundum ASD

A

Large defect in ASD, involves foramen ovale

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16
Q

How does ASD present

A

No symptoms
Reccurent chest infections / wheeze
Arrythmia (from 40yo)

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17
Q

What are ASD murmur

A

Ejection systolic murmur

Split second heart sound

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18
Q

What physical effect does ASD have on the heart

A

right ventricular dilatation

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19
Q

How do you manage ASD

A

OBSERVATION: as defect may close / shrink over time

Measure ratio of pulmonary:systemic blood flow

  • <1.5 no closure
  • > 1.5 or ASD large enough to cause RV dilatation: closure

Secundum:; cardiac catheterisation, insert occlusive device
Partial: surgical correction

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20
Q

What age is ASD treated at

A

3-5 years old

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21
Q

What is a ventricular septal defect categorised as

A 
Small = smaller than aortic valve 
Large = larger than aortic valve
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22
Q

What is the murmur occurring with large VSD

A

pansystolic

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23
Q

When should the ductus arteriosus close

A

1 month after expected delivery date

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24
Q

How do you manage patent ductus arteriosus

A

Close using coil / occlusive device through cardiac catheter

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25
What test shows RtL shunt?
Hyperoxia (Nitrogen Washout) test
26
How does Hyperoxia (Nitrogen Washout) test work
place infant in 100% oxygen for 10 minutes | if PaO2 stays low (<15kPA) >> CYANOTIC HEART DISEASE
27
How do you manage a cyanosed neonate
ABC > artificial ventilation if necessary Start prostaglandin infusion immediately to maintain duct patency (key for survival) Surgery at 6 months
28
What kind of blood movement occurs in cyanotic heart disease (RtL shunt)
deoxygenated blood into systemic circulation
29
What are the abnormalities in tetralogy of fallot
Ruksana Validates Orkid's Patheticness RV hypertrophy VSD Overriding aorta Pulmonary artery stenosis
30
What is the outcome of the tetralogy of fallot
Excessive strain on RV
31
What is the key presentation in TOF
Severe cyanosis Hypercyanotic spells Squyatting on exercise
32
When does TOF present
Cyanosis within months / yeara | Worse when crying / feeding
33
What murmur occurs in TOF
LOUD ejection systolic
34
What is CXR presentation in TOF
boot shaped heart
35
What is the TGA
aorta and pulmonary arteries swap places So two completely independent systems form Incompatible with life, but foetus survives in utero due to patent ductus arteriosus
36
When does TGA present in neonate
within DAYS !!!! as soon as ductus arteriosus closes
37
What is CXR appearance of TGA
Egg on stick
38
What surgery is done in TGA
Balloon atrial septostomy - break flap valve of foramen ovale and encourage mixing of blood then Arterial Switch procedure
39
What is Eisenmenger syndrome aetiology
Large Left to right shunt not treated early Causes pulmonary arteries to become hypertrophied, resistance to flow increases > increased pulmonary vascular resistance > RIGHT TO LEFT SHUNT FORMED
40
How does Eisenmenger syndrome present
``` 20-40 year olds Triad CHE - Cyanosis - HF - Erythrocytosis ```
41
What is the treatment for Eisenmenger syndrome
heart-lung transplant
42
Who is ASVD common in
Down syndrome
43
What is ASVD
large valve stretching across entire atrio ventricular junction
44
What are outflow obstructions that occur in a well child
Aortic stenosis Pulmonary stenosis Aortic coarctation
45
Explain aortic stenosis
Aortic valve leaflets fuse together | this restricts exit from left vntricle
46
How do you treat aortic stenosis
balloon valvulotomy / aortic valve replacement
47
What are aortic stenosis feratures
reduced exercise tolerance chest pain syncope
48
what is aortic coarctation
narrowing of the aorta
49
what are features of adult aortic coarctation
``` gets progressively more severe asymptomatic systemic HTN in right arm Ejection systolic murmur Radio femoral delay ```
50
What signs present on CXR in aortic coarctation
``` Rib notching (due to delevlopmentof large collatewral intercostal arteries() 3 sign (visible notch( ```
51
How do you manage aortic coarctation
stent
52
what are features of child aortic coarctation
acute circulatory collapse on day two when ductus closes
53
What is rheumatic fever
Multisystem immune response to preceding infection with group A beta haemolytic strep
54
How many people does RF progress to RHD
up to 80%
55
What are sx of Rheumatic fever
2-6 weeks after pharyngeal / skin infection | Polyarthritis, fever, malaise
56
How do you treat RHD
Aspirin (suppress inflammatory response of joint and heart) Anti-strep antibiotics (PenV, benzylpenicillin, amoxicillin) Corticosteroids
57
Who do you give prophylaxis to prevemnt RHD
Until age of 21 / 10 years after RF
58
What is prophylaxis for RHD
benzathine penicillin MONTHLY for 10 years since last episode or until age of 21
59
What criteria are used for RF diagnosis
Jones criteria
60
What investigations do you do for IE
Blood cultures | Echo (vegetations on valve leaflet)
61
What is the most coommon pathogen to cause IE
Strep Viridans
62
What is treatment for Strep viridans on native / prosthetic valves
beta lactam + gentamycin, 6 weeks
63
what are presenting signs of PDA
``` left subclavian thrill continuous machinery murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat ```
64
How do you manage aortic coarctation in neonates (usually presenting at 48h old, when DA closes)
Prostaglandin infusion to maintain patency | Surgical repaair
65
How do you manage SVT
if haemodynamically stable: vagal maneuvres, adenosine | If unstable: cardioversion
66
How do you manage tetralogy of fallot
prostaglandin infusion Blalock Taussig shunt Definitive surgery to repair defect from 4m onward
67
What is Blalock Taussig shunt
artificial tube between subclavian artery and pulmonary artery
68
What dwefects are repaired by surgery in TOF
Close VSD | Relieve right ventricle outflow obstruction
69
How do you manage hypercyanotic spells in TOF
1. place patient in knees to chest position 2. aadminister oxygen 3. IV line > phenylpeprhine, morphine suplhate, propanolol 4. sodium bicarb if prolonged attacks 5. refer. to cardiac centree
70
describe a hypercyanotic spell in TOF
attack of paroxysmal hyperpnoea and increased cyanosis occur spontaneously OR after feeding/prolonged crying/defcation
71
How do you manage tricuspid atresia
Medical: prostaglandin infusion + cardioresp support (oxygen, mechanical vent, inotropes, IV fluid) Blalock Taussig shunt insertion > corrective surgery
72
What sound do you hear in VSD
loud pansystolic murmur at lower left sternal edge | Quiet pulmonary second heart sound
73
How do youm manage VSD
Observation (small shunts close spontaneously) Prophylactic amox if high risk of developing endocarditis large VSD: open heart surgerty
74
what are side effects of prostaglandins
apnoea jittering seizures flushing vasodilation hypotensions
75
what are the top causes of a grey baby who is cyanotic at 3-5 days
sepsis TGA inborn errors of metabolism NAI

Y5 Paediatrics (30 decks)

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