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Paediatrics > Cardiac disease > Flashcards

Cardiac disease Flashcards

1
Q

What is the most common congenital heart disease?

A

VSD

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2
Q

What are the R-L shunts?

A

Tetralogy of Fallot (TOF)

Transposition of the Great Arteries (TGA)

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3
Q

What colour would you expect an infant with a R-L shunt to be?

A

Cyanosed - blue

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4
Q

What are the L-R shunts?

A

VSD
ASD
Patent/persistent ductus arteriosus (PDA)

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5
Q

How does heart failure tend to come about in neonates?

A

Obstructed systemic circulation

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6
Q

What are the causes of neonatal heart failure?

A
  1. Hypoplastic L heart syndrome
  2. Critical aortic valve stenosis
  3. Severe aortic coarctation
  4. Interruption of the aortic arch
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7
Q

How does heart failure tend to come about in infants?

A

High pulmonary blood flow

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8
Q

What are the causes of infant heart failure?

A
  1. VSD
  2. ASD
  3. Large PDA
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9
Q

How does heart failure tend to come about in older children/adolescence?

A

R or L sided heart failure

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10
Q

What are the causes of older children/adolescent heart failure?

A
  1. Eisenmenger
  2. Cardiomyopathy
  3. Rheumatic
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11
Q

When is a VSD considered small?

A

Smaller than the aortic valve (i.e.

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12
Q

When is a VSD considered large?

A

Larger than the aortic valve (i.e. >~3mm)

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13
Q

How does a small VSD present?

A

Asymptomatic

HS - PANSYSTOLIC, loud murmur at lower L sternal edge

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14
Q

What are the heart sounds (HS) for a small VSD?

A

PANSYSTOLIC, LOUD, at the lower L sternal edge

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15
Q

A loud murmur implies what?

A

A smaller defect (greater turbulance)

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16
Q

What is the management for a small VSD?

A

Advise will close spontaneously

F/U with paediatrician + discharge with normal ECG and Echo

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17
Q

How does a large VSD present?

A

After 1 week of age, the child’s growth begin to falter and becomes SOB + tachycardic. If a more subtle change in these signs, may present with recurrent chest infections. Child is in heart failure, hepatomegaly present as result of HF
HS - PANSYSTOLIC, soft murmur at lower L sternal edge, may be no murmur

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18
Q

What are the HS in a large VSD

A

PANSYSTOLIC, SOFT murmur at lower L sternal edge BIT may be NO MURMUR

19
Q

In a child with a large VSD, what would you see on their CXR?

A
  1. Cardiomegaly
  2. Enlarged pulmonary arteries
  3. Increased pulmonary vascular markings
  4. Pulmonary oedema
20
Q

By what age, in a child with a large VSD, would you see ECG changes, and what are those changes?

A

By 2 months you would expect to see biventricular hypertrophy

21
Q

How is a child with a large VSD managed?

A

Management by paediatric MDT
Sx of heart failure treated with diuretic + captopril
Additional calorie intake - dietician input
Advise parents child will require surgery, usually at 3-6 months

22
Q

What are the two types of ASD?

A
  1. Secundum ASD - 80%

2. Partial atrioventricular septal defect

23
Q

What is a secundum ASD?

A

Involves centre of atrial septum, involving foramen ovale

24
Q

What is different about the mitral (L AV) valve in partial atrioventricular septal defects?

A

It is tricuspid, where it is usually bicuspid

25
Q

How do ASD’s present?

A

Usually asymptomatic
May have recurrent wheeze/chest infections
HS - ESM at UPPER L sternal edge

26
Q

What are the HS in ASD?

A

ESM at UPPER L sternal edge (due to increased flow across the pulmonary valve from the L to R shunt)

27
Q

How is an ASD managed?

A

If the ASD is large enough such that it is causing R ventricle dilatation intervention is required. This will usually take place between 3 and 5 y/o. A secundum ASD = insertion of an occlusion device in cath lab, a partial AVSD = surgical correction

28
Q

Which children are at greater risk of TGA?

A

Those born to mothers with poorly controlled/uncontrolled diabetes during pregnancy

29
Q

When does cyanosis become most pronounced in TGA + why?

A

2nd day of life - if these is no concurrent septal defect, closure of the DA on the 2nd day results in a loss of mixing, hence cyanosis. It is less pronounced if there is a concurrent VSD etc.

30
Q

What are the HS in TGA?

A

II HS is LOUD and SINGLE
There isn’t necessarily a murmur, but if there is, it will be systolic + due to increased outflow into the L (in this case pulmonary) outflow tract

31
Q

What is the classical appearance of TGA on CXR?

A
  1. Narrow upper mediastinum
  2. Egg-on-side appearance
  3. Increased pulmonary vascular markings
32
Q

What is the management of TGA?

A

MUST FACILITATE MIXING
1. Prostaglandin-infusion - maintain DA patency
2. Atrial septostomy - essentially, tearing of the atrial septum via balloon catheter
(The above are ‘buying time’ procedures)
3. Definitively = arterial switch procedure

33
Q

What are the features of TOF?

A
  1. Large VSD
  2. Overriding of the aorta
  3. Sub-pulmonary stenosis
  4. RV hypertrophy
34
Q

What is the ‘classic’ presentation of TOF?

A

Severe cyanosis +
Hypercyanotic (Tett) spells +
Squatting on exercise +
Clubbing

35
Q

How does TOF usually present now, in developed countries?

A

Dx from USS antenatally or cyanosis + murmur in first 2/12

36
Q

What is the HS in TOF

A

LOUD, HARSH, ESM from first day of life at pulmonary listening point

37
Q

What are the classical findings of TOF on CXR?

A
  1. ‘Boot-shaped’ heart
  2. Decreased pulmonary markings (due to decreased pulmonary flow)
  3. Pulmonary artery bay
38
Q

When is definitive surgery performed for TOF, and what is done?

A

At 6 months

The VSD is closed and RV outflow tract obstruction is relieved

39
Q

When is a hypercyanotic spell considered ‘prolonged’ and what is done about it?

A

Prolonged = beyond 15 mins
Sedation + pain relief; IV propranolol; IV fluids; bicarbonate for acidosis; muscle paralysis and ventilation to reduce O2 requirement

40
Q

What does absent femoral pulses mean in the context of congenital heart disease?

A

Coarctation of the aorta

41
Q

When does the DA usually close by?

A

Within 2 days of birth

42
Q

What is the definition of PDA?

A

If the DA has remained patent for >1 month after the EDD

43
Q

What are the signs in PDA?

A
  1. Continuous murmur, below the L clavicle, that continues into diastole
  2. Collapsing/bounding pulse

Paediatrics (27 decks)

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