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cardiac disorders Flashcards

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1
Q

causes of a left-to-right shunt?

A
  • VSD
  • ASD
  • PDA
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2
Q

presentation of left-to-right shunt?

A

breathless

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3
Q

causes of a right-to-left shunt?

A
  • ToF

- TGA

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4
Q

presentation of a right-to-left shunt?

A

blue

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5
Q

a) how does AVSD present?

b) why?

A

a) blue and breathless

b) blood from both ventricles is mixing

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6
Q

causes of outflow obstruction in a WELL child?

A
  • PS

- AS

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7
Q

cause of outflow obstruction in a sick neonate?

A

CoA

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8
Q

which cardiac conditions can a maternal rubella infection cause?

A
  • peripheral pulmonary stenosis

- PDA

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9
Q

cardiac presentation in child where there is maternal SLE?

A
  • complete heart block
  • anti-Ro
  • anti-La
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10
Q

which cardiac conditions can maternal warfarin therapy cause?

A
  • pulmonary valve stenosis

- PDA

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11
Q

which cardiac conditions can foetal alcohol syndrome cause?

A
  • ASD
  • VSD
  • ToF
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12
Q

congenital heart diseases seen in Down syndrome?

A
  • AVSD

- VSD

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13
Q

immediate management in duct-dependent cyanosis?

A

prostaglandin!!!

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14
Q

causes of ejection systolic murmur?

A
  • AS
  • ASD
  • PS
  • HOCM
  • ToF
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15
Q

causes of pansystolic murmur?

A
  • MR
  • TR
  • VSD (‘harsh’)
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16
Q

causes of a late systolic murmur?

A
  • MV prolapse

- CoA

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17
Q

causes of an early diastolic murmur?

A
  • AR

- PR

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18
Q

cause of continuous murmur?

A

PDA

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19
Q

which conditions could bring on an innocent murmur?

A
  • febrile illness

- anaemia

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20
Q

4 Ss of an innocent murmur?

A
  • soft blowing
  • systolic only
  • sternal edge (left)
  • symptomless (pt is asymptomatic)
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21
Q

presentation of heart failure?

A
  • breathlessness
  • sweating
  • poor feeding (and FTT)
  • recurrent chest infections
  • tachypnoea
  • tachycardia
  • hepatomegaly
  • cool peripheries
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22
Q

character of murmur heard in heart failure?

A

galloping rhythm

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23
Q

causes of right-sided heart failure?

A
  • pulmonary hypertension
  • long-standing rheumatic fever
  • tricuspid regurgitation
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24
Q

signs of right heart failure?

A
  • ankle oedema
  • sacral oedema
  • ascites
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25
commonest cause of heart failure in neonate?
- coarctation of the aorta - severe aortic stenosis - any other left ventricular outflow obstruction
26
causes of heart failure in infants?
- high pulmonary blood flow - VSD - ASD - large PDA
27
causes of heart failure in older children?
- eisenmenger syndrome (right sided only) - rheumatic heart disease - cardiomyopathy
28
normal O2 sats for an infant?
>93%
29
infectious cause of cyanosis with respiratory distress in neonate?
septicaemia following GBS infection
30
presentation of congenital heart disease?
- antenatal ultrasound finds increasing proportion - murmur - cyanosis - heart failure - left-to-right shunt usually - shock
31
character of murmur in a small VSD?
- loud, pansystolic murmur at lower left sternal edge | - louder = smaller defect!
32
management of a small VSD?
- none - they close spontaneously - follow up shows that murmur has disappeared
33
main complication of a small VSD?
- bacterial endocarditis | - keep good dental hygiene
34
age at presentation of large VSD?
>1 week old
35
features of large VSD?
- heart failure with breathlessness - FTT - recurrent chest infections - hepatomegaly - tachypnoea - tachycardia - active precordium
36
character of murmur in large VSD
- soft pansystolic murmur | - no murmur = very big VSD!
37
commonest type of ASD?
secundum ASD
38
features of ASD?
- asymptomatic - recurrent chest infections / wheeze - arrhythmia (in 40s) - murmur
39
what is heard in auscultation in ASD?
- ejection systolic mumur - loudest at upper left sternal edge - fixed, split S2 sound
40
character of murmur in a partial AVSD?
apical pansystolic
41
signs on CXR of ASD?
- cardiomegaly - enlarged pulmonary arteries - increased pulmonary vascular markings
42
signs on ECG in secundum ASD?
- partial right bundle branch block | - right axis deviation
43
gold standard investigation for ASD?
echocardiography
44
management of a) secundum ASD? b) partial AVSD?
a) cardiac catheterisation | b) surgery at 3-5 years (to prevent RSHF)
45
purpose of nitrogen washout test?
to determine if cyanosed neonate has congenital heart disease
46
describe the nitrogen washout test
- neonate placed in 100% O2 for 10 mins - if right radial arterial PaO2 <15kPa, then cyanotic heart disease (ToF, TGA) - BUT must exclude pulmonary hypertension first
47
management of right-to-left shunt?
- ABCs | - prostaglandin infusion 5ng/kg/min
48
commonest cyanotic congenital heart disease?
tetralogy of Fallot
49
4 cardinal features of ToF?
- large VSD - overriding aorta - RVOTO - RV hypertrophy (last sign)
50
symptoms of ToF?
- murmur in first 2m of life - severe cyanosis - clubbing of fingers and toes (older children)
51
character of murmur heard in ToF?
- loud, harsh ejection systolic - left sternal edge - from day 1 of life
52
signs on CXR of ToF?
- boot-shaped heart - right-sided aortic arch - pulmonary artery "bay" - decreased pulmonary vascular markings
53
ECG changes in ToF?
- normal at birth | - RVH when older
54
management of ToF?
- surgery at 6 months - closes VSD - artificial patch can be put across pulmonary valve
55
management of hypercyanotic spells in ToF?
- most are self-limiting - if lasts >15 mins, give morphine - then IV propanolol - bicarbonate (corrects the acidosis)
56
what is the artery set up in TGA?
- aorta comes out of RV - PA comes out of LV - O2 blood going to lungs, de-O2 blood going to body - no mixing, two parallel circuits
57
symptoms of TGA?
- cyanosis - loud, single S2 - may be a systolic murmur
58
X-ray signs in TGA?
- cardiac shadow looks like "egg on side" | - increased pulmonary vascular markings
59
ECG in TGA?
normal
60
management of TGA infant?
- maintain the ductus arteriosus with prostaglandins | - balloon atrial septostomy
61
explain eisenmenger syndrome
- happens following a L-to-R shunt - pulmonary arteries eventually get stenosed - they get more resistant to flow - leads to pulmonary HTN - shunt reverses (R-to-L) - 10-15 years of age - before shunt reverses, their symptoms get eased
62
a) conditions with common mixing? | b) presentation?
a) complete AVSD, tricuspid atresia | b) blue and breathless
63
which condition is complete AVSD most associated with?
Down syndrome
64
ECG finding in complete AVSD?
superior axis
65
presentation of complete AVSD in neonate?
- cyanosis | - heart failure at 2/3 weeks of age
66
management of complete AVSD?
- treat the heart failure | - surgical repair at 3-6 months

paediatrics (10 decks)

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