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Cardio Flashcards

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1
Q

How common are congenital cardiac abnormalities?

A

1-2% of the population. 8:1000 are significant

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2
Q

What are the different ways congenital cardiac disease can present? What are some cardiac?

A
  • Cyanotic (right to left shunt): Tetralogy of Fallot, TGA
  • Acyanotic/breathless (left to right): VSD, PDA, ASD
  • Outflow obstruction (asymp/collapse): PS, AS, coarctation
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3
Q

What are some causes of congenital cardiac disease? Which CHD they classically associated with?

A

Chromosomal abnormality:

  • Down’s (30%): VSD, AVSD
  • Edwards + Patau: complex
  • Turner’s (15%): bicuspid aortic valve (AS), coarctation
  • DiGeorge (80%): aortic arch anomaly, ToF
  • Noonan: HOCM, ASD

Maternal factors:

  • Rubella: PS, PDA
  • SLE: complete heart block
  • Warfarin, alcohol, DM
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4
Q

What is the common cardiac defect in Down’s?

A

VSD, AVSD

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5
Q

What is the common cardiac defect in Turners?

A

Bicuspid aortic valve causing AS, coarctation

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6
Q

Describe the changes that occur in the fetal circulation at birth

A

At birth, liquid out of lungs -> decreased intrathoracic pressure -> decreased resistance in pulmonary vessels -> increased blood flow
Decrease R sided pressures and increased left sided (due to return from pulmonary) -> closure of foramen ovale
After several days: PDA closes

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7
Q

What are some features of innocent murmurs?

A
  • Soft, blowing
  • Left sternal edge
  • Systolic
  • No systemic features (breathlessness, cyanosis)
  • Normal pre and post-ductal sats
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8
Q

What are some causes of innocent murmurs?

A
  • Anaemia

- Infection/illness

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9
Q

How does heart failure present in children?

A

SOB (worse on feeding/exertion), poor feeding, sweating

Poor weight gain, ^HR and RR, murmur, enlarged heart, hepatomegaly

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10
Q

What are some causes of heart failure in children?

A

Neonates- obstruction eg coarctation. Also AVSD
Infants- left-to-right shunt eg VSD, large PDA
Children- Eisenmenger, RHD, cardiomyopathy

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11
Q

Why can coarctation cause collapse in the first few days of life? What is the term that is used for this type of condition? What is the treatment?

A

Severe obstruction means arterial perfusion is supplied by the DA. Closure occurs in the first few days of life -> rapid worsening + decreased flow
This is called duct-dependent circulation, and treatment is to maintain the DA with prostaglandins

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12
Q

What is Eisenmenger syndrome? What causes it?

A

A complication of untreated left-to-right shunt, where high flow through the pulmonary vessels causes pulmonary hypertension -> eventual reversal of the shunt -> cyanosis.
Caused by VSD, ASD, PDA

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13
Q

A newborn boy becomes cyanotic after several hours. Saturations are 88%. What is the initial management?

A

ECG and CXR

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14
Q

What are the signs of ASD on examination and CXR?

A

Examination:
Ejection systolic murmur at upper left sternal edge (due to high flow across pulmonary valve)
Fixed and widely split S2

CXR:
Cardiomegaly
Pulmonary oedema, enlarged arteries

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15
Q

What is the best investigation for diagnosing CHD?

A

Echo

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16
Q

What are the types of ASD? How are they managed?

A
  • Secundum (most): hole in middle of the septum. Cardiac catheterisation later in childhood
  • Primum, part of partial AVSD: assoc with Down’s. Surgical correction later in childhood.
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17
Q

What is a small VSD?

A

<3mm

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18
Q

How does a VSD present?

A

Small: asymptomatic

  • Pansystolic murmur, lower left sternal edge
  • Quiet P2

Large: cause heart failure, recurrent chest infection

  • Soft pansystolic murmur, apical mid-diastolic murmur
  • Loud P2
  • CXR shows cardiomegaly, pulm oedema, enlarged arteries
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19
Q

How is VSD managed?

Study These Flashcards
A

Small: allow spontaneous closure
Large: surgical correction at 3-6 months. Treat heart failure with diuretics.

20
Q

Define PDA. What is the main risk factor?

Study These Flashcards
A

Failure of the DA to close after 1 month from the expected delivery date. Prematurity

21
Q

What are the signs of PDA?

Study These Flashcards
A

Bounding pulse
Continuous machine-like murmur
Possible heart failure in very severe cases

22
Q

What is the management of PDA?

Study These Flashcards
A

PG inhibitors eg. indomethacin

Cardiac catheterisation + occlusion at 1 year

23
Q

How is cyanotic heart disease investigated?

Study These Flashcards
A
  • Hyperoxia test: place baby in chamber with 100% O2 for 15 mins. Cyanotic- still low saturation on ABG
  • CXR: exclude lung disease
  • ECG
  • Echo
24
Q

What is the acute management of cyanotic neonates?

Study These Flashcards
A

A-E

Start prostaglandin infusion (keep DA open)

25
What are the morphological features of Tetralogy of Fallot?
- Large VSD - Overriding aorta - RV outflow tract obstruction eg. PS - Right ventricular hypertrophy
26
How does Tetralogy of Fallot present?
- Cyanosis with hypercyanotic/'Tet' spells (blue, crying, irritable, SOB with feeding) - Squatting on exercise (to improve venous return)
27
What are the signs of Tetralogy on exam + CXR?
Exam: - Loud ejection systolic murmur left sternal edge - Single S2 CXR: - 'Boot' shaped heart, small - Pulmonary artery 'bay'
28
Describe the management of Tetralogy
Surgery at 6 months to close VSD and open RVOT - May need balloon dilatation in early life to relieve cyanosis - Prolonged Tet spells may need propranolol
29
Describe the pathophysiology of TGA
The aorta arises from the RV and the pulmonary artery from the LV -> two separate circulations Often co-existing defect eg. ASD, VSD that allows mixing
30
How does TGA present? What are the signs?
Early life with severe cyanosis (esp after DA closure) Exam: Loud and single S2, no murmur CXR: Egg on side heart, increased pulm vessels
31
What is the management of TGA?
- Improve mixing with prostaglandin infusion - Balloon atrial septostomy (Rashkind) to allow mixing - Surgery within several weeks of life
32
What is the pathophysiology of tricuspid atresia?
Complete absence of the tricuspid valve -> non-functioning RV Cyanosis/SOB
33
What are some symptoms of aortic stenosis?
Reduced exercise tolerance Syncope Chest pain
34
What are some signs of aortic stenosis?
Ejection systolic murmur upper L sternal edge Slow-rising pulse Carotid thrill Soft A2
35
What are some signs of pulmonary stenosis?
Widely split S2, soft P2 | Systolic ejection click/murmur over upper L sternal edge
36
What are some signs/symptoms of coarctation?
Neonatal collapse (preductal) Absent/weak femoral pulses Hypertension in the R arm, ejection systolic murmur, continuous murmur on back
37
What is the most common type of arrhythmia in children?
SVT
38
What is the management of SVT?
1st: vagal manouvres eg. carotid massage 2nd: IV adenosine 3rd: cardioversion eg. DC, flecainide
39
In a child with syncope, what features from the history would make you worried about a cardiac cause?
- Not caused by an emotional stressor - Exercise-induced - Hx of palpitations - FHx of sudden cardiac death
40
What are the features of acute rheumatic fever?
``` Major criteria: Polyarthritis Erythema marginatum Subcut nodules Pancarditis: endo, myo, peri Sydenham chorea ``` ``` Minor: Fever Polyarthralgia Raised acute phase proteins Prolonged PR interval ```
41
What is the management of rheumatic fever?
Rest + high dose aspirin Prevent recurrence with monthly IM benzathine penicillin for 10 years Surgical repair of valves
42
Which CHD types predispose to infective endocarditis?
Tetralogy, TGA, VSD, PDA and bicuspid aortic valves. Also anything with prosthetic materials
43
How does infective endocarditis present?
``` High fever New/changed murmur Malaise Splinter haemorrhages Janeway lesions Roth's spots Neuro signs Splenomegaly ``` Anaemia Raised ESR/CRP Haematuria
44
What is the most common causative organism of infective endocarditis?
Most common: Strep viridans
45
What is the management of infective endocarditis?
Blood cultures!!! Involve MDT of cardio, ID, neuro, surgeons Initiate sepsis 6 IV broad spectrum antibiotics eg. beta-lactam +/- gent/vanc for 6 weeks
46
Describe BLS for children
- Check for safety, call for help - Airway: head tilt chin lift - Breathing: check for 10s. Give 5 rescue breaths - Circulation: check for 10s. Start compressions 15:2

Paediatrics (13 decks)

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