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Phase 3a Paeds > cardio > Flashcards

cardio Flashcards

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1
Q

Foetal anatomy:
what are the 3 shunts and what are their functions?

A

-Foramen ovale (R + L Atria)
-Ductus arteriosus (pul artery + aorta)
(Both bypass lungs)

-Ductus venosus (umbilical vein into IVC)

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2
Q

What blood vessels run through the umbilical cord? what do they carry?

A

1 umbilical vein (oxygenated blood to baby)
2 umbilical arteries (deoxygenated away from baby)

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3
Q

Name some cyanotic cardiac disease?

A

-Tetrology of fallot
-transposition of great arteries
-tricuspid atresia
-total anomalous pulmonary venous return

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4
Q

cyanosis is when Hb is?

A

deoxygenated Hb >5g/dL

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5
Q

Acyanotic can become cyanotic due to?

A

Eisenmenger syndrome

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6
Q

what is eisenmenger syndrome?

A

ASD or VSD allows L to R shunting causing pulmonary htn
Pulmonary pressure > systemic, then R to L shunting
Blood bypasses lung = cyanosis

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7
Q

what do benign murmurs occur?

A

Turbulent flow through naturally smaller valves

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8
Q

Is a thrill normal or pathological?
when is a thrill common?

A

Thrill = pathological
Common during febrile illness and anemia (high CO)

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9
Q

How do benign murmurs sound?

A

Soft blowing murmur
aSx
Systolic only
left Sternal edge
no added Sounds
varies with poSture

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10
Q

what are the main RFs for congenital heart disease (CHD)?

A

Maternal rubella
diabetes
downs

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11
Q

what does CHD increase the risk of?

A

IE + arrhythmia risk

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12
Q

Sx of CHD?

A

Poor feed
Failure to thrive

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13
Q

Dx of CHD?

A

echo

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14
Q

Tx of CHD?

A

Surgery
Indomethacin / NSAIDS (<1y)
Alprostadil (prostaglandin E1) >1y

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15
Q

what is the MC CHD in babies?

A

ventricular septal defect

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16
Q

what is an atrial septal defect?

A

Failure of atrial septum to close
(acyanotic)

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17
Q

what are the types of atrial septal defects?

A

Ostium secundum (80%)
MC = Centre of atrial septum

osmium primum
(lower part of atria)

formen ovale

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18
Q

RF for atrial septal defect?

A

Downs!!
foetal alcohol syndrome

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19
Q

Sx of atrial septal defect?
what is heard on auscultation?

A

Mid systolic crescendo decrescendo at upper L sternal border
Fixed S2 splitting
(high O2 sats in RA, RV, PA = extra blood volume = delayed pul valve closure = S2 split)

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20
Q

Dx of atrial septal defect?

A

antenatal scan
newborn examination

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21
Q

Tx of Atrial septal defect?

A

Monitor child - small openings may close
Surgery - via catheter or open heart, patch/plug in place
Anticoagulants

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22
Q

Complications of atrial septal defect?

A

Paradoxical embolism (RA -> LA -> Systemic circulation)
Stroke
AF / Aflutter
Pulmonary htn
RHF
eisenmengers

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23
Q

what is a ventricular septal defect?

A

Septum between ventricles has opening

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24
Q

RF for ventricular septal defect?

A

Downs

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25
what is heard in ventricular septal defect? quieter = ?
Harsh pan systolic murmur at L lower sternal border quieter = bigger
26
Dx of ventricular septal defect?
Antenatal scan newborn examination
27
Tx of ventricular septal defect?
Small + no pulmonary htn or HF = watched over time Bigger = surgical - tranvenous catheter / open
28
RF for atrioventricular septal defect?
Downs!
29
Sx and what is heard in atrioventricular septal defect?
No murmur severe distress
30
Tx of atrioventricular septal defect?
ECHO HF Tx
31
What is patent ductus arteriosus?
failure of ductus ateriosus to close leading to blood moving from aorta to pulmonary artery High pul htn + right heart strain
32
when does the ductus arteriosus normally stop functioning and closes?
Stops functioning = 1-3 days closes at 2-3 weeks
33
RF for patent ductus arteriosus
Rubella (1/3) prematurity
34
Sx and what is heard in patent ductus arteriosus?
Poor growth, infections, dyspnoea, lower body cyanosis -Continuous machinery murmur at L subclavian border -Wide pulse pressure (bounding collapsing pulse) -Heaving apex
35
Tx of patent ductus arteriosus?
ECHO monitoring <1y = NSAIDs / Indomethacin >1y = surgery
36
Dx of patent ductus arteriosus?
ECHO - ventricular hypertrophy
37
why do we give NSAIDS for patent ductus arteriosus?
Prostaglandins keep Ductus arteriosus open NSAIDS inhibit prostaglandin activity
38
what is the MC cause of cyanotic CHD in 50-70% children?
tetralogy of fallot
39
what is tetralogy of fallot?
4 heart abnormalities
40
what are the 4 abnormalities in tetralogy of fallot?
1. pulmonary stenosis 2. R ventricular hypertrophy 3. large ventricular septal defect 4. Overriding aorta
41
RF for tetralogy of fallot?
Di Georges Downs Rubella Maternal DM M>40Y Foetal alcohol
42
Sx of tetralogy of fallot? what is heard?
Cyanosis of lips and fingers at birth clubbing after months feeding difficulties fail to develop Ejection systolic murmur at pulmonary valve
43
what are 'tet spells' in tetralogy of fallot?
High O2 = heart pumps more blood = Sudden low O2 Sats (worsened L to R) = cyanotic episode = improved by squatting
44
why is a 'tet spell' in tetralogy of fallot improved by squatting?
High vascular resistance in peripheral arteries high systemic circulation pressure High pressure L>R side Shunt temporarily reverses
45
Dx of tetralogy of fallot?
Antenatal Chest x ray = boot shaped heart (RVH) ECG = R axis deviation ECHO = degree
46
Tx of a tet spell in tetralogy of fallot?
O2 Morphine IV fluids (+ bicarb if acidotic) IV Propanolol (peripheral vasoconstrictor = relaxed RV)
47
Tx of tetralogy of fallot?
Neonates = prostaglandin infusion GS = total surgical repair - VSD closure, pul stenosis corrected (outflow tract enlarged) in 1st year life
48
what is transposition of great arteries?
Pulmonary arteries + aorta swap places
49
RF for transposition of great arteries? associated with?
Maternal DM VSD, CoA, pul stenosis
50
Sx of transposition of great arteries?
No Sx in utero as FO + DA Cyanotic within 1h birth tachypnoea often another shunt present (ASD, VSD, PDA) no murmur
51
Dx of transposition of great arteries?
ECHO Chest xray = sideways egg
52
Tx of transposition of great arteries?
Neonates = prostaglandin E1 infusion (keeps DA open) Surgical correction
53
what is levo - transposition of great arteries?
R + L ventricle switch too normal function Acyanotic
54
what is coarctation of the aorta?
narrowing of aorta, distal to branches, near ductus arteriosus
55
RF for coarctation of the aorta?
turners
56
Sx of coarctation of the aorta?
High BP in upper body + head, low BP in lower body -Htn + bounding pulse in upper body - weak/absent femoral pulse - R-R / R-F delay -Cold extremeties - dizziness / epistaxis
57
what is coarctation of the aorta associated with?
berry aneurysm + HTN
58
Dx of coarctation of the aorta? what is heard?
systolic murmur between 2 clavicles Chest xray = intercostal artery tortousity, figure 3 sign, rib notching (Roester sign)
59
Tx for coarctation of the aorta?
Balloon angioplasty
60
what is triscupid atresia? what is it associated with?
absence of tricuspid valve (no opening) non functional RV assoc with another shunt
61
What is hypoplastic Left heart syndrome?
malformation of L heart, hypoplastic LV + mitral atresia
62
What is ebstein anomaly?
Tricuspid valve (septal and posterior leaflets) is set lower in R side of heart towards apex = bigger RA and smaller RV
63
what is ebstein anomaly associated with? RF for it?
associated with ASD + WPW RF = maternal lithium
64
what murmurs are heard in ebstein anomaly?
gallop rhythm + sail sound 2x murmurs: 1. Pan systolic (tricuspid regurgitation) 2. Mid diastolic (tricuspid stenosis)
65
Heart failure manifests as?
oedema (facial and sacral)
66
Causes of Heart failure in: neonates? infants? older?
severe co-arctation of aorta L to R shunts eg. VSD, ASD, AVSD, PDA Eisenmengers, RHD, cardiomyopathy
67
Sx of Left heart failure?
backs up in lungs SOB, gallop rhythm, cool peripheries, cardiomegaly
68
Sx of right heart failure?
backs up In body -peripheral oedema -hepatomegaly
69
Tx for Heart failure?
-Ionotropes (increases heart contraction) -ABAL (ACE-I, BB, Aldosterone agonist eg. spironolactone, Loop diuretics eg. furesomide) -High calorie diet
70
What is infective endocarditis? RF?
Infection into inflammation of heart valves CHD
71
Causes of infective endocarditis?
S.aureus MC S.viridans S.epidermidis HACEK
72
What would you typically see in a Px with infective endocarditis? How would it present? What are all kids with IE + CHD having surgery given?
Fever and new murmur with increased risk in CHD All kids with CHD having surgery given prophylactic Abx
73
Sx of infective endocarditis?
DUKE criteria 2 major or 1 major 2 minor New murmur, fever, septic signs, immunological signs vegetations = brain emboli / stroke
74
Dx of infective endocarditis?
Bloods (high WCC, ESR/CRP) Blood cultures MC+S ECHO (vegetations)
75
Tx of infective endocarditis?
High dose IV Abx for 4-6 weeks IV Gentamicin + flucloxacillin
76
What Is rheumatic fever? pathophysiology? MC cause of?
Autoimmune condition which occurs 2-4 weeks post group A strep infection (sore throat) T2 hypersensitivity vs M protein - molecular mimicry (strep antigens + Px tissues same) - cross react with smooth muscle mitral stenosis
77
rheumatic fever cause? ages it affects? M or F? RF involves heart what % of the time?
Strep pyogenes ages 5-15 M 50%
78
Sx of Rheumatic fever?
JONES FEAR Major (Jones): -Joints (migrating upwards polyarthritis) -Organ inflammation (carditis) -Nodules SC -Erythema Marginatum (non itchy rash, red margin + clear centre - chest) -Sydenham chorea (uncoordinated involuntary jerky movements) Minor (Fear) -Fever >38*c -ECG changes (Prolonged PR) -Arthralgia (without arthritis) -Raised ESR/CRP 2 major or 1 major + 2 minor
79
Dx of Rheumatic fever?
Jones criteria Bloods Antistreptolysin O titre (ASOT) Anti DNAase B +ve ECG ECHO Aschoff body (nodules in heart of RF Px due to inflammation)
80
Tx of rheumatic fever?
stat IV Benzylpenicillin then PO phenoxymethylpenicillin Pericarditis = NSAIDS Chorea = haloperidol / diazepam reduce reoccurrence = IM Benzathine benzylpenicillin
81
Complications of rheumatic fever?
Reoccurance valvular HD HF Scarring Fibrosis = RHD = myocarditis, endocarditis, pericarditis
82
what is brugada syndrome? Dx?
Autosomal dominant 5CN5A mutation Na+ channel Dx = ECG
83
What are the ECG findings in brugada syndrome?
pseudo RBBB ST segment elevation V1-V3 Saddle back ST-T elevation
84
What is the MC pads dysarrhythmia?
SVT WPW
85
What does WPW cause on ECG?
Slurred delta wave PR <120ms Wide QRS
86
Tx of SVT? Acute? long term: medical + surgical ?
Acute = vasovagal, adenosine medical = bisoprolol surgical = catheter ablation (bundle of Kent)

Phase 3a Paeds (14 decks)

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