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Cardio Flashcards

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1
Q

When during pregnancy are cardiac abnormalities detected?

A

during 20 week antenatal scan

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2
Q

What are the characteristics of a L to R shunt?

What are common conditions that would result in a L to R shunt?

A

breathless

VSD (30%)

Persistent arterial duct (12%)

ASD (7%)

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3
Q

What are the characteristics of a R to L shunt?

What are common condiitons that would result in a R to L shunt?

A

blue

tetralogy of Fallot (5%)

transposition of great arteries (5%)

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4
Q

What are the characteristics of a mixing shunt?

What are common condiitons that would result in a Mixed shunt?

A

breathless and blue

atrioventricular septal defect

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5
Q

What are the characteristics of an outflow obstruction in a well child?

What are common conditions?

A

Asymptomatic + murmur

Pulmonary Stenosis

Aortic Stenosis

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6
Q

What are the characteristics of an outflow obstruction in a sick neonate?

What are common conditions?

A

Collapsed w/shock

Coarctation of aorta

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7
Q

What can cause congenital heart disorders ?

How can they be grouped?

A

Maternal syndrome - rubella, SLE

Maternal Drugs - warfarin, fetal alcohol syndrome

Chromosomal - down’s, edward’s, Patau’s, william’s

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8
Q

Describe circulation in the fetus?

A

Pressure in RA > LA

Foramen ovale held open, blood flows across atrial septum –> left atrium —–> left ventricle —–> body

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9
Q

What happens to the fetal circulation at birth/first breath?

A

Resistance to pulmonary blood flow decreases

Volume of blood flowing through the lungs increases 6x and this causes an increase in LA pressure

Placenta becomes excluded, so volume of blood to right atrium decreases

Change in pressure causes foramen ovale to close

ductus arteriosus also closes

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10
Q

IF a congenital heart condition is picked up antenatally what is the next step? What options are then available?

A

Fetal echo

allows for - counselling, termination, management plan antenatally, offer delivery close to cardiac centre

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11
Q

What is an innocent murmur?

A

4S - aSymptomatic patient, Soft blowing murmur, Systolic murmur, not diastolic, left Sternal edge

normal heart sounds
no parasternal thrill
no radiation

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12
Q

When do innocent or flow murmurs occur? Why?

A

Febrile illness

Anaemia

caused by increased cardiac output

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13
Q

What are the symptoms heart failure?

A

Breathlessness
Sweating
Poor Feeding
Recurrent Chest Infections

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14
Q

What are the signs of heart failure?

A

Poor weight gain

tachypnoea

tachycardia

heart murmur

cardiomegaly

cool peripheries

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15
Q

What are the causes of heart failure in neonates?

A

hypoplastic left heart syndrome

critical aortic valve stenosis

severe coarctation of the aorta

interruption of aortic arch

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16
Q

What are the causes of heart failure in infants?

A

VSD

AVSD

Large persistent ductus arteriosus

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17
Q

What are the causes of heart failure older kids and adolescents?

A

Eisenmenger syndrome

Rheumatic heart disease

Cardiomyopathy

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18
Q

In the first week of life, what is a usual cause of heart failure?

A

left heart obstruction

If significant, arterial perfusion via arterial duct = duct dependent system of circulation

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19
Q

After first week of life what is a usual cause of heart failure? What are the short and long term consequences of this?

A

most likely left-to-right shunt

short term : pulmonary oedema and breathlessness and pulmonary vascular resistance decreases and increases flow from L -> R

long term : symptoms will increase up to 3 months, then improve as pulmonary vascular resistance increases in response to the L -> R shunt

this then leads to Eisenmonger syndrome

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20
Q

What is Eisenmonger syndrome? What is treatment?

A

irreversibly raised pulmonary vascular resistance

causes shunt to become R –> L and teenager to become blue

treatment is a heart-lung transplant

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21
Q

What can cyanosis and respiratory distress be an indication of?

A

i) cardiac disease
ii) respiratory disease
iii) persistent pulmonary hypertension
iv) infection
v) metabolic disease

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22
Q

What investigations would you carry out in suspected for congenital cardiac abnormality?

A

CXR + ECG - not diagnostic but gives baseline for future reference

Echo + Doppler USS - diagnostic

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23
Q

How does an Atrial Septal Defect present? What signs are normally present?

A

commonly none
recurrent chest infection
arrythmias

Ejection Systolic Murmur at the Left Upper Sternal Edge
Split second heart sound

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24
Q

What would imagin show in an atrial septum defect? How would you manage this?

A

cardiomegaly
enlarged pulm. arteries

cardiac catheterisation with an occlusive device

surgical correction

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25
How does a SMALL Ventricular Septal Defect present? What signs are normally present?
Presents asymptomatically Loud pansystolic murmur Lower Left Sternal Edge Quiet Pulmonary Second Sound
26
What would you see on CXR and ECG or a SMALL VSD? How would you manage it?
CXR and ECG are normal Will close spontaneously However maintaining good dental hygiene to avoid bacterial endocarditis is important
27
How would a LARGE Ventricular Septal Defect present? What signs are present?
Heart failure with breathlessness Failure to thrive after 1 weeks old Recurrent chest infections Signs ; tachypnoea, tachycardia, soft pansyst murmur or no murmur active precordium loud pulmonary second sound
28
What would you see on imaging of patient with a LARGE Ventricular Septal Defect?
cardiomegaly enlarged pulmonary artery pulmonary oedema
29
How would you manage a LARGE Ventricular Septal Defect?
Diuretics + captopril additional calorie input surgery
30
What is a PDA?
Patent Ductus Arteriosus blood flow from aorta to pulmonary artery
31
How would a PDA present?
continuous murmur beneath the left clavicle increased pulse pressure if the duct is large -> heart failure and pulmonary hypertension
32
What investigation would you diagnostic for PDA?
Echo CXR and ECG would you be normal
33
How would you manage a PDA?
coil or occlusive device to decrease risk of bacterial endocarditis and pulmonary vascular disease
34
What are the components that make up the tetralogy of fallot?
Large VSD Overriding Aorta with respect to ventricular septum Subpulmonary stenosis causing right ventricle outflow tract obstruction Right Ventricular hypertrophy as a result
35
How would tetralogy present? How is it normally diagnosed?
Severe cyanosis, hypercyanotic spells, squatting on exercise, developing in late infancy Diagnosed normally antenatally or around 2 months when murmur is heard
36
What signs are seen with tetralogy of fallot?
clubbing of fingers and toes in older children loud harsh ejection systolic murmur at the Left Sternal Edge
37
What would you see on CXR of tetralogy of fallot?
small heart, RV hypertrophy concavity on left heart border
38
How would you manage a tetralogy of fallot?
Surgery at 6 months of age close VSD and relieving RV outflow tract obstruction Blalock-Taussig shunt
39
Acutely, how would you treat a hypercyanotic spell in a child with tetralogy of Fallot?
sedation and pain relief IV propanolol IV volumre administration Bicarb to correct acidosis reduce metabolic demand
40
What is happening to the blood vessels in transposition of great arteries?
RV -> Aorta -> blue blood to body LV -> Pulm. Artery -> pink blood to lungs
41
What is the prognosis for transposition of great arteries?
incompatible with life unless there is mixing of blood that's why often co-exists with VSD, ASD, PDA
42
How does TGA present ?
cyanosis normally by day 2
43
What signs seen in TGA?
cyanosis second heart sound loud and single usually no murmur
44
What is seen on CXR of TGA?
narrow upper mediastinum 'egg on side' appearance of the cardiac shadow
45
How would you manage TGA?
maintain ductus arteriosus with prostaglandin infusion ballon atrial septostomy surgery to swicth arteries
46
In what population is AVSD commonly seen?
children with Down's Syndrome
47
When is AVSD diagnosed? How does it present?
Presents on antenatal USS Cyanosis at birth HF @ 2-3weeks no murmur
48
How would you manage AVSD?
manage HF medically surgical repair 3-6 months of age
49
What are examples of complex congenital heart diseases that cause common mixing of blood?
Tricuspid atresia Mitral atresia double inlet left ventricle common arterial trunk
50
How would tricuspid atresia present?
common mixing of systemic and pulmonary venous return in LA causes i) cyanosis in the newborn period ii) child well @ birth and becomes cyanoses or breathless
51
How would you manage tricuspid atresia?
Blalock - Taussig shunt insertion Pulmonary artery banding
52
What is aortic stenosis commonly associated with?
mitral valve stenosis and coarctation of aorta
53
How would aortic stenosis present?
asymp murmur reduced exercise tolerance, chest pain on exertion or syncope In neonates - critical stenosis can lead to HF then shock
54
What signs would you see in aortic stenosis?
small volume, slow rising pulses carotid thrill ejection syst. murmur at RUSE radiating to neck
55
What would you see on CXR of patient with Aortic Stenosis?
prominent left ventricle and dilation of ascending aorta
56
How would you manage aortic stenosis?
balloon valvotomy aortic valve replacement
57
How would pulmonary stenosis present?
neonates with critical stenosis will become cyanosed
58
What signs would you see in pulmonary stenosis?
Ejection systolic murmur at LUSE
59
What would you see on CXR of pulmonary stenosis?
Pulmonary Artery dilation
60
How would you manage pulmonary stenosis?
Transcatheter balloon dilation
61
How would adult-type coarctation of aorta present? what signs?
asymptomatically systemic hypertension in right arm signs = ejection systolic murmur upper sternal edge radio femoral delay
62
What would you see on CXR of patient with Adult-type CoA?
rib notching 3 sign
63
How would you manage adult-type CoA?
stent
64
How would outflow obstruction in a sick infant present? what would be the immediate management?
Present with heart failure leading to shock Resus with ABC Prostaglandin commenced at earliest opportunity
65
What is the difference between adult-type coarc and paediatric coarct?
ductus is closed in the adult form while remains open in the paediatric one
66
How would coarct present?
normal during first day of life collapse during 2nd or following days, as the duct closes
67
What signs would you seen in a infant with coarctation?
sick infant with severe HF absent femoral pulses severe metabolic acidosis
68
What would you see on CXR of coarct and how would you manage it?
cardiomegaly from HF and shock surgical repair
69
What is hypoplastic left heart syndrome?
underdeveloped entire left side of the heart mitral valve is small or atretic left ventricle small aortic valve atresia
70
How would hypoplastic left heart syndrome present?
detected antenatally by USS becomes very ill after birth, duct dependant circulation absence of peripheral pulses
71
How would you treat HLHS? At what points in time?
Norwood procedure (first 2 weeks) Glenn/ Hemi-Fontan (6 months) Fontan (3 years)
72
What is sinus arrhythmia?
It is a normal arrythmia in children, it is detectable as a cyclical change in HR with respiration Acceleration during inspiration Deceleration during expiration
73
What is the most common childhood arrhythmia?
Supraventricular tachycardia
74
How would you manage a child with SVT?
circulatory and respiratory support Vagal stimulating manoevres (carotid sinus massage, cold ice pack) IV adenosine Electrical cardioversion
75
In SVT, once sinus rhythm is restored, what can be used for maintenance?
Flecainide or sotalol which can be stopped after one year if relapse or are at risk - percutaneous radiofrequency ablation can be used
76
What associations are seen with congenital heart block?
related to anti-Ro/anti-La antibodies in maternal serum | mothers usually latent connective tissue disorders
77
What are causes of syncope?
Neurocardiogenic - prolonged standing Situational - defecation, urination, cough Orthostatic - BP fall >20mmHg after 3 mins Ischaemic Arrythmic - heart block, SVT
78
What organisms are commonly responsible for rheumatic fever?
group A beta-hemolytic streptococcus
79
When do you normally see contraction of rheumatic fever?
following 2-6 week latent phase after pharyngeal infection polyarthritis mild fever
80
What is the long-term consequence of Rheumatic fever?
mitral stenosis
81
How would you manage rheumatic fever?
best rest and anti-inflamm aspirin if fever and inflamm doesn't resolve --> corticosteroids HF treated with dieretics and ACE-I Anti-strep abx if persisting infection
82
What can be given prophylactically for rheumatic fever?
benzathine penicillin
83
Who are at risk of infective endocarditis?
All children with congenital heart disease
84
When should infective endocarditis be suspected ?
Should be suspected in any child or adult with sustained fever, malaise, raised ESR, unexplained anaemia or haematuria
85
What organism is most commonly responsible for Infective Endocarditis?
alpha hemolytic strep
86
What investigations would you carry out for infective endocarditis?
multiple blood cultures echo - vegetations
87
How would you treat infective endocarditis?
high-dose penicillin and aminoglycoside for 6 weeks through IV
88
What would you suspect in any child with an enlarged heart and heart failure?
dilated cardiomyopathy
89
How would you treat dilated cardiomyopathy?
diuretics ACE-I Carvedilol some might need a heart transplant
90
How would define pulmonary hypertension?
>25mmHg have a large post-tricuspid shunt w. high pulmonary blood flow and low resistance
91
How would you treat pulmonary hypertension?
Inhaled nitric oxide IV MgSo4 Endothelin receptor antagonists
92
What is Ebstein's Anomaly? What are conditions are associated with it?
Ebstein's anomaly is a congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle. It is sometimes referred to as 'atrialisation' of the right ventricle. ``` tricuspid incompetence (pan-systolic murmur, giant V waves in JVP) Wolff-Parkinson White syndrome ```
93
What medication usage in-utero is associated with Ebstein's Anomaly?
Lithium

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