Cardio Flashcards by Sarah Abrams

To which group of mothers are infants with congenital heart block most commonly born to?

Those with connective tissue disorders

With anti-Ro, anti-La antibodies

How well did you know this?

Not at all

Perfectly

Sudden loss of consciousness during exercise, stress or emotion

Long QT syndrome

How well did you know this?

Not at all

Perfectly

What is the most common cause of cardiac problem in children?

Congenital lesion

How well did you know this?

Not at all

Perfectly

What are the pressures in the sides of the heart in a fetus?

L pressure low (low lung return)

R pressure high (receiving systemic venous return)

How well did you know this?

Not at all

Perfectly

What happens at birth in the heart?

Foramen ovale closes because pressure builds in L atrium, reduces in R atrium. FO has one way flap

DA also closes as pulmonary artery pressure increases

How well did you know this?

Not at all

Perfectly

What is the most common symptom of a L to R shunt?

Breathlessness (or asymptomatic) because lungs become congested. Particularly in neonates who are trying to feed

How well did you know this?

Not at all

Perfectly

What are three types of L to R shunts?

ASD
VSD
PDA

How well did you know this?

Not at all

Perfectly

What are two types of ASD?

Secundum (80%) - patent foramen ovale

Partial atrioventricular

How well did you know this?

Not at all

Perfectly

What are the symptoms of ASD?

Largely asymptomatic
Breathlessness
Recurrent infections/wheeze
Later arrhythmias

How well did you know this?

Not at all

Perfectly

What are the clinical features of ASD?

Breathlessness

ESM (loudest at LUSE)
Split second heart sounds

How well did you know this?

Not at all

Perfectly

What are the heart sounds in ASD?

ESM loudest at LUSE

Split second heart sound

How well did you know this?

Not at all

Perfectly

What are the CXR features of ASD?

Enlarged heart
Increased pulmonary vasculature markings
Visible pulmonary arteries

How well did you know this?

Not at all

Perfectly

What are the ECG features of ASD?

(Increased R sided pressure, RV enlargement)=

RBBB
RAD

How well did you know this?

Not at all

Perfectly

What is the management for ASD?

Observation

If there is significant RV dilatation with raised pulmonary pressures, use an occlusive device to “close” the FO

How well did you know this?

Not at all

Perfectly

What percentage of congenital heart disease cases are VSD?

30%

How well did you know this?

Not at all

Perfectly

What are two types of VSD?

Small (<3mm e.g. smaller than aortic valve)

Large (>3mm)

How well did you know this?

Not at all

Perfectly

What may be heard on auscultation of a child with a small VSD?

PSM at LLSE

Quiet P2

How well did you know this?

Not at all

Perfectly

What management should be considered in a small VSD?

Bacterial endocarditis prevention

How well did you know this?

Not at all

Perfectly

How does a large VSD present?

HEART FAILURE
SOB, FTT, recurrent chest infections

Tachypnoea, tachycardia,
Hepatomegaly

How well did you know this?

Not at all

Perfectly

Auscultation large VSD

Soft PSM

Apical MDM

How well did you know this?

Not at all

Perfectly

What will be heard on auscultation of a child with a huge VSD?

Nothing - no turbulent flow because valve so big

How well did you know this?

Not at all

Perfectly

CXR and ECG features of VSD

CXR: enlarged heart, increased pulmonary vasculature, pulmonary oedema
ECG: Bilateral ventricular hypertrophy

How well did you know this?

Not at all

Perfectly

What is the management for child with large VSD?

Management of heart failure:
- Diuretics (furosemide)
- Captopril 
- Digoxin 
Increased calories (if FTT)

How well did you know this?

Not at all

Perfectly

What is a complication of a large VSD?

Eisenmenger’s syndrome

How well did you know this?

Not at all

Perfectly

What is Eisenmenger's syndrome?

L to R shunt causes pulmonary HTN. Eventually this pressure is raised above L side, and shunt switches to R to L = cyanosis

What are two (broad) causes of PDA?

Failure to close (congenital) | Prematurity

What is a persistent ductus arteriosus?

Failure of DA to close by 1 mo (generally a defect in constrictor mechanism)

Ausculation child with PDA

Continuous murmur loudest beneath L clavicle

What happens to the pulse pressure in PDA?

Increased

CXR/ECG features of PDA

CXR: often normal but with features of HF if large ECG: often normal, but LVH, or RVH (if pHTN)

What are children with a PDA at increased risk of?

Bacterial endocarditis, pulmonary vascular disease (Eisenmenger's)

How is a PDA managed?

MEDICAL (closure) - Prostacyclin synthetase inhibtor - IV Indomethacin - Ibuprofen

When should a PDA be kept open? How?

If there is a duct dependent circulation (e.g. a R to L shunt additionally). Kept open using prostaglandin infusion until that anomaly is sorted

What is the commonest presentation of R to L shunts?

Cyanosis within the first week of life

What is the mainstay of treatment to keep ducts open?

Prostaglandin infusion

How is a cyanotic heart disease investigated?

Nitrogen washout test. Measure R radial PaO2. If <15 kPa, cyanotic heart disease

What are two examples of R to L shunts?

Tetralogy of Fallot | Transposition of the Great Arteries

What is the commonest cause of cyanotic heart disease?

Tetralogy of fallot

What are the four anatomical features of tetralogy of fallot?

Large VSD Pulmonary stenosis Aorta lies over ventricular septum Resulting RVH

What are four physiological features of ToF?

Cyanosis Hypercyanotic spells Dyspnoea Fainting

Two clinical features of ToF?

Clubbing | Loud ESM at LSE

CXR/ECG features of ToF

CXR: small heart, uplifted apex, pulmonary artery "bay" ECG: RVH (no S wave)

Medical management of ToF

Hypercyanotic spells lasting >15 mins - Knees to chest in parent's arms - Sedation/pain relief - IV propranolol - IVI - HCO3- to correct acidosis - Artifical ventilation to reduce metabolic demand (With view to surgery at 6 mos)

Surgical management of ToF

Close VD, relieve obstruction

What happens in transposition of great arteries?

Essentially two parallel circulations (R-R and L-L). Incompatible with life WITHOUT an open duct

Ausculation TOGA

Loud, single S2

CXR/ECG TOGA

CXR: egg shaped heart on side ECG: normal

Management of TOGA

Improve mixing - PROSTAGLANDIN INFUSION to keep ducts open Ballon septostomy to keep ducts open

In what syndrome is AVSD quite common?

Down's

What happens in tricuspid atresia?

Right ventricle is small and non function. | Mixing occurs through patient foramen ovale (in L ventricle) and patient VSD allows blood out pulmonary artery

What is the management for triscupid atresia?

KEEP DUCTS OPEN - prostaglandin infusion | Blalock Taussig - shunt insertion from subclavian to pulmonary

Clinical features of AS?

ESM radiating to carotid Carotid thrills Slow rising pulse - Dyspnoea - Syncope - Chest pain (All worse on exercise)

CXR/ECG features of AS

CXR: enlarged heart (LV). Dilatation of ascending aorta ECG: LVH

Management for AS

Regular clinical/ECHO monitoring Balloon valvulotomy (TAVR) Antibiotic/anticoagulant prophylaxis

Ausculation PS

ESM UPLSE

Give three examples of outflow obstruction in sick infant

- Coarctation of aorta - Interruption of aortic arch - Hypoplastic L heart

What is the mainstay of treatment in outflow obstructions?

Prostaglandin infusions to keep ducts patent for mixing

When does coarctation of aorta present?

2 days (when DA closes)

Clinical features of coarctation of aorta?

Absent femoral pulse Severe metabolic acidosis Severe heart failure

Whcih syndrome is interruption of aortic arch associated with?

Di George

What is interruption of aortic arch codependent on?

PDA (R to L shunt)

Clinical features of hypoplastic left heart syndrome

All peripheral pulses absent

Commonest childhood arrhythmia

SVT

SVT acute management

Circ and resp support Vasovagal manoevres - carotid sinus massage, cold ice pack on face, bear down ADENOSINE (IV/IO) Synchronised DC

SVT maintenance management

Fleicanide | Propranolol

Clinical features SVT

Reduced CO = pulmonary oedema Hydrops fetalis IUD

What symptoms are suggestive of a cardiac cause of syncope?

Arrythmias Symptoms on exercise FHx sudden unexplained death

How can vasovagal syncope be managed?

Look out for warning signs Avoid triggers Physical counter pressure manoeuvres, tilt training May need to increased salt (consider furosemide) to improve volume

How long is the latent interval in RhF?

2-6 weeks

Which infection does RhF follow?

GA haemolytic strep

Age range of RhF?

5-15 years

Major criteria RhF

``` Carditis/murmur Arthritis S/c nodules Erythema marginatum (map-like) Sydenham's chorea (2-6mos after) ```

Minor criteria RhF

``` Arthralgia Fever Hx RhF Raised APPs (ESR/CRP) Prolonged PR interval ```

Acute management of RhF

Bed rest and anti-inflammatories (ASPIRIN)

How is RhF prevented from recurring?

Benzathine penicillin (monthly)

What might congenital heart disease raise the risk of?

Bacterial endocarditis

Features of bacterial endocarditis

- Fever (prolonged) - Malaise - New murmur - Raised ESR - Unexplained anaemia/haematuria - Splinter haemorrhages, JWL, ON, clubbing - Roth spots

Investigations fof suspected BE?

2 blood cultures BEFORE abx | Echo (vegetations)

Commonest causative organisms in BE?

Strep viridans

Management of BE?

Resuscitation Abx (penicillin and gentamicin)

Commonest congenital heart defect

VSD

Second commonest congenital heart defect

PDA