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Cardiology Flashcards

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1
Q

What are the 4 cardiac abnormalities that are classically found in Tetralogy of Fallot?

A

VSD
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

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2
Q

Is Tetralogy of Fallot a cyanotic or acyanotic condition? What determines the extent of cyanosis?

A

Tetralogy of Fallot is a cyanotic lesion

The severity of the pulmonary stenosis is what determines the extent of the cyanosis

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3
Q

What murmur is heard with Tetralogy of Fallot?

A

Ejection systolic

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4
Q

What are the S+S of Tetralogy of Fallot?

A 
Cyanosis
Clubbing
Poor feeding
Poor weight gain/failure to thrive 
Ejection systolic murmur
Tet spells
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5
Q

What is the investigation of choice to diagnose Tetralogy of Fallot?

A

Echocardiogram

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6
Q

What is the characteristic feature seen in CXR with Tetralogy of Fallot?

A

Heart has a “boot-shaped” appearance

This is due to RVH

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7
Q

What are Tet spells?

A

Intermittent periods where the right-to-left shunt becomes temporarily worsened, precipitating a cyanotic episode

Occurs in situations where pulmonary vascular resistance increases or systemic resistance decreases (exercise, walking, crying)

This allows blood to flow from the RV into the aorta

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8
Q

How do Tet spells typically present?

A 
Irritability
Cyanosis
SOB
Reduced consciousness
Seizures

Older children may be squatting (this increases systemic vascular resistance)

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9
Q

How are Tet spells managed?

A

Older children - squat
Younger children - knees to chest

Supplementary O2
Beta blockers
IV fluids
Morphine
Sodium bicarbonate 
Phenylephrine infusion
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10
Q

How is Tetralogy of Fallot managed?

A

Neonates - prostaglandin infusion to maintain PDA

Definitive management - open heart surgery

Prognosis >90%

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11
Q

What is Transposition of the great vessels?

A

Congenital heart defect in which the attachments of the aorta and pulmonary trunk are swapped

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12
Q

Why might babies with Transposition of the great vessels survive immediately after birth?

A

An additional heart defect - PDA, VSD, ASD

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13
Q

How does Transposition of the great vessels present?

A

Presents with cyanosis at birth

If initially compensated by PDA/VSD/ASD:
Respiratory distress
Tachycardia
Poor feeding
Failure to thrive 
Sweating
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14
Q

What is the definitive management for Transposition of the great vessels?

A

Open heart surgery

Cardiopulmonary bypass machine is sued to perform an arterial switch procedure in the first few days of life

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15
Q

How might Transposition of the great vessels be managed until definitive corrective surgery can be performed?

A

Prostaglandin E2 to maintain PDA

Balloon septostomy - create ASD

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16
Q

What is the most common congenital cardiac defect?

A

VSD

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17
Q

What conditions are associated with VSD?

A

Down’s syndrome

Turner’s syndrome

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18
Q

Is VSD a cyanotic or acyanotic lesion?

A

Acyanotic

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19
Q

How does a VSD present?

A

Can be symptomless and only present in adulthood

Typical symptoms:
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive
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20
Q

What type of murmur is typically heard with a VSD?

A

Pan-systolic
Left lower sternal border in the 3rd and 4th intercostal spaces

May be a systolic thrill

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21
Q

How should a small VSD be managed?

A

Watch and wait - may close spontaneously or become smaller

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22
Q

How should larger VSDs be managed?

A

Surgical correction - transvenous catheter closure via femoral vein or open heart surgery

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23
Q

Is ASD a cyanotic or acyanotic lesion?

24
Q

List the types of ASD from most to leas common.

Study These Flashcards
A

Ostium secundum
Patent foramen ovale
Ostium primum

25
How does an ASD present?
``` SOB Difficulty feeding Poor weight gain/failure to thrive LRTI Murmur ```
26
What type of murmur is typically heard with an ASD?
Mid-systolic, crescendo-decrescendo murmur Loudest at upper left sternal border Fixed split second heart sound
27
How are ASDs managed?
Small and asymptomatic: Watch and wait Larger and/or symptomatic: Surgical correction via transvenous catheter closure and anticoagulants (aspirin, warfarin, NOACs)
28
What are the potential complications of ASDs?
Stroke Atrial fibrillation or atrial flutter Pulmonary hypertension and right-sided heart failure Eisenmenger syndrome
29
Describe the typical presentation of PDA?
``` SOB Difficulty feeding Poor weight gain LRTI Murmur ```
30
What type of murmur is typically heard with PDA?
Continuous crescendo-decrescendo 'machinery' murmur May be a left subclavicular thrill
31
What is the best imaging modality to diagnose PDA?
Echocardiography
32
How are PDAs usually managed?
Can monitor until 1 year of age via echo Administer Indomethacin Unlikely that a PDA will close spontaneously after 1 year - transcatheter or surgical closure
33
Where does the narrowing in aortic coarctation typically occur?
Around the ductus arteriosus
34
Which genetic condition is associated with aortic coarctation?
Turner's syndrome
35
How does aortic coarctation typically present in neonates?
Weak femoral pulses
36
What are the signs of aortic coarctation in infancy?
Tachypnoea and increased work of breathing Poor feeding Grey and floppy baby
37
What are the signs of aortic coarctation in childhood?
Left ventricular heave due to LVH Underdevelopment of the left arm (where there is reduced flow to the left subclavian artery) Underdevelopment of the legs
38
What would a four limb BP show in aortic coarctation?
High BP in limbs supplied by arteries that come before the narrowing Lower BP in limbs that come after the narrowing
39
What are the management options for aortic coarctation?
Prostaglandin E2 to maintain the ductus arteriosus | Surgical
40
How does aortic stenosis present?
Mild stenosis: asymptomatic, discovered incidentally ``` Moderate stenosis: Fatigue SOB Dizziness Fainting Symptoms worse on exertion ``` Severe stenosis: Heart failure in the first few months of life
41
What type of murmur is typically heard with aortic stenosis?
Ejection systolic, crescendo-decrescendo murmur Radiates to carotids Loudest in the 2nd ICS, upper right border of sternum Ejection click just before murmur Palpable thrill during systole
42
Describe the pulse felt in aortic stenosis.
Slow rising pulse | Narrow pulse pressure
43
What is the gold standard imaging modality for aortic stenosis?
Echocardiogram
44
What are the management options for aortic stenosis?
Percutaneous balloon aortic valvuloplasty Surgical aortic valvotomy Valve replacement
45
What are the potential complications of aortic stenosis?
``` LV outflow tract obstruction Heart failure Ventricular arrhythmia Bacterial endocarditis Sudden death, often on exertion ```
46
What conditions are associated with pulmonary valve stenosis?
Tetralogy of Fallot William syndrome Noonan syndrome Congenital rubella syndrome
47
How does pulmonary stenosis present?
Fatigue on exertion SOB Dizziness Fainting
48
What are the signs of pulmonary stenosis?
Ejection systolic murmur Palpable thrill in pulmonary area Right ventricular heave due to RVH Raised JVP with giant 'a' waves
49
What is the gold standard imaging modality for pulmonary stenosis?
Echocardiogram
50
What is the treatment of choice in managing symptomatic/severe pulmonary stenosis?
Balloon valvuloplasty (inserting a catheter into the femoral vein, through the IVC and right side of heart to the pulmonary valve)
51
What is Ebstein's anomaly?
Where the tricuspid valve is lower in the right side of the heart, causing a bigger right atrium and small right ventricle
52
Ingestion of which drugs predisposes a foetus to Ebstein's anomaly?
Lithium and benzodiazepines
53
How does Ebstein's anomaly typically present?
``` Evidence of heart failure (oedema) Gallop rhythm and S3 and S4 Cyanosis SOB Tachypnoea Poor feeding Collapse or cardiac arrest ```
54
What is the gold standard imaging modality for Ebstein's anomaly?
Echocardiogram
55
How is Ebstein's anomaly managed?
Medical management - treating arrhythmias and heart failure, prophylactic abx to prevent infective endocarditis Definitive management - surgical correction

Paediatrics (14 decks)

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