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paediatrics > cardiology > Flashcards

cardiology Flashcards

1
Q

what is the epidemiology of congenital heart disease?

A
  • 30% of all congenital anomalies
  • incidence of 8 in 1,000 live births
  • 8 common lesions account for 80% cases of congenital heart disease
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2
Q

what are the 8 commonest congenital anomalies?

A
  • ventricular septal defect (VSD)
  • patent ductus arteriosus (PDA)
  • atrial septal defect (ASD)
  • pulmonary stenosis
  • aortic stenosis
  • coarctation of the aorta
  • transposition of the great vessels
  • teratology of fallot
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3
Q

What is the aetiology of congenital heart disease?

A

genetics: trisomy 13, trisomy 18, trisomy 21 (AVSD), turner, noonan, williams, 22q11 deletion syndrome
environment: drugs, infection (TORCH) , maternal (diabetes mellitus, systemic lupus erythematous)

teratogenic insult

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4
Q

What history may a child present with?

A
  • Feeding, Weight and Development issues
  • Cyanosis
  • Tachypnoea, Dyspnoea
  • Exercise Tolerance
  • Chest Pain
  • Syncope
  • Palpitation
  • Joint Problems
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5
Q

What may be found on examination of child with heart issues?

A
  • Abnormal weight or height
  • Dysmorphic features
  • Cyanosis
  • Clubbing
  • Tachypnoea/ dyspnoea
  • Pulses/apex (check femoral pulses)
  • Hear sounds (clicks, splits, 3rd and 4th)
  • Murmurs
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6
Q

What investigations may carried out?

A
  • Blood Pressure
  • O2 saturation, arterial BGA
  • ECG (12 lead, 24hrs, event monitor)
  • CXR
  • Echocardiogram
  • Catheter
  • Angiography
  • MRI/A
  • Exercise testing (ECG, sO2)
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7
Q

What are the treatment principles for paediatric cardiology?

A
  • If you can fix it then do it
  • If you can’t fix it the improve the situation
  • If you can do neither then replace it
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8
Q

Give examples of how paediatric cardiology problems can be improved?

A

Medication

Palliative procedures
-BT shunt, balloon valvoplasty, prostaglandin infusion, pulmonary banding

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9
Q

How can murmurs be characterised?

A

Timing in Cardiac Cycle
-Systole / Diastole / Continuous

Duration

  • Early / Mid / Late
  • Ejection / Holo or Pan Systolic

Pitch / Quality

  • Harsh or Mixed Frequency (Turbulence)
  • Soft or Indeterminate
  • Vibratory / Pure Frequency (Laminar Flow
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10
Q

Name 4 sites to check for murmurs.

A
  • Upper right sternal border
  • Upper left sternal border
  • Lower left sternal border
  • Apex
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11
Q

What proportion of childhood murmurs are innocent?

A

70-80%

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12
Q

What are the 4 innocent murmurs of childhood?

A
  • Still’s murmur (LV outflow murmur)
  • Pulmonary outflow murmur
  • Carotid/brachiocephalic arterial bruits
  • Venous hum
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13
Q

What are the common features of innocent childhood murmurs?

A
  • Systolic murmur (continuous in venous hum)
  • No other signs of cardiac disease
  • Soft murmur, grade 1/6 or 2/6
  • Vibratory, musical
  • Localised
  • Varies with position, respiration, exercise
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14
Q

Who do Still’s murmurs affect?

A

2-7 year olds

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15
Q

What do Still’s murmurs sound like?

A

Soft systolic; vibratory, musical,”twangy”

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16
Q

Where can Still’s murmurs be heard?

A

Apex and left sternal border

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17
Q

When do Still’s murmurs increase?

A

In the supine position and with exercise

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18
Q

Who do pulmonary outflow murmurs affect?

A
  • 8-10 year olds

- Often children with a narrow chest

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19
Q

What do pulmonary outflow murmurs sound like?

A

Soft systolic and vibratory

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20
Q

Where can pulmonary outflow murmurs be heard?

A
  • Upper left sternal border

- They are well localised and do not radiate to the back

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21
Q

When do pulmonary outflow murmurs increase?

A

In the supine position and with exercise

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22
Q

Who do carotid arterial bruits affect>?

A

2-10 year olds

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23
Q

What do carotid arterial bruits sound like?

A

Harsh systolic, 1/6-2/6

24
Q

Where can carotid arterial bruits be heard?

A

Supraclavicular, radiates to the neck

25
Q

When do carotid arterial bruits increase?

A

With exercise

26
Q

When do carotid arterial bruits decrease?

A

On turning head or extending neck

27
Q

Who does venous hum usually affect?

A

3-8 year olds

28
Q

What does venous hum sound like?

A
  • Soft, indistinct

- Continuous murmur, sometimes with diastolic accentuation

29
Q

Where can venous hum be heard?

A

Supraclavicular

30
Q

When is venous hum heard?

A

When child is in upright position

31
Q

When does venous hum disappear?

A

On lying down or turning the head

32
Q

What are the 3 main types of VSD?

A
  • Subaortic
  • Perimembranous
  • Muscular
33
Q

What shunt is associated with VSD?

A

L to R

34
Q

What type of murmur is heard in VSD?

A
  • Pansystolic murmur lower left sternal edge, sometimes with thrill
  • In very small VSDs, early systolic murmur
  • In very large VSDs diastolic rumble due to relative mitral stenosis
35
Q

What may there be signs of in large VSDs?

A

Signs of cardiac failure in large VSDs, eventually leading to biventricular hypertrophy and pulmonary hypertension

36
Q

What is Eisenmenger syndrome?

A

The process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic right-to-left shunt.

37
Q

How can VSDs be closed?

A
  • Amplatzer device

- Patch closure

38
Q

How are ASD sometimes detected in adulthood?

A

Patient may present with AF, heart failure or pulmonary hypertension

39
Q

What murmur is associated with ASDs?

A

Wide fixed splitting of 2nd heart sound, pulmonary flow murmur

40
Q

How do ASDs present in childhood?

A

Very few clinical signs as there is good chance of spontaneous closure

41
Q

What is atrioventriculo-septal defect associated with?

A

Trisomy 21

42
Q

What is AVSD?

A

Singular AV valve with ostium primum ASD and high VSD

43
Q

How can pulmonary stenosis present?

A
  • Mild= asymptomatic

- Moderate/severe= severe exertional dyspnoea and fatigue

44
Q

What murmur is associated with pulmonary stenosis?

A

Ejection systolic murmur upper left sternal border with radiation to back

45
Q

How can pulmonary stenosis be managed?

A

Balloon valvoplasty until the child is well past puberty and a replacement can be performed

46
Q

How can aortic stenosis present?

A
  • Mostly asymptomatic

- Severe= reduced exercise tolerance, exertional chest pain, syncope

47
Q

What murmur is associated with aortic stenosis?

A

Ejection systolic murmur upper right sternal border, radiation into carotids

48
Q

What changes occur in the foetal circulation at birth?

A
  • Pulmonary vascular resistance falls
  • Pulmonary blood flow rises
  • Systemic vascular resistance is increased
  • Ductus arteriosus closes
  • Foramen ovale closes
  • Ductus venosus closes
49
Q

Who is PDA common in?

A

Very common in pre-term infants

50
Q

How is PDA treated in pre term babies?

A
  • Fluid restriction/ diuretics
  • Prostaglandin inhibitors (indomethacin, ibuprofen)
  • Surgical ligation
51
Q

How is PDA manages in term babies?

A

Good chance of spontaneous closure, not prostaglandin sensitive

52
Q

How can coarctation of the aorta be imaged

A
  • ECHO
  • MRI
  • 3D MRI
  • CT angiogram
53
Q

How is coarctation of the aorta managed?

A
  • Re-open PDA with Prostaglandin E1 or E2
  • Resection with end-to-end anastomosis
  • Subclavian patch repair
  • Balloon Aortoplasty
54
Q

What is the problem in translocation of the great vessels?

A
  • Aorta comes from RV
  • Pulmonary trunk from LV

Essentially means blood circulates without being oxygenated

55
Q

What procedure is carried out in a transposition of the great vessels to allow blood flow through both sides?

A

Rashkind’s atrial septostomy

56
Q

What is the definitive treatment for translocation of the great vessels?

A

Switch procedure

57
Q

What are the 4 components of teratology of Fallot?

A
  • Pulmonary stenosis
  • VSD
  • Right ventricular hypertrophy
  • Overriding aorta

paediatrics (37 decks)

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