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Cardiology Flashcards

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1
Q

What are the 2 main (general) causes of congenital heart disease? (2)

A

Genetics (mono/poly)

External teratogens

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2
Q

How may congenital heart disease initially present? (5)

A

Antenatal Dx
Detection of heart murmur (NB innocents)

Heart failure
Shock
Cyanosis

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3
Q

What are the symptoms of a L-R shunt?

Give some egs (3)

A

Breathless

ASD
VSD
PDA

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4
Q

What are the symptoms of a R-L shunt

Give some egs (2)

A

Blue

ToF
TGA

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5
Q

What are some symptoms of common mixing

Give an eg

A

Breathless + blue

AVSD

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6
Q

Give egs (2) of heart conditions seen in well children with obstrn

A

Aortic stenosis

Pulm stenosis

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7
Q

In sick neonates with obstrn heart disease
How would they present?
Give some egs (2)

A

Collapsed with shock

Coarc of Ao
HLHS

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8
Q

List the causes of heart failure in:
Neonates (3)
Infants (3)
Older children / adolescents (3)

A

Neonates - obstruction / duct dependant lesions:
Hypoplastic LH
Critical Aortic Stenosis
Severe coarctation of Ao

Infants - high plum flow:
VSD
AVSD
Large PDA

Older - L/R heart failure:
Eisenmengers (R HF only)
Rheumatic heart disease
Cardiomyopathy

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9
Q

List some symptoms (4) of heart failure in children

List some signs (6)

A

SOB
Poor feeding
Sweating
Recurrent chest infections

Tachypnoea/tachycardia
Poor wt gain
Heart murmur / gallop
Enlarged heart
Hepatomegaly
Cool peripheries
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10
Q

What types of drugs may be used in heart failure for infants (L-R shunt / high plum flow) (3)

A

Diuretics
ACEi (captopril)
+ poss B-blocker/digoxin

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11
Q

What are the features of an innoSent murmur (4S’s +3)

A

Soft
Systolic
aSymp
left Sternal edge

+ no parasternal thrill
+ no added sounds
+ no radiation

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12
Q

What ages are innocent murmurs often heard?

What other scenarios / conditions may one be heard in? (2)

A

30% of 3-4y/o

Febrile illness / Anaemia (due to increased CO)

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13
Q

When / where may a venous hum be heard

A

Common + harmless
May disappear on supine/ jugular occlusion/ head sideways
Heard over R clavicle

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14
Q

List the diff types of acyanotic heart disease (7)

A 
ASD
VSD
AVSD
PDA
AS
PS
Coarc of Ao
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15
Q

List the diff types of cyanotic heart disease (5)

A 
Hypoplastic LH
ToF
Transposition of Great Vessels
Pulm atresia
Tricuspid atresia
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16
Q

What are the 2 diff types of ASD

How do they present? (6)

A

Secundum (80%) - involves foramen ovale
or Partial AVSD (pAVSD)
→ Both sim presentation:

Usually asymp
Recurrent chest infections/wheeze
Ejection systolic (L sternal edge - pulm valve flow)
Split 2nd heart sound
pAVSD - apex pansystolic (AV valve regurg)
Arrhythmias when middle aged

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17
Q

What 3 Ix can be done into ASD?

+ what would be seen in each?

A

CXR: enlarged heart / enlarged pulm aa’s / increased pulm vasc markings

ECG:
Secundum; RBBB / R axis deviation
pAVSD; -ve deflection in aVF (displaced AV node)

ECHO - confirms anatomy (Dx)

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18
Q

How is a secundum ASD managed?

How is a pAVSD managed?

A

Secundum → catheter device closure/occlusion at 3-5yrs

pAVSD → surgical correction at 3yrs

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19
Q

What is the proportion of small VSDs to large?

How small is considered a small VSD?

A

VSDs are 30% all congenital heart disease
Small VSDs - 80-90% VSDs
Large VSDs - 10-20%

Small VSDs are <3mm (smaller than aortic valve)

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20
Q

What will be seen O/E + CXR/ECG/ECHO in a small VSD

A

O/E: loud pansystolic (L lower sternal edge)
CXR: normal
ECG: normal
ECHO: shows anatomy w. no pulm HT (+doppler echo assess haemodynamic effects)

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21
Q

How are small VSDs managed?

A

Will close spontaneously

Ensure good dental hygiene to prevent endocarditis

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22
Q

What are the features of a large VSD?

A 
Heart failure symptoms:
SOB
Poor feeding / failure to thrive after 1wk old
Tachypnoea/cardia
Recurrent chest infections
Hepatomegaly

Heave
Soft (large) pan systolic at LLSE
Apical pan-diastolic (mitral flow)
Loud pulm 2nd sound (pulm aa BP)

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23
Q

What will be seen on CXR/ECG/ECHO in large VSD?

A 
CXR - Similar to ASD:
Enlarged heart
Enlarged pulm aa's
Increased pulm vascular markings
\+ Pulm oedema (not in ASD)

ECG: bilateral hypertrophy (upright T wave) (pulm HT)

ECHO: shows defect

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24
Q

What is the risk of not surgically treating large VSDs early enough?

A

Must be done by 3-6m otherwise → chronic pulm HT → Eisenmengers

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25
What signs may be elicited O/E in pulmonary stenosis? (3) | What may be seen on CXR/ECG?
Ejection systolic murmur (+click) at ULSE Poss thrill Poss heave (in severe) CXR: Normal OR Pulm aa dilation ECG: RV hypertrophy (upright T in V1)
26
How is pulmonary stenosis surgically managed?
Balloon valvotomy (trans-catheter balloon dilation)
27
What other cardiac structural defects can be assoc w. aortic stenosis in children?
AS can be individual | or assoc w. mitral stenosis + Ao Coarc
28
How does Aortic Stenosis present?
``` Most are asymp Severe: Reduced exercise tolerance Chest pain on exertion Syncope ```
29
What signs can be elicited O/E in Aortic Stenosis (5)
``` Carotid thrill (always) Slow-rising pulse Ejection-systolic at URSE 2nd Ao sound Apex ejection click ```
30
What may be seen on CXR / ECG in Aortic Stenosis
CXR: Normal OR Enlarged LV ± Dilated ascending aorta ``` ECG: LV hypertrophy (Deep S in V2 + Tall R in V6) LV strain (downwards T) (severe AS) ```
31
What % of Down's syndrome kids have AVSD?
15-20%
32
What other cardiac structural defect is seen in AVSD?
Also obliteration of pulm/aortic valves | + only AV valves left (but often v leaky)
33
What are some possible murmur characteristics that may be seen in AVSD? (3)
``` Systolic ejection (pulm valve flow + S2 splitting) Mid-diastolic (LLSE - mitral flow) Apical holosystolic (radiating to L axilla - mitral insuff) ```
34
What will be seen on CXR in AVSD? (2) | + on ECG? (5)
Cardiomegaly + Increased pulm vasculature ``` L axis deviation RA enlarged Bi-ventricular hypertrophy Incomplete RBBB Prolonged PR interval (1st degree block - abnorm AVN) ```
35
How is AVSD managed?
Medically treat heart failure | Surgically repair defect at 3-6m
36
What lesions may cause outflow obstruction in a well child? (3)
Pulm stenosis Aortic stenosis Coarctation
37
What signs seen in Aortic Stenosis? (2) + in Pulm Stenosis? (1) + in Coarctation? (2)
Murmur URSE + carotid thrill Murmur ULSE (+ no carotid thrill) Systemic hypertension + Radio-femoral delay
38
How does Coarctation of Aorta occur (pathophysiology)? | What other conditions is is assoc w.? (3)
Arterial duct tissue encircling aorta at ductus arteriosus → aorta constriction when duct closes → severe LV outflow obstrn Assoc w. VSD, Turners, Bicuspid aortic valve
39
How does coarctation of aorta present?
``` Normal Ex on 1st day 2nd day (duct closing) → acute circulatory collapse: Severe heart failure Absent femoral pulse Severe metab acidosis Poss ULSE murmur ```
40
What will be seen on CXR + ECG in Coarctation?
CXR - cardiomegaly from HF/shock | ECG - normal
41
How is Coarctation of Aorta managed?
Prostaglandins HF drugs Surgical repair: angioplasty ± stenting
42
What is tricuspid atresia?
Valve absent/abnormal → blood flow from RA-RV blocked | Must have ASD+VSD to survive (+ usually has PDA)
43
What is pulmonary atresia? | How will it present?
Valve absent/abnormal → blood flow heart-lungs blocked No prob in utero but after birth quickly cyanosed (only thing providing O2 to lungs is PDA)
44
List some duct-dependant lesions (7)
``` Coarctation TGA HLHS PA TA AS PS ```
45
What is the immediate management for duct-dependant lesions? (2)
IV prostaglandins short term | Formaldehyde infiltration longer-term
46
What time frame is classed as persistent patent ductus arteriosus? Why does it occur?
Persistent = not closed within 1m of EDD (common in pre terms) Due to failed mechanism constricting duct
47
What are the features seen in PDA? (4)
Breathlessness (L-R shunt) Continuous murmur behind L clavicle Raised pulse pressure (collapsing/bounding pulse) Pulm HT ± HF (if duct v large)
48
What is seen in PDA on CXR / ECG / ECHO?
CXR: normal ECG: normal (if v big - sim features to large VSD) ECHO: duct easily seen
49
What are the risks if PDA is not closed up? (2) | How is it closed?
Bacterial endocarditis Pulmonary vascular disease Closure done trans-catheter - coil/occlusion device at 1y/o Occasionally surgical ligation req
50
List some causes for cyanosis in newborn/infants
``` Cyanotic congenital heart disease Resp: Surfactant defc Meconium asp Pulm hypoplasia ``` Persistent pulm HT of newborn (pulm resisx failed to fall) Infection / septicaemia (GrpB Strep etc) Metab acidosis + shock
51
What are the 4 features in Tetralogy of Fallot?
Large VSD Overriding of Aorta (w. respect to vent septum) Subpulmonary Stenosis (RV outflow obstrn) RV hypertrophy (as result)
52
How may ToF present?
``` Antenatal Dx OR Dx after murmur in 1st 2m life OR Hypercyanotic spells in 1st few days (irritability/SOB/pallor) ```
53
What clinical signs may be seen in ToF?
Clubbing (fingers + toes) Loud harsh ejection systolic murmur (L sternal edge) Cyanosis + shortening murmur (as RB outflow obstrn worsens)
54
What is seen on CXR in ToF? (5)
EGG ON SIDE Relatively small heart Uptilted apex (RB hypertrophy) Pulmonary aa 'bay' - concavity on L heart border R sided aortic arch (poss) Reduced pulm vasc markings (reduced flow)
55
What is seen on ECG in ToF?
Normal at birth | RV hypertrophy when older (upright T wave in V1)
56
How is ToF managed initially/medically? (5)
Hypercyanotic spells usually self-limiting Any hyper cyanotic spells >15mins req prompt Tx: Sedation IV propanolol IV fluids HCO3- (for acidosis) Paralysis + ventilation
57
How may ToF be surgically managed?
VSD/Pulm valve repair (using patch) V cyanosed infants → BT shunt (subclav aa → pulm aa)
58
What are the main features of TGA?
Cyanosis***: profound + presents 2nd day (ductal closure) Less severe if more mixing/other abns Usually no murmur (poss from LV/pulmonary high flow)
59
What would be seen on CXR in TGA? (3) | + on ECG
Narrow upper mediastinum (pedicle) Egg on side contour (RV hypertrophy) Increased pulm vasc markings ECG usually normal
60
How is TGA managed? (3)
IV prostaglandins Balloon atrial septostomy (reverses foramen ovale valve) Later arterial switch (+ coronary aa transfer)
61
What congenital heart lesion is commonly seen in Turners?
Coarctation of Ao
62
What congenital heart lesions may be seen in Noonan's syndrome?
Pulmonary stenosis* (usually asymp) Hypertrophic cardiomyopathy (infancy HF) ASD/VSD
63
What are the 4 features of a hypoplastic L heart?
Mitral valve small/atretic LV v small Aortic atresia Coarctation of Aorta
64
What would be the presentation of a neonate after birth, with hypoplastic L heart? (3)
V SICK Ductal constriction → profound acidosis / rapid CV collapse Weak/absence of all peripheral pulses
65
What are the cardiac effects in Marfans? (2)
Weakened walls of aorta (→ aneurysm/dissection) | Mitral/tricuspid prolapse → regurg
66
What are the ECG features of supra ventricular tachycardia (SVT)? (3)
Narrow complex tachycardia at 250-300bpm T wave inversion (occurs w. HF) Short PR if in sinus rhythm
67
What are the possible effects of SVT in utero? | How does SVT present in a neonate?
Can → hydrous fetalis / intrauterine death Neonate: poor CO + pulm oedema → HF
68
How is immediate management of SVT managed? (4)
Circulatory (correct acidosis) + Resp support (vent if req) Vagal stimulation manouvres (carotid sinus massage) IV adenosine - 1st line (induces AV block) Electrical cardioverion w. synchronised DC shock - if adenosine fails
69
How is SVT managed once sinus rhythm is restored? | + how managed if WPW syndrome?
Maintenance therapy e.g. flecainide / sotalol | WPW - atrial pacing / ablation of accessory pathway
70
List some causes of myocarditis
Viruses: influenza / coxsackie / adenovirus Rubella / polio / Lyme Medication allergies Exposure to certain chems/fungi/parasites/radiation/drugs
71
What is myocarditis? | Which age group is it more severe in?
Immune chemical + disease/infection damage → swollen/thick myocardium → HF Affects infants more severe > children
72
List some symptoms of myocarditis in infants (7)
Failure to thrive Feeding probs HF Fever Low urine output Pale peripheries Anxiousness
73
List some symptoms of myocarditis in children > 2yrs (6)
``` Nausea Fatigue Cough Chest pain Belly ache Swelling (legs, feet, face) ```
74
What Ix can be done into myocarditis? (8 (5 bloods))
CXR (enlarged borders) ECHO (Dx) ``` Blood cultures LFTs U&Es FBC Ab screen Heart biopsy ```
75
How is myocarditis managed (4)
``` NO CURE - treat symps/minimise damage until resolves Diuretics ACEis B-Blocker (carvedilol) Abx/Steroids/NSAIDs/IVIGs ```
76
What are the main cardiac-related RFs for subacute bacterial endocarditis (SBE)? (4)
``` Turbulent flow: VSD Coarctation PDA Prosthetics ```
77
What are the classical signs of SBE? (5) | + any peripheral signs that may be present? (7)
``` Fever Malaise Raised ESR Anaemia Haematuria Always consider SBE with these features + excluded other DDx ``` ``` Clubbing (late sign) Splinter haemorrhages Necrotic skin lesions Signs of neuro infarcts Retinal infarcts Arthritis/arthralgia Splenomegaly ```
78
What is the commonest cause of SBE?
Streptococcus viridians (a-haemolytic)
79
How is SBE managed?
High-dose IV penicillin/aminoglycoside (genta) 6wks

Child Health (14 decks)

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