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CP2 Paeds > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Abbrevations; VSD, ASD, PDA, TGA, AVSD, AS, PS, HLHS, FTT, LLSE, SVT

A

VSD-ventricular septal defect

ASD-Atrial septal defect

PDA-Patent ductus arteriosus

TGA-Transposition of great arteries

AVSD-Atrioventricular septal defect

AS-Aortic stenosis

PS-Pulmonary stenosis

HLHS-Hypoplastic left heart syndrome

FTT-Failure to thrive

LLSE-Lower left sternal edge

SVT-Supraventricular tachycardia

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2
Q

Draw and label fetal circulation

A
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3
Q

Signs and symptoms of heart failure

A

Symptoms

  • Breathlessness esp. on feeding/exertion
  • Sweating
  • Poor feeding
  • Recurrent chest infection

Signs

  • Poor wght gain
  • Tachypnoea
  • Tachycardia
  • Heart murmour/ gallopp rhythm
  • Hepatomegaly
  • Cool peripheries
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4
Q

History taking and examinations for cardiac disease

A

History Taking

  • SOCRATES +
  • HxPC
    • Feeding
    • Wght loss
    • Lethargy
    • Sweating
    • SOB
    • Chest infections
  • PSHx, e.g. VSD,
  • PMHx e.g. downs,
    • Obs Hx abnormalities on scan?
  • DHx,
  • FHx e.g. VSD,
  • SHx e.g. smoking and alcohol during preg
  • ICE parents

Examinations

  • CV incl BP, pulses, CAP, HR
  • Resp incl. SATS, RR
  • Wght Hgt
  • Abdo
  • Temp
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5
Q

DD for heart failure

A
  • Anaemia - tachcardia and SOB
  • Reflux - poor feeding + breathlessness
  • CF - recurrent chest infection w/ poor wght gain
  • Shock - tachyopneoa, tachycardia
  • Sepsis - tachyopneoa, tachycardia
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6
Q

Initial management of heart failure

A

ABCDE

  • Oxygen
  • As required
    • Digoxen
    • Furosemide
    • Fluids
  • If necesarry intubation and morphine for sedation

Case by case find cause and treat

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7
Q

Cardiac causes of heart failure

A

Neonates: obstructed systemic circulation e.g. aortic valve stenosis, hypoplastic left heart synrome

Infants: high pulmonary blood flow e.g. VSD, AVSD

Children/adolescents: R/L heart failure e.g. Eisenmengers syndrome, rheumatic heart disease

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8
Q

Signs of an innocent heart murmour

A

The S’s

  • aSymptomatic
  • Soft blowing murmour
  • Systolic
  • left Sternal edge
  • no abnormal heart Sounds

Being febrile/anaemic can make innocent murmours worse

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9
Q

What is venous hum

A

Sound heard above R clavicle radiating into neck

Continuous unchanging

Commonly mixed up with PDA

Sound can be stopped by pressure on internal jugular vein on the same side

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10
Q

Draw a labelled diagram of the heart cycle

A
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11
Q

What murmour do you get in AS

A

Ejection systolic with non-fixed splitting of second heart sound loudest at the upper right sternal edge

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12
Q

What murmour do you get in VSD

A

Pan systolic murmour at the lower left sternal edge

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13
Q

What murmour do you get in ASD

A

Ejection systolic murmour with fixed splitting of second heart sound best heard at the upper left sternal edge

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14
Q

What murmour do you get in PDA

A

Continuous left subclavian murmour

(sound is from different areas on chest)

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15
Q

What murmour do you get in AVSD

A

YOU DONT!!!! haha lol

or at least it’s very quiet

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16
Q

What murmour do you get in tetralogy of Fallot

A

Harsh ejection systolic murmour at the left sternal edge from day 1 of life

(sound also contains pulmonic regurg)

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17
Q

What murmour do you get in TGA

A

Mixed

  • Loud single second heart sound
  • Usually no murmour
  • Sometimes systolic murmour
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18
Q

What murmour do you get in PS

A

Ejection systolic murmour best heard at the upper left sternal edge

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19
Q

Draw and label the valve areas on the chest wall

20
Q

Draw and label where murmour are best heard on the chest wall

21
Q

List 5 acyanotic/pink/breathless/left to right heart defects

Study These Flashcards
A
  1. AS/coarc
  2. PS
  3. VSD
  4. ASD
  5. PDA
22
Q

List the mixed presentation of blue and breathless heart defects

23
Q

Epidemiology, features, ECG, CXR, Echo and management of VSD

Study These Flashcards
A

Epidem

  • 30% of congenital cardiac defects are VSD
  • Common w/ downs T21 and fetal alcohol syndrome

Features

  • Small-asymptomatic
  • Large-heart failure, breathlessness, FTT after 1 week, recurrent chest infections
  • Signs-pan systolic murmour at LLSE
    • Large-tachycardia, tachypnoea, hepatomegaly,

ECG

  • Biventricular hypertrophy by 2/12

CXR

  • Cardiomegaly
  • Enlarged pulomary aa
  • Increased pulomary vascular markings
  • Pulmonary odema

Echo

  • Demonstrates anatomy of defect, haemodynamic effect and pulmonary HTN

Management

Small

  • Will close spontaniously
  • Whilst still patent prevent bacterial endocarditis through good dental hygiene

Large

  • Heart failure-diuretics + captopril (ACE inhibitor)
  • Calorie input PRN
  • Surgery at age 3-6 months to prevent Einsenmengers syndrome
24
Q

Epidemiology, features, ECG, CXR, Echo and management of ASD

Study These Flashcards
A

Epidem

  • Fetal alcohol syndrome, Noonans syndrome

Features

Symptoms

  • Usually none
  • Recurrent chest infections/wheeze
  • Arrhythmias in fourth decade on

Signs

  • Ejection systolic murmour hears over pulmonic area ULSE
  • Fixed split second heart sound

ECG

  • Partial RBBB, RAD (RV hypertrophy)

CXR

  • Cardiomegaly
  • Enlarged pulm. aa’s
  • Incr. pulm. markings

Echo

  • Delineate anatomy mainstay diagnostic tool

Management

  • Cardiac catheterisation and insertion of occlusive device
25
Epidemiology, features and management of AS
Epidem * Turner syndrome 45XO, Williams syndrome Features Symptoms * Usually asymptomatic * Reduced exercise tolerance * Chest pain on exertion * Syncope on exertion * Neonates w/ critical AS - heart failure and shock Signs * Carotid thrill * Ejection systolic murmour in aortic area Management * In more sever cases balloon valvotomy * Eventually probably gonna need aortic valve replacement
26
Epidemiology, features and management of PS
Epidem * Warfrin during pregnancy, Noonan syndrome Features Symptoms * Most asymptomatic * Severe duct depedant PS in neonates-cyanosis in first few days Signs * Ejection systolic murmour pulmonic area * When severe RV heave Management * When pressure gradient across valve becomes marked - trans-catheter balloon dilation
27
What genetic disorder is AVSD most common in
Downs T21
28
Features, ECG, CXR of AVSD
Features * Usually present at antenatal screening * Symptoms * Cyanosis at birth OR * Heart Failure at 2-3 weeks * Signs * No murmour * Usually Downs ECG * Superior axis (LAD) CXR * Non specific * Cardiomegaly * Pulmonary hypertension (harsh vascular markings)
29
When do the fetal circulatory aspects close?
Ductus arteriousus-2-3 days after birth Foramen ovale-with first few breaths Ductus venosum-4 days ish
30
Features and management of PDA
Features * Continuous murmour L subclavicular * Heart failure * Pulmonary HTN Management * Closure with occlusive device via cardiac catheter at age 1
31
Features, associated features/syndromes, diagnosis, and management of coarcation of aorta
Features * Usually presents at 2/7 * Acute circulatory collapse due to closure of PDA--duct dependant lesion * Signs * Sick baby * Heart failure * Absent femorals (in exam this is either coarc or HLHS, supposed to be slightly stronger in coarc) * Severe metabolic acidosis Associated features/syndromes * Bicuspid aortic valve * Turner syndrome 45XO * Williams syndrome Diagnosis * History, echo, CXR, ECG Management * ABC * Prostaglandin infusion * Early surgical intervention balloon dilation may be used
32
List 5 duct-dependant lesion
1. Interuption of aortic arch 2. Coarctiation of aorta/stenosis 3. Pulmonary stenosis 4. TGA 5. HLHS
33
Immediate management of closure of duct dependant lesions
ABC Prostaglandin infusion (5ng/kg/min)
34
Aetiology, Features, ECG, Management of SVT
Aet * Accessory conduction pathway is set up --\> premature activation of atria * Usually no structural abnormalities Features Child is classically well with only fast heart rate * Symptom * Heart failure * Sign * 250-300 BPM * Pulmonary odema ECG * Complex tachycardia * May have absent/obscured P waves * If severe may have ischaemic changes + t wave inversion in lateral leads Management Pharm * IV adenosine Non-Pharm * Positive pressure ventilation * Vagal stimulation manouvers e.g. carotid sinus massage/ice water to face * Electrical cardioversion (shock em)
35
List 2 cyanotic/blue/right to left heart defects
ToF TGA
36
List key features of Fallots
1. Pulmonary stenosis 2. Overriding aorta 3. VSD 4. RV hypertrophy
37
Early and Late management of fallots
Early * Initially medical * If cyanosed may require shunt (Blalock–Taussig shunt) /ballooning of R outflow early * If hypercyanotic episode lasts more than 15 mins: give sedation+pain relief (morphine), IV propanolol, IV fluids, bicard for acidosis, reduce o2 demand through ventilation and mm paralysis Late * Definitive surgery at 6 months
38
What is TGA and how is a PDA important
* The aortic like structure drains R heart (deox) to systemic circulation * The pulmonary aa structure drains the L heart (ox) to lungs I.E. THE GREAT ARTERIES ARE SWITCHED Not so much a problem when ductus arteriosus is open as it allows some ox blood to body and some deox blood to lungs. This stops when it closes. Two closed circuits are created deox blood will onle flow round body and ox blood will only flow round lungs.
39
Management of TGA
In acutely sick cyanosed child mixing must be immediatly improved: 1. Keep arteriousus patent --\> prostaglandin 2. Balloon atrial septostomy (blow a whole in the atrial septum--\> balloon through femoral vv into R heart, through foramen ovale, inflated and pulled back through Eventually all patient need definitive surgery in neonatal period--\> arterial switch procedure (exactly what is sounds like)
40
List syndromes associated with cardiac disease
**Turners -** 45XO webbed neck slow development of girls, becomes apprant around 5 * Aortic valve stenosis/coarc **Noonans -** short stature, learning issues, concave chest, webbed neck + flat nose bridge, in girls and boys * ASD, pulmonary stenosis **Williams -** short, neonate hypercalcaemia, mild LD, elfin face, small upturned nose, wide mouth and full lips * Aortic stenosis (supravalvular) **Downs -** brachycephaly, single palmar crease, epicanthic folds (hooded lids), usually require neonatal gut surgery * ASVD, VSD **Marfans -** disorder of CT, tall, thin, flexible joints * Aortic root dilation, mitral regurg
41
Features and management of HLHS
Features May be detected antenatally Most sever duct dependant lesion as there is almost no flow through L heart Symptoms * Sick * Heart failure * Shock Signs * Severe acidosis * Circulatory collapse * Weakness/absence of peripheral pulses esp femoral Management * ABC * Prostaglandin * Difficult operation --\> Norwood procedure
42
Causes and features of myocarditis
Causes * 2ary to metabolic disease * Viral infection of myocardium e.g. rheumatic Features * Previously well child * Cardiomyopathy * Heart failure * Fever
43
Risk factors, causes and management of subacute bacterial endocarditis in children
Risk factors * Artificial valves * IV drug users (mum) or IV use in hospital * Catheter * Bad oral hygiene (thrush) * Congenital heart defect esp. VSD, coarc aorta, PDA * Valve defect Causes * Most common - streptococci viridans (a α- haemolytic streptococcus) in mouth * streptococcus intermedius * enterococci (UTI/gut) * coagulase negative staphylococci Management * High dose IV penicillin with aminoglycodside e.g. gentamicin for 6 weeks * If prosthesis exist eradication is difficult, surgical removal may be required * Prophylaxis - good oral hygiene, avoid piercings
44
Recite the rule of threes pneumonic
3 holes * VSD * ASD * PDA 3 blocked pipes * Aortic stenosis * Pulmonary stenosis * Coarc aorta 3 blue babies * Fallots * TGA * Complex CHD (this is just to make the pneumonic really)
45
Divide the common congenital heart issues into cyanotic and acyanotic
Cyanotic * Fallots * TGA Acyanotic * ASD * VSD * Pulmonary stenosis * Aortic stenosis * Coarc aorta

CP2 Paeds (8 decks)

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