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Cardiology Flashcards

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1
Q

What is the most common cause of heart disease in children?

A

Congenital

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2
Q

How do left-to-right shunts present?

A

Breathlessness

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3
Q

What are the common causes of left to right shunts?

A

Ventricular septal defect - VSD
Persistent arterial duct - PDA
Atrial septal defect - ASD

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4
Q

How to right-to-left shunts present?

A

Blue Examples - AVSD, complex congenital heart disease

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5
Q

What is a common mixing congenital heart lesion?

A

Atrioventricular defect

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6
Q

How does an outflow obstruction present in a well child?

A

Asymptomatic with a murmur

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7
Q

What are examples of outflow obstructions (well child)?

A

pulmonary stenosis

aortic stenosis

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8
Q

How does an outflow obstruction present in a sick neonate?

What is the cause?

A

Collapsed with shock

Coarctation of the aorta

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9
Q

Where does the foramen ovale lie?

A

Between the left and right atrium

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10
Q

Where is the ductus arteriosus?

A

connects the pulmonary artery to the aorta

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11
Q

Describe fetal circulation (long)

A

the left atrial pressure is low as little blood returns from the lungs, right atrial pressure is high as it receives all systemic venous return
blood flows across the foramen ovale from the right atrium to the left atrium

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12
Q

Describe the changes to circulation at birth

LONGG

A

With the first breaths, resistance to pulmonary blood falls and the volume of blood flowing through the lungs increases six fold
RISE IN LEFT ATRIAL PRESSURE
Volume of blood returning to right atrium falls
Pressure difference causes foramen ovale close

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13
Q

When does the ductus arteriosus normally close?

A

within the first few hours or days

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14
Q

What happens when ducts in babies who rely on duct-dependent circulation close?

A

They rapidly deteriorate

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15
Q

How does congenital heart disease present?

A

antenatal cardiac ultrasound diagnosis
detection of a heart murmur
shock
cyanosis

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16
Q

When is the fetal heart checked?

A

Between 18/20 weeks gestation - cardiac anomaly can then be identified and surgery booked antenatally

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17
Q

Most common presentation of congenital heart disease?

A

heart murmur

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18
Q

What are the hallmarks of an innocent heart murmur (30%) ?5 S’s

A 
aSympotomatic patient 
Soft blowing murmur 
Systolic murmur only, not diastolic
left Sternal edge 
no Signs

Also:
Normal heart sounds with no added sounds
No parasternal thrill
No radiation

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19
Q

What conditions mean innocent murmurs are more likely to be heard?

A

anaemia

febrile illness

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20
Q

Which tests can help distinguish between innocent and pathological murmur?

A

ECG
Chest radiograph
get paediatric cardiology review

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21
Q

What are the symptoms of heart failure?

A

breathlessness (particularly on feeding and exertion)
sweating
poor feeding
recurrent chest infections

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22
Q

What are the signs of heart failure?

A 
Poor weight gain 
Tachypnoea
Tachycardia
Heart murmur - gallop rhythm 
Enlarged heart 
Hepatomegaly 
Cool peripheries
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23
Q

What are the main causes of heart failure in neonates?

A

Hypoplastic left heart syndrome
Critical aortic valve stenosis
Severe coarctation of the aorta
Interruption of the aortic arch

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24
Q

What are the main causes of heart failure in infants?

A

ventricular septal defect
atrioventricular septal defect
large persistent ductus arteriosus

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25
What are the main causes of heart failure in older children and adolscents?
Eisenmenger syndrome (right heart failure only) Rheumatic heart disease Cardiomyopathy
26
When are foetus's especially at risk of developing an AVSD?
Down's syndrome Previous child with heart disease Mother with congenital heart disease
27
Why might heart murmurs present late in neonates?
pulmonary resistance is still high therefore VSD or PDS may only become apparent with pulmonary resistance falls a few weeks after birth
28
What happens when the duct closes in duct dependent circulation?
severe acidosis collapse death unless ductal patency is restored
29
What cause heart failure in the first weeks of life?
left to right shunt | pulmonary vascular resistance falls and there is an increased in left to right shunt and increasing pulmonary flow
30
What is Eisenmenger syndrome?
irreversibly raised pulmonary vascular resistance resulting from chronically raised pulmonary arterial pressure
31
What is central cyanosis a sign of?
fall in arterial blood oxygen tension
32
What are the causes of cyanosis in a newborn infant?
cardiac disorders - congenital heart disease respiratory disorders - respiratory distress syndrome persistent pulmonary HTN of the newborn infection - septicaemia from group B inborn error of metabolism
33
What is the key for early survival in neonates with duct dependent circulation?
maintaining ductal patency
34
What are the causes of cyanosis in infants (high pulmonary flow)?
ventricular septal defect atrioventricular septal defect large persistent ductus arteriosis
35
What are the causes of cyanosis in older children and adolescents (right or left heart failure)?
Eisenmenger syndrome Rheumatic heart disease Cardiomyopathy
36
What are the left to right shunts?
atrial septal defects (ASDs) VSDs persistent ductus arteriosus (PDA)
37
What are the two different types of ASD?
secundum ASD - 80% | partial atrioventricular septal defect (AVSD)
38
What are the symptoms of ASD?
none - commonly recurrent chest infections/wheeze arrhythmias - fourth decade onwards
39
What are the physical signs of ASD?
Ejection systolic murmur heard at ULSE A fixed split second heart sound
40
What would be seen on a chest radiograph in ASD?
cardiomegaly | pulmonary arteries and increased pulmonary vascular markings
41
What would be seen on an ECG in secundum ASD?
partial RBBB right axis deviation right ventricular enlargement
42
What would be seen on an ECG in partial AVSD?
superior QRS axis
43
What is the management for ASD?
Secundum ASDs - cardiac catheterization with insertion of occlusion device partial AVSD - surgical correction is required treatment takes place 3-5 years
44
What are the symptoms of small VSDs?
aSymptomatic
45
What are the physical signs of small VSDs?
Loud pansystolic murmur at lower left sternal edge Quiet pulmonary second sound
46
What are the investigation results in a small VSD?
Chest radiograph - normal ECG - normal Echo - demonstrates precise anatomy of the defect
47
What is the management of a small VSD?
lesions will close spontaneously
48
What makes a VSD 'large'?
defects are the same size or bigger
49
What are the symptoms of large VSDs?
heart failure with breathless and faltering growth after 1 week old recurrent chest infections
50
What are the physical signs of a VSD?
``` Tachypnoea Tachycardia Enlarged liver from heart failure Active precordium Soft pansystolic murmur or no murmur Apical mid-diastolic murmur Loud pulmonary second sound ```
51
What would be seen on a chest radiograph with a large VSD?
cardiomegaly enlarged pulmonary arteries increased pulmonary vascular markings pulmonary oedema
52
What would be seen on an ECG in a large VSD?
Biventricular hypertrophy by 2 months of age
53
What would be seen on an echocardiogram in a patient with a large VSD?
demonstrates the anatomy of the defect haemodynamic effects and pulmonary hypertension
54
How is a large VSD managed?
Diuretics Captopril Calories (high energy intake via NG tube) Surgery at 3-6 months of age
55
What are the symptoms of a PDA?
None
56
What are the signs of PDA?
continuous murmur at ULSE +/- bounding pulses
57
How is PDA managed?
Coil or device closure at cardiac catheter at 1 year of age or ligation
58
What are the right to left shunts that occur?
tetralogy of fallot | transposition of great arteries
59
How do these right to left shunts present?
CYANOSIS (blue)
60
What are the 4 cardinal features of tetralogy of fallot?
a large VSD overriding aorta with respect to ventricular septum subpulmonary stenosis RVH
61
What are the clinical features of tetralogy of fallot?
Cyanosis Loud ejection systolic murmur at ULSE Clubbing of fingers and toes Hypercyanotic spells
62
What is the management of tetralogy of fallot?
Surgery at 6-9 months
63
What would the investigations show in tetralogy of fallot?
Chest radiograph - small heart, uptilted apex due to RVH, ECG - normal at birth , RVH when older
64
What are the clinical features of transposition of the great arteries?
Cyanosis | Usually no murmur
65
What does a chest radiograph in transposition of the great arteries?
classical finding - "egg on side" appearance increased pulmonary vascular markings are common ECG = normal
66
How of children with transposition of the great arteries managed?
prostaglandin infusion balloon arterial septostomy arterial switch operation in neonatal period
67
What is Eisenmenger syndrome?
high pulmonary blood flow due to large left to right shunt or common mixing is not treated at an early stage, then the pulmonary arteries become thick walled and the resistance to flow increases. At 10-15 years the shunt reverses and teenager becomes blue. Situation is progressive and adults die of right sided heart failure.
68
What are the two common mixing lesions?
AVSD (complete) | Complex disease - e.g. tricuspid atresia
69
What are the clinical features of AVSD?
``` Downs syndrome (VSD more common than AVSD) Cyanosis at birth No murmur Superior axis on ECG Presentation at antenatal US screening ```
70
What are the clinical features of complex diseases like tricuspid atresia?
Cyanosis | Breathless
71
How are complex diseases like tricuspid atresia managed?
Shunt (Blalock-Taussig) Pulmonary artery banding Surgery (Glen and later Fondon op)
72
What are the different types of outflow obstruction in the well child?
Aortic stenosis Pulmonary stenosis Adult type coarctation of the aorta
73
What are the clinical features of AS?
``` small volume, slow rising pulses carotid thrill (always) ESM at URSE (Asymptomatic) Delayed and soft aortic sternal sound Apical ejection click ```
74
What would be seen on ECG or Chest radiograph in AS?
Normal
75
How is AS managed?
Balloon dilation
76
What are the clinical features of pulmonary stenosis?
asymptomatic ESM best heard at ULSE | If severe there is a prominent right ventricular heave (RVH)
77
How is pulmonary stenosis managed?
Balloon dilation
78
What are the clinical features of adult type coarctation of the aorta?
asymptomatic systemic HTN in the right arm ESM at upper sternal edge Collateral heard with CONTINUOUS murmur--> Radio-femoral delay
79
What would be seen on a chest radiograph in coarctation of the aorta? (adult type)
Chest radiograph - Rib notching due to development of large collateral intercostal arteries sign with a visible notch in descending aorta
80
What would be seen on an ECG in coarctation of the aorta (adult type)
LVH
81
What is the management for coarctation (adult type) of the aorta?
Stent insertion or surgery
82
What are the duct dependent lesions?
coarctation of the aorta interruption of the aorta hypoplastic left heart syndrome
83
How does coarctation of the aorta present?
examination on first day of life is normal the neonates usually present with acute circulatory collapse at 2 days of age when the duct closes
84
What are the physical signs seen in coarctation of the aorta?
a sick baby with severe heart failure absent femoral pulses severe metabolic acidosis
85
What would be seen on a chest X-ray with coarctation of the aorta?
Cardiomegaly
86
How is coarctation of the aorta managed?
Maintain ABC | Surgical repair is performed soon after diagnosis
87
What is hypo plastic left heart syndrome?
underdevelopment of the entire left side of the heart (mitral valve is small, aortic valve atresia, ascending aorta is small almost always coarctation of the aorta)
88
What are the clinical features of hypoplastic left heart syndrome?
- may be detected antenatally on screening - if detected after birth they are the sickest of all neonates presenting with duct dependent systemic circulation - there is no flow through the left side of the heart so there is profound acidosis and rapid CV changes - absence of all peripheral pulses
89
How is hypoplastic left heart syndrome managed?
``` Prostaglandin infusion Maintain ABC Norwood procedure (surgery) Further op (Glenn or hemi-Fontan) at 6 months old and again at 3 years (Fontan) ```
90
What is superventricular tachycardia (SVT)?
most common childhood arrhythmia | HR rapid - between 250-300
91
How does SVT present clinically?
Causes poor cardiac output and pulmonary oedema Presents with symptoms of heart failure in the neonate or young infant Causes hydrops fetalis and interuterine death
92
What does SVT look like on an ECG?
narrow complex tachycardia of 250-300 beats/min If heart failure is severe then there may be changes suggestive of MI with T wave inversion in the lateral precordial leads When in sinus rhythm, a short P-R interval may be discernible In Wolf-Parkinson-White syndrome, the early antegrade activation of the ventricle via the pathway results in a short P-R interval and a delta wave
93
How is SVT managed?
``` circulatory and respiratory support tissue acidosis is corrected vagal stimulating manoeuvres IV adenosine electrical cardioversion ```
94
What are some examples of vagal stimulating manoeuvres?
carotid sinus massage or cold ice pack to face
95
What is myocarditis?
dilated cardiomyopathy (a large poorly contracting heart) should be suspected in any child with an enlarged heart and heart failure who has previously been well
96
What causes of myocarditis?
may be inherited | secondary to metabolic disease may result from direct viral infection of myocardium
97
How is the diagnosis made in myocarditis?
Echocardiography
98
How is myocarditis treated?
Diuretics ACEI carvediolB-adrenoceptor blocking agents some children ultimately require heart transplantation
99
What are the risk factors for subacute bacterial endocarditis (SBE)?
all children of any age with congential heart disease - including neonates highest risk when there is turbulent jet of blood (VSD, coarctation of the aorta, PDA, prosthetic material in surgery)
100
What are the clinical signs of SBE?
``` fever anaemia splinter haemorrhages clubbing (late) necrotic skin lesions changing cardiac signs splenomegaly neurological signs from cerebral infarction retinal infarcts arthritis/arthralgia haematuria ```
101
What is the common causative organism for SBE?
a-haemolytic streptococcus
102
How is SBE treated?
high dose penicillin in combination with aminoglycoside, giving 6 weeks of IV therapy and checking serum levels of abx will kill the organism #if infected prosthetic material then less chance of complete eradication and surgical removal may be required
103
What are the syndromes associated with cardiac disease?
Turners Downs Noonans Marfans

Paediatrics (13 decks)

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