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Cardiology Flashcards

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1
Q

What two broad categories is congenitial heart disease divided into

A

Acyanotic (not blue)

Cyanotic (blue)

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2
Q

What is Acyanotic Congenital heart disease characterised by

A

Left to Right Shunt - increase flow into R heart and lungs

Outflow Obstruction

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3
Q

What are the main acyanotic congenital heart disease

A 
Left to right Shunts:
VSD - Ventricular Septal Defect 
ASD - Atrial Septal Defect
PDA - Patent Ductus Arteriosis 
AVSD - Atrioventricular Septal Defect

Outflow Obstruction:
Coarctation of the aorta
Aortic Stenosis
Pulmonary Stenosis

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4
Q

What is Cyanotic Heart disease characterised by

A

Right to Left Shunt

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5
Q

What are the main types of cyanotic heart disease

A

The 5 Ts

  1. Transportation of the Great Arteries
  2. Tetralogy of Fallot
  3. Truncus Arteriosus
  4. Tricuspid Atresia
  5. Total Anomalous pulmonary vascular return
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6
Q

What are the types of ASD and which is most common

A

Ostium Secundum - most common
Ostium Primidum
Sinus Venous ASD

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7
Q

What is Ostium Secundum

A

Defects high in septum - asymptomatic usually until adulthood

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8
Q

What ids Ostium Primidum

A

Defects opposing endocardial cushions associated with AV valve anomalies - usually present earlier

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9
Q

Why do small/ moderate sized defects not usually present until adulthood

A

Shunts increase with age

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10
Q

How may an ASD present and who is it common in

A 
Asymptomatic when younger
- Alcohol fetal syndrome 
- Downs Syndrome 
Older children and adults get symptoms of: 
- fixed splitting
- ejection systolic murmur 
- palpitations 
- SOBOE
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11
Q

What is the ASD murmur

A

Fixed widely Split S2

Ejection Systolic Murmur in pulmonary area

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12
Q

What tests would you perform for ASD

A

ECG
CXR: progressive right atrial enlargement
ECHO is diagnostic

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13
Q

How would you manage ASD

A

Closure of the defect

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14
Q

What is Patent Ductus Arteriosis and who is it most common in

A

Aorta and pulmonary artery still connected

Common in pre-term babies

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15
Q

What symptoms do you get in PDA

A

Poor feeding
Failure to thrive
Tachypnoea
Breathlessness

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16
Q

What is a complication of PDA

A

PDA related eisenmengers syndrome (PHTN):

  • cyanosis
  • Clubbed and blue toes but normal fingers
  • Heart Failure: Hepatomegaly and Oedema
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17
Q

What is the PDA murmur

A

Classic continuous machinery murmur

Large L to R shunt/ HF then gallop rhythm, thrill and active precordium

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18
Q

How does a ventricular septal defect present

A
  • May be asymptomatic
  • Even large ones may be asymptomatic until PVR has fallen (PVR is high at birth and falls over the weeks following birth)
  • Poor feeding
  • Failure to thrive
  • Tachypnoea
  • Breathlessness
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19
Q

What murmur is heard in VSD

A
  • Pan Systolic Murmur

- Active precordium, Thrill, Gallop Rhythm

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20
Q

What does a louder murmur usually mean

A

Smaller defect

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21
Q

What complications may you get in VSD

A

Hepatomegaly
Oedema
Eismengers Syndrome

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22
Q

What investigations may you perform in VSD

Study These Flashcards
A

ECG

CXR - may see cardiomegaly, large pulmonary arteries and marked pulmonary plethora

23
Q

What is Atrioventricular Septal Defect

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A

Basically a hole in the centre of the heart

24
Q

What is AVSD associated with

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A

Downs Syndrome

25
Why is it important to screen all Downs Syndrome children for AVSD and how is it screened
- Can lead to more rapidly developing Pulmonary Vascular Resistance - Echocardiogram
26
How does AVSD present
Poor feeding Failure to thrive Tachypnoea Breathlessness
27
What murmur is present in AVSD
- Murmur arises from valvular regurgitation rather than septal defect - may get ejection systolic, mid diastolic, pansystolic - Active precordium, Thrill, Gallop Rhythm
28
What complications may you get in AVSD
Eishmengers Syndrome HF: Hepatomegaly, Oedema
29
What is coarctation of the aorta
Narrowing of Descending Aorta
30
Who is COA common in
More common in boys Bicuspid Aortic Valve Turners Syndrome
31
How does COA usually present
Asymptomatic unless severe: | - Complete/ Almost complete obstruction will present collapsed and acidotic with HF - Urgent Repair!!!!
32
What are the clinical signs of COA
- HTN - Weak femoral pulses (always compare to brachials) - Radio-femoral delay - 4 limb BP: discrepancy between upper and lower limb BP - Ejection Systolic murmur (can be heard over back in older children after collaterals develop
33
How may aortic stenosis present
May be asymptomatic unless severe: - Chest pain - Syncope - Failure to thrive - Child may present collapsed and acidotic
34
What signs will be observed in aortic stenosis
Weak pulses Ejection systolic murmur in aortic area Thrill palpable in suprasternal and carotid region
35
What causes pulmonary stenosis
congenital | Acquired: rheumatic heart disease
36
How does Pulmonary stenosis usually present
Asymptomatic
37
What are the signs of pulmonary stenosis
Ejection systolic murmur at LUSE Murmur can radiate to round back if branches also stenosed Right Ventricular heave if significant stenosis
38
What are the features of Tetralogy of Fallot
- Ventricular Septal Defect - Pulmonary Stenosis - Hypertrophy of R ventricle - Overiding Aorta
39
How do tetralogy of Fallot patients present
Depends on lesion, severity and age - Cyanosis: patients are blue, restless, agitated and cry, worsening short severe exacerbations causing distress - Toddlers squat to increase peripheral resistance - Difficulty feeding, failure to thrive and clubbing - Acidosis - Collapse/Death (increased risk of MI, Stroke)
40
How is tetralogy of fallot diagnosed
murmur: harsh ejection systolic murmur LLSE CXR: classic boot shaped heart
41
How is tetralogy of fallot treated
O2, Morphine IV propanol b-blockers Corrective Surgery at 6 months
42
What is Eisenmengers Syndrome
High pressure pulmonary flow damages pulmonary vasculature - causing increased pulmonary vascular resistance and RV pressure - therefore shunt reverses and patients turn blue
43
What two groups can heart failure be classed into
- Over circulation failure volume overload in cardiac chambers - Pump failure from congenital/acquired conditions
44
What are examples of over circulation failure
- conditions associated with increased pulmonary blood flow | - L to R shunts
45
What are examples of pump failure
Congenital: Aortic stenosis, COA, pulmonary stenosis Inflammatory: Viral myocarditis, HIV dilated cardiomyopathies rhythmicdisturbances: tachycardiomyopathy
46
What are the signs and symptoms of HF
``` tachypnoea and dyspnoea Poor feeding and failure to thrive irritability Fatigue Oedema Weight loss, passing out, chest pain (older children) ```
47
What investigations for suspected HF
- CXR - cardiomegaly - ECG - tachycardia, LV hypertrophy, conduction blocks - Echo - structural disease - Biomarkers and bloods
48
How do you treat HF
Treat the cause!!! Drug management: digoxin (rhythm), diuretics (cogestion) Pacemaker, Cardioverter Defibrillator Heart Transplant
49
What is the transportation of the great arteries
When the aorta and pulmonary artery have been swapped round
50
What should you screen for in TOGA and what would be seen on X-ray
22q deletion | Egg on the side
51
How does TOGA present
Cyanosis Collapse Acidosis
52
How do you manage TOGA and TOF acutely
Prostaglandin to keep the ASD or VSD open until surgery
53
How do you close PDA
Ibuprofen | Surgery to close it
54
When does the forum ovale close and where is it
First breath | Between the two atria

Paediatrics (13 decks)

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