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Paedriatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the 8 commonest lesions that account for most congenital heart diseases?

A 
Ventricular septal defect (VSD)
Patent ductus arteriosus (PDA)
Atrial septal defect (ASD)
Pulmonary stenosis
Aortic stenosis
Coarctation of the aorta
Transposition of great arteries
Tetralogy of Fallot
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2
Q

What is the aetiology of most congenital heart diseases?

A

Genetic susceptibility

Teratogenic insult

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3
Q

What are the environmental factors that might cause congenital heart diseases?

A

Drugs: alcohol, amphetamines, cocaine, ecstasy, phenytoin, lithium
Infections: TORCH
Maternal: DM, SLE

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4
Q

What are the TORCH infections?

A

Toxoplasma
Rubella
CMV
Herpes

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5
Q

30% of what have CHD?

A

Chromosomal abnormalities

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6
Q

Which chromosomal abnormalities in particular can have CHD?

A

Trisomy 13, 18 and 21

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7
Q

What is trisomy 21 particularly associated with?

A

AVSD

ASD and VSD more common

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8
Q

Which CHD is Turner syndrome associated with?

A

Co-arctation of aorta

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9
Q

Which CHD is Noonan syndrome associated with?

A

Pulmonary stenosis

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10
Q

Which CHD is Williams syndrome associated with?

A

Supravalvular aortic stenosis

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11
Q

What do you ask in a history about CHD?

A 
Feeding, weight, development
Cyanosis
Tachypnoea, dyspnoea
Exercise tolerance
Chest pain
Syncope
Palpitation
Joint problems
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12
Q

What should you examine a child with CHD?

A 
Weight/height
Dysmorphic features
Cyanosis
Clubbing
Tachy-/dyspnoea
Pulses/apex (femoral)
Heart sounds
Murmurs
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13
Q

What investigations would you do in a child with potential CHD?

A 
BP
O2 sats, ABG
ECG
CXR
ECHO
Catheter
Angiography
MRI/A
Exercise testing
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14
Q

What can the timing of murmurs be in the cardiac cycle?

A

Systole
Diastole
Continuous

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15
Q

What can the duration of murmurs be?

A

Early/mid/late

Ejection/holo- or pan systolic

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16
Q

What can the pitch/quality of murmurs be?

A

Harsh or mixed frequency (turbulence)
Soft or indeterminate
Vibratory/pure frequency (laminar flow)

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17
Q

What percentage of innocent murmurs are innocent?

A

70-80%

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18
Q

What are the 4 types of innocent murmurs?

A
  1. Still’s murmur (LV outflow murmur)
  2. Pulmonary outflow murmur
  3. Carotid/brachiocephal IC arterial bruits
  4. Venous Hum
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19
Q

What are common features of innocent murmurs?

A 
Systolic murmur (cont. venous hum)
No other signs cardiac disease
Soft murmur
Vibratory/musical
Localised
Varies with position, respiration, exercise
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20
Q

What age does Still’s murmur usually present?

A

2-7yrs

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21
Q

What are the characteristics of Still’s murmur?

A

Soft systolic, vibratory/musical

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22
Q

Where is Still’s murmur heard best?

A

Apex, left sternal border

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23
Q

When does Still’s murmur increase?

A

Respiration

With exercise

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24
Q

What age does pulmonary outflow murmur usually present?

A

8-10yrs

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25
Q

What are the characteristics of a pulmonary outflow murmur?

A

Soft systolic, vibratory

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26
Q

Where is a pulmonary outflow murmur heard best?

A

Upper left sternal border (ULSB)

Well localised, not radiating to back

27
Q

When does a pulmonary outflow murmur increase?

A

Increases in supine position, with exercise

28
Q

What kind of child does a pulmonary outflow murmur usually affect?

A

Narrow chested

29
Q

What age does carotid/brachiocephal IC arterial bruits usually present?

A

2-10yrs

30
Q

What are the characteristics of a carotid/brachiocephal IC arterial bruit?

A

1/6-2/6 systolic, harsh

31
Q

Where is a carotid/brachiocephal IC arterial bruit heard best?

A

Supraclavicular

Radiates to neck

32
Q

When does a carotid/brachiocephal IC arterial bruit increase?

A

Increases with exercise

Decreases on turning head or extending neck

33
Q

What age does venous hum usually present?

A

3-8yrs

34
Q

What are the characteristics of venous hum?

A

Soft, indistinct

Continuous murmur, sometimes with diastolic accentuation

35
Q

Where is a venous hum heard best?

A

Supraclavicular

36
Q

When can a venous hum be heard?

A

Only in upright position

Disappears on lying down/when turning head

37
Q

What are the 3 main types of VSD?

A

Subaortic
Perimembranous
Muscular

38
Q

What is the shunt in a VSD?

A

L to R shunt

39
Q

What is the clinical presentation of VSD?

A

Pansystolic murmur lower left sternal edge

Sometimes thrill

40
Q

What is the clinical presentation of a very small VSD?

A

Early systolic murmur

41
Q

What is the clinical presentation of a very large VSD?

A

Diastolic rumble due to relative mitral stenosis

42
Q

What is Eisenmenger syndrome?

A

Any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, reversal of flow, and cyanosis

43
Q

How are VSD’s closed?

A

Amplatzer occlusion device

Patch closure - open heart surgery

44
Q

How are atrial septal defects sometimes detected in adulthood?

A

AF
Heart failure
Pulmonary hypertension

45
Q

What are the clinical signs of atrial septal defects?

A

Few clinical signs

Usually spontaneous closure

46
Q

What are the features of an atrial septal defect on auscultation?

A

Wide fixed splitting of 2nd heart sound

Pulmonary flow murmur

47
Q

Which chromosomal abnormality is an atrioventricular-septal defect associated with?

A

Trisomy 21

48
Q

What are the clinical signs of pulmonary stenosis?

A

Asymptomatic in mild stenosis

Moderate and severe: dyspnoea and fatigue

49
Q

What are the features of pulmonary stenosis on auscultation?

A

Ejection systolic murmur, ULSB

Radiation to back

50
Q

What is a balloon valvoplasty for?

A

Balloon valvuloplasty is a procedure to repair a heart valve that has a narrowed opening

51
Q

What are the clinical features of aortic stenosis?

A

Mostly asymptomatic

Severe: reduced exercise tolerance, exertional chest pain, syncope

52
Q

What are the features of aortic stenosis on auscultation?

A

Ejection systolic murmur URSB

Radiation into carotids

53
Q

What are the changes in fatal circulation at birth?

A 
Pulmonary vascular resistance falls
Pulmonary blood flow rises
Systemic vascular resistance increases
Ductus arteriosus closes
Foramen vale closes
Ductus venosus closes
54
Q

How is patent ductus arteriosus treated?

A

Fluid restriction/diuretics
Prostaglandin inhibitors
Surgical ligation

55
Q

What is coarctation of the aorta?

A

Narrowing of the aorta

56
Q

What are the investigations for coarctation of the aorta?

A

MRI (3D)

57
Q

What are the options for management of coarctation of the aorta?

A

Re-open DA with prostaglandin
Resection with end-to-end anastomosis
Subclavian patch repaird
Balloon aortoplasty

58
Q

What is transposition the great arteries?

A

The two main blood vessels leaving the heart, the pulmonary artery and the aorta are swapped over

59
Q

What are the surgical options for transposition of the great arteries?

A

Atrial septostomy

Switch procedure

60
Q

What is Tetralogy of Fallot?

A

Defect affecting structure of heart, usually four:

  1. Pulmonary stenosis
  2. VSD
  3. Right ventricular hypertrophy
  4. Overriding aorta
61
Q

How many defects are there normally in ToF?

A

4

62
Q

What are the 4 defects normally seen in ToF?

A
  1. Pulmonary stenosis
  2. VSD
  3. Right ventricular hypertrophy
  4. Overriding aorta
63
Q

What is the treatment for ToF?

A

Open heart surgery in first year of birth

64
Q

What is a sign of ToF?

A

Blue-tinged skin

Paedriatrics (19 decks)

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