Cardiology Flashcards
(97 cards)
1
Q
Symptoms of cardiac failure (4)
A
Breathlessness
Sweating
Poor feeding
Recurrent chest infections
2
Q
Signs of cardiac failure (8)
A
Poor W gain Incr HR Incr RR Heart murmur Gallop rhythm Cardiomegaly Hepatomegaly Cool peripheries
3
Q
When are cardiac abnormalities picked up antenatally?
A
Routine scan 18-20 weeks
4
Q
HR <1 y/o
A
110-160
5
Q
HR 2-5 y/o
A
95-140
6
Q
HR 5-12 y/o
A
80-120
7
Q
HR 12+ y/o
A
60-100
8
Q
Cardiac abnormalities in older children (3)
A
Eisenmenger syndrome
Rheumatic heart disease
Cardiomyopathy
9
Q
Cause of Eisenmenger syndrome
A
Untreated L–>R shunt
10
Q
Effect of Eisenmenger syndrome (3)
A
Pulmonary HTN
R –> L shunt
Blue teen - cyanosis
11
Q
Tx Eisenmenger syndrome
A
Heart-lung transplant
12
Q
General Mx heart failure (6)
A
Bed position - semi-upriht O2 Sufficient kcal Diuretics + ACEi B-blockers + digoxin PG infusion (if duct dependent)
13
Q
LLSE
A
Tricuspid valve
14
Q
ULSE
A
Pulmonary valve
15
Q
URSE
A
Aortic valve
16
Q
MSLE
A
Mitral valve
17
Q
What % of children will have an innocent murmur
A
30%
18
Q
Features of an innocent murmur (S’s)
A
Asymptomatic patient Short duration Systolic only L Sternal edge No added heart sounds No thrill No radiation
19
Q
3 types of innocent murmurs (3)
A
Venous hum
Flow
Musical
20
Q
Where is venous hum
A
ULSE - above Right clavicle
21
Q
How to stop venous hum
A
Supine position
If patient turns head
22
Q
Where is flow murmur
A
MLSE
23
Q
What causes a flow murmur?
A
Acute fever
24
Q
Where is a musical murmur
A
LLSE
25
Features of a pathological murmur (4)
All diastolic/pan-systolic
Loud >3/6
Continuous
Associated abnormalities
26
S+S of pathological murmur (5)
```
SOB
Tired/fatigue
FTT
Cyanosis
CLubbing/hepatomegaly
```
27
L --> R lesions (3)
VSD
PDA
ASD
28
R --> L lesions (2)
TOF
| Transposition of GA
29
Mixing lesion (1)
Complete AV septal defect
30
Outflow obstruction - well child (2)
Pulmonary stenosis
| Aortic stenosis
31
Outflow obstruction - sick child (1)
CoA
32
Causes of cardiac lesions (10)
```
Familial
Chromosomal: Downs
Chromosomal: Edwards
Syndromes: Williams,
Syndromees: Turners
Intrauterine infections - rubella
Meds
Maternal disease
Alcohol/Drugs
Childhood infections
Kawasaki
```
33
What are the 3 shunts in the foetus?
```
Ductus venosus
Foramen ovale (FO)
Ductus ateriosus (DA)
```
34
Role of ductus venosus
Umbilical vv --> IJV
| For O2'd blood to enter heart
35
Role of foramen ovale
RA --> LA
36
Role of ductus arteriosus
Pulm aa--> Aorta
37
What 3 things close the ductus arteriosus?
O2
Bradykinin
Indomethacin
38
What 3 things keep the ductus arteriosus open?
Decr O2
Premature baby
PG E2
39
In what situation would you want the DA to remain open?
Duct-dependent lesions:
CoA
TGA
PS/AS/ atresia
40
Changes to foetal circulation at birth
```
Initiation by 1st breath
--> Incr pulmonary blood flow --> incr P in LA
Decr placental circ --> FO closes
Closure DA
Closure umbilical aa
Closure of DV
```
41
Why does the umbilical aa close at birth?
Mechanical/thermal changes
42
3 holes
VSD
ASD
PDA
43
3 blocked pipes
PS
AS
CoA
44
3 blue babies
TOF
ToGA
Common mixing
45
What are the 2 types of ASD
Secundum (80%)
| Partial AVSD
46
What is ASD Secundum
Defect in centre of atrial septum involving FO
47
What is partial AVSD?
Defect in AV septum
48
Symptoms ASD (3)
Commonly none
Recurrent Chx infection
Wheeze
49
Signs ASD (3)
Ejection systolic murmur
Split 2nd heart sound
If partial - pansystolic murmur @ apex
50
Ix ASD
CXR (cardiomegaly)
ECG (RBBB secundum, sup QRS for partial)
Echo***
51
Mx ASD - secundum
Cardiac catheterisation
52
Mx ASD - partial
Surgical correction
53
What % congenital heart disease is VSD?
30%
54
Features of a small VSD <3mm (2)
Asymp
| Pansystolic murmur @ LLSE
55
Mx small VSD (2)
Lesions close spontaneously
| Follow up by pediatrician/cardiologist
56
Size of a large VSD
Same/bigger than aortic valve
57
Features of large VSD (6)
```
Failure + breathlessness after 1 week
Tachypnoea
Tachycaria
ENlarged liver
Soft pansystolic murmur
Thrills over heart
```
58
Ix Large VSD (3)
CXR - cardiomeg, enlarged PA, oedema
ECG - hypertrophy
Echo
59
Mx large VSD (3)
Diuretics
Incr Kcal
Surgery @3-6m to prevent Eisenmenger's
60
Features PDA (2)
Continuous murmur beneath clavicle
| Bounding pulse
61
Ix PDA (3)
ECG
CXR
ECho
62
Mx PDA (2)
Close w/ indomethocin @1yr
OR
Surgical ligation
63
What is a complete AVSD
Large defect in middle of atrial septum --> ventricular septum
64
Features AVSD (3)
Cyanosis @ birth
HF @ 2-3 w
No murmurs
65
What syndrome is complete AVSD associated with?
Downs
66
Mx AVSD
Tx HF medically
| Surgery @ 3-6m
67
What is the most common cyanotic heart disease?
ToF
68
4 components of ToF (VOSH)
VSD
Overriding of aorta
Subpulmonary stenosis
RV hypertrophy
69
S+S ToF (3)
Severe cyanosis
Clubbing
Ejection systolic murmur L sternal edge from day 1
70
Ix ToF (4)
AN USS (picked up)
CXR
ECG
Echo
71
Mx ToF - initial
PG E2 infusion
| Surgery to fit shunt
72
Mx TOF >4months
Definitive surgery
73
How should hypercyanotic spells in ToF be managed? (>15mins) (4)
Morphine
IV propranolol
IV volume admin
Bicarbonate
74
What is TGA
Aorta connected to RV
| Pulmonary aa connected to LV
75
When does TGA usually present?
2nd day of life
76
Mx TGA (3)
Maintain patency of DA
PG
Balloon Atrial septostomy (acute)
Arterial swtich procedure
77
When does CoA present?
day 2
78
Signs CoA (5)
```
Sick baby
Heart failure
Murmur
Absent femoral/R-F delay
Metabolic acidosis
```
79
Ix CoA (2)
ECG
| CXR - cardiomegaly
80
Syndromes causing CoA (4)
Turners
Marfans
NFM
Bicuspid AV
81
Surgical Mx CoA
Surgical repair
| Balloon angioplasty to buy time
82
What are the common duct dependent lesions? (5)
```
CoA
TGA
HLHS
Pulmonary atresia
Triscupid atresia
```
83
What is the most common cause of SVT?
Re-entry within the AVN
84
Features SVT (4)
HR between 25-300
Sx HF
Hydrops fetalis/intrauterine death
Re-entry tachycardia
85
ECG features SVT
Narrow complex tachyC
| If heart failure --> T wave inversion
86
Mx SVT
Circulatory/resp support
Vagal stimulating manouvers
IV adenosine
ECV
87
Vagal stimulating manouvres for SVT (2)
Carotid sinus massage
| Cold ice pack to face
88
Which cardiac disorders is Noonans associated with? (4)
PS
Hypertrophic cardiomyopathy
ASD
VSD
89
How does Marfan's affect the heart?
Walls of aorta weakened --> aneurysms/dissection
| Mitral/tricuspid valves prolapse
90
Symptoms Kawasakis (7)
```
Fever > 5 days
Non-purulent conjunctivitis
Red mucous membranes
Cervical lymphadenopathy
Rash
Red palms/soles
Peeling fingers/toes
```
91
Mx Kawasakis (3)
IV Immunoglobulin
Aspirin
Steroids
92
Which genetic syndrome is associated with Aortic stenosis
Turners
93
PS Aortic stenosis (4)
Cool peripheries
Mottled skin
Incr RR
Globally reduced pulses
94
Murmur Aortic stenosis
Ejection murmur
95
Which genetic syndrome is Pulmonary stenosis associated with?
Noonans
96
PS Pulmonary stenosis (3)
Pink baby
Ejection systolic murmur
Usually asymp
97
What is the most common cardiac defect in Turners
CoA
