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Paediatrics > Ch 17 - Cardiac disorders > Flashcards

Ch 17 - Cardiac disorders Flashcards

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1
Q

Heart disease in children is mostly congenital. The most common congenital abnormalities (account for 80%) can be categorized into 5 groups - name these

A

Left-to-right shunts (breathless)

Right-to-left shunts (blue)

Common mixing (breathless & blue)

Outflow obstruction in well child (asymptomatic with murmur)

Outflow obstruction in sick neonate (collapsed with shock)

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2
Q

Give 3 examples of left-to-right shunts (breathless)

A
  1. VSD
  2. presistent arterial duct (PDA)
  3. ASD
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3
Q

Give 2 examples of right-to-left shunts (blue)

A

tetralogy of fallot

transposition of great arteries

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4
Q

Give 1 example of common mixing defect (blue and breathless)

A

Atrioventricular septal defect (complete)

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5
Q

Give 2 examples of outflow obstruction in a well child

A

Pulmonary stenosis

aortic stenosis

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6
Q

Give an example of outflow obstruction in a sick neonate

A

coarctation of aorta

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7
Q

The most common presentation of congenital heart disease is a heart murmur; give 4 hallmarks of an innoSent ejection mumur

A

aSymptomatic

Soft blowing murmur

Systolic murmur only (not diastolic)

Left Sternal edge

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8
Q

Causes of HF in neonates (4)

A

Hypoplastic left heart syndrome (severely underdeveloped LH - small LV & aorta)

Severe AS

severe aortic coarctation (narrowing at area of ductus arteriosus)

interruption of aortic arch (gap between ascending & descending thoracic aorta - in a sense the complete form of coarctation of aorta)

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9
Q

Causes of HF in infants (3)

A

VSD

ASD

large PDA

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10
Q

causes of HF in older children (3)

A

Eisenmenger syndrome (RH failure only)

rheumatic HD

cardiomyopathy

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11
Q

Features of HF (6)

A

Tachycardia,

tachypnoea

murmur

creps oedema

cool peripheries sacral oedema cardiomegaly hepatomegaly

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12
Q

HF in 1st week of life usually results from LH obstruction e.g. coarctation of aorta. What is the pathophysiology? how would you manage?

A

If very severe coarctation, the only thing that can maintain perfusion is if the ductus arteriosus is open - allowing a R to L shunt “duct dependent circ”.

When this duct closes, the baby rapidly devlopes severe acidosis, collapse & death - unless you restore the ductal patency via PROSTAGLANDIN infusion.

Followed by prompt surgical repair

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13
Q

After 1st week of life progressive HF is probably due to L to R shunt. Explain the pathophysiology (3)

A

L to R shunt (e.g. VSD) results in eventual increase in pulmonary blood flow > pulmonary oedema > dyspnoea

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14
Q

If an L to R shunt is left untreated will develop Eisenmenger syndrome - explain pathophysiology (4)

A

Eventually in response to the L to R shunt, the pulmonary vasc resistance will rise (at about 3 months age) > symptoms will improve but if left untreated will develop Eisenmenger syndrome - which is irreversibly raised pulmonary vascular reistance (resulting from chronically raised pulmonary arterial pressure/flow) this also causes the shunt to become from R to L - and the teenager becomes blue. (requires heart lung trasnplant)

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15
Q

Causes of cyanosis (6) (physical sign that causes bluish discoloration of the skin and is due to lack of oxygenated blood)

A

Cardiac - R to L shunts, common mixing, outflow obstruction

Resp - RDS, meconium aspiration Persistent pulmonary HTN of newborn (pulmonary resistance fails to fall post natally) Septicaemia Inherited metabolic disorders

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16
Q

Name the types of ASDs (2), and where the defects are in these specifically (2)

A

Secundum ASD (80%) - defect in CENTRE of ATRIAL SEPTUM involving foramen ovale

Partial atrioventricular septal defect (pAVSD) - defect of AV septum (both present with similar signs and symptoms)

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17
Q

Partial AVSD is a defect of AV septum and is characterised by: (2)

A

An inter-atrial communication between bottom of atrial septum & AV valves Abnormal AV valves (left AV valve has 3 leaflets & leaks - regurgitates)

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18
Q

Features of ASDs (6)

A

symptoms - usually none,

can get reccurent chest infections,

arrythmias - after 4th decade

Physical signs: Ejection systolic murmur best heard at upper left sternal edge - due to increased flow via pulmonary valve (because of L to R shunt) Fixed & split 2nd heart sound

if partial AVSD will hear an apical pansystolic murmur (due to regurg)

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19
Q

CxR signs of ASDs (3)

A

Cardiomegaly

Larger PAs

increased vascular markings

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20
Q

ECG signs of ASDs (3)

A

Secundum ASD shows partial RBBB + RAD (due to RV hypertrophy)

pAVSD shows superior QRS axis

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21
Q

Management of ASDs (2)

A

treatment only if significant ASD (ie large enough to cause RV dilation)

Secundum ASDs - cardiac catheterization with insertion of an occlusion device pAVSD - require surgery

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22
Q

Murmur of Small VSDs (1)

A

asymptomatic loud pansystolic murmur at lower left sternal edge

quiet pulmonary 2nd sound (p2) (NO PULMONARY htn)

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23
Q

Ix (3) and management (1) of VSDs

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A

Ix - CxR & ECG (normal), echo + doppler

Management - spontaneous closure - murmur disappears

prevent bacterial endocarditis via good dental hygiene

24
Q

Large VSDs - same size/larger than aortic valve, features (6)

Study These Flashcards
A

HF + SOB + failure to thrive after 1 week old recurrent chest infections tachycardia tachypnoea

soft pansystolic mumur/ no mumur (implying larger defect)

apical mid-diastolic murmur - from increased blood flow across the mitral valve after the blood has circulated through the lungs

25
Ixs (3) & management (3) of VSD
CxR - cardio megaly + large PAs + increased vascular markings + pulmonary oedema ECG - biventricular hypertrophy Echo - pulmonary HTN management - diuretics + ACEis, surgery
26
PDA - definition, associations (3), features (3)
Failure of DA closure by 1 month associations - *Down's, prematurity, female, rubella* features - loud P2, continous mumur at upper left sternal edge, bounding pulse (increased pulse pressure)
27
PDA - Ix (3), management (3)
Ix - CXR, ecg - usually normal, echo management - prostaglandin synthetase inhibitors e.g. ibuprofen; occlusion device closure via catheter, surgery
28
Hyperoxia (nitrogen washout test): defintion (1), method (3), management (1)
**Used to determine heart disease in a CYANOSED infant** give 100% oxygen for 10 min \> check right radial PO2, if remains less than 15kPa = congenital cyanotic heart disease (if \>20 then not) *managemnet - prostaglandin infusion to maintain ductal patency*
29
Tetralogy of fallot - the 4 cardinal features
PROV: subPulmonary stenosis (causing RV outflow obstruction) RV hypertrophy (as a result of above) Overriding aorta - with respect to septum large VSD
30
Tetralogy of fallot features (4)
**Clubbing** **hypercyanotic** spells - rapid increase in cyanosis, inconsolable crying + SOB + pallor squatting on exercise in infants **loud harsh ESM at left sternal edge**
31
Tetralogy of fallot Ix (3)
CxR - small heart, **'boot shaped'** because RVH will cause uptilting of apex. **pulmonary artery 'bay'** echo ecg - RVH signs
32
Tetralogy of fallot management (3)
**surgical VSD closure** + RV obstruction relief **_Blalock-taussig shunt_** - connects a branch of subclavian artery with PA - allowing more blood to flow to lungs symptomtatic treatment of hypercyanotic episodes - propanol, ventilation, morphine
33
Transposition of great arteries: definition
**RV connected to aorta & LV connected to PA** = deoxygenated blood to body & oxygenated blood to lungs = I**NCOMPATIBLE with life**; _unless mixing occurs_ - which often does (as ppl with this often have other congenitatl defects) e.g. ASD/VSD/PDA
34
Transposition of great arteries: features (2)
Consistenly present cyanosis starting from day 2 Loud S2 may have systolic murmur
35
Transposition of great arteries: Ix (3)
**CxR - narrow upper mediastinum (**due to anterposterior relationship of great vessels) **'egg on side' appearance** ECG - norm Echo
36
Transposition of great arteries: management (3)
Prostoglandin infusion ## Footnote **balloon atrial septostomy** **arterial switch procedure**
37
Complete atrioventricular septal defect (common mixing): features (3), Ix (2), management (2)
F - **Down's, cyanosis at birth, SOB** Ix - ECG - superior axis, Echo - ***5 LEAFLET VALVE*** (in centre of heart) M - t*reat HF (diuretics etc.), surgical repair at 3 months*
38
Complex congenital heart disease e.g. tricuspid atresia: definition, features (2), management (3)
D - basically only LV is effective (small and non functional RV) F - cyanosis in neonate if duct dependent, SOB M - **Blalock Taussig shunt (i**ncrease blood flow to lungs) palliation - **'hemi-fontan operation' = connect SVC to RPA** **'fontan operation' = connect IVC to RPA**
39
Outflow obstruction in well child: AS: features (5)
**ES murmur** Slow rising pulse carotid bruits low volume pulse exertional chest pain syncope
40
Outflow obstruction in well child: AS: Ix (2), management (2)
CxR - normal/ **LVH** + **post-stenotic ascending aorta dilatation** ECG - **LVH signs** Management - **Balloon valvotomy, AV replacement**
41
Outflow obstruction in well child: PS: features (3)
most asymptomatic if critical stenosis neonates have duct dependent circ & will therefore present in 1st few days of life with cyanosis ESM, prominent RV heave (if severe), ejection click
42
Outflow obstruction in well child: PS: Ix (2) & management (2)
CxR - post-stenotic PA dilation ECG - RVH signs (upright T wave in V1) M - trans-catheter balloon dilation
43
Outflow obstruction in well child: Adult type aortic coarctation: definition + features (3)
uncommon lesion that is not duct dependent - so presents later as it becomes more severe over yrs F - asymp, systemic HTN in R arm, ES murmur, collaterals heard wit continuous murmu at the back, radio-femoral delay
44
Outflow obstruction in well child: Adult type aortic coarctation: Ix (CxR 2 signs, ECG)
CxR - **'rib-notching' due to large intercostal collateral arteries for bypassing obstruction.**'3 sign' - visible notch in descending aorta at site of coarctation ECG - LVH signs
45
Outflow obstruction in well child: Adult type aortic coarctation: management (2)
**Stent insertion surgical repair**
46
Outflow obstruction in sick neonate: aortic coarctation: features (3), Ix (2), Management (3)
F - **acute circ collapse at day 2 (as DA closes)**, **absent femoral pulses, severe acidosis** Ix - CxR - cardiomegaly & normal ECG M - prostaglandin infusion, stent insertion, surgical repair
47
Outflow obstruction in sick neonate: interruption of the aortic arch: defintion, features (4), management (3)
D - no connection between proximal aorta & distal to DA - **so CO is dependent on R-L shunt** F - VSD is usally present; present with shock, **associated with Di George syndrome**, absent femoral pulses + left brachial pulse M - Prostaglandin infusion, VSD closure + Aortic arch repair
48
Outflow obstruction in sick neonate: hypoplastic LH syndrome: definition, features (3), management (2)
D - basically underdevelopment of LH - LV small non functional, mitral & aortic valve atresia, aortic coarctation F - all peripheral pulses absent, collapse, acidosis M - **norwood procedure, hemi-fontan at 6 months, fontan at 3 years**
49
SVTs: features (3), ix (1)
F - most common childhood arrythmia, **HR rapid - 250-300bpm**; *hydrops fetalis; intrauterine death* I x - ECG - **narrow complex tachy 250-300,** if WPW syndrome short PR interval + delta wave
50
SVT management: acute (2), maintenance (2)
Acute - **Vagal manoeuvres - carotid sinus massage IV adenosine** - breaks re-entry circuit - terminating SVT **DC cardioversion** maintenance - **Flecainide; ablation of accessory pathway**
51
Congenital complete heart block: defintion, features (3), management (1)
D - prevention of development of normal conductive tissue in heart by **anti-ro/la abs** in maternal serum (these mumus have connective tissue disorders e.g. sjogrens) F - most asymptomatic for years, syncope, in utero death, HF M - Endocardial pacemaker implantation
52
long QT syndrome: feature (1), complication (1), associations (3)
Feature - sudden LOC during exercise/stress/emotion complication - sudden death from VT if goes unrecognised associations - autsomal dominant inheritance, erythromycin therapy, electrolyte disorders, head injury
53
Syncope: causes (4),
Common in teenagers, mostly not cardiac cause neurocardiogenic - prolonged standing, vagal symptoms situational - defacation, coughing, urination, swallowing orthostatic - BP fall \> 20 mmHg Ischaemic Arrythmic - Heart block, SVT, VT (increase suspicion of cardiac cause if FH of sudden death, exercise symptoms, palpitations)
54
Rheumatic fever: causes, features (5), Ix (1), management (3)
C - S. Pyogenes (5-15yr olds) F - Joints - migrating polyarthralgia, myocarditis, subcutaneous nodules, erythema marginatum, syndenham's chorea mitral stenosis most common long term damage Ix - ECG - prolonged PR interval M - NSAIDs, steroids, ABs
55
IE: causes (2), features (4), Ix (3), mangement (2), prophylaxis (1)
C - S. viridans, enterococcus, S. aureaus F - roth spots, janeway, oslers, splinter haemorrhages, clubbing, splenomagly, haematuria, changing murmur Ix - blood culture, Echo, CRP/ESR M - high dose penicillin, aminoglycoside P - good dental hygiene

Paediatrics (22 decks)

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