Further Cardiac Conditions Flashcards by Can I get Uhhhh?

What is the most common childhood arrhythmia?

SVT

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Why does SVT occur?

Tachyarrhythmia from above Bundle of His- localised re-entry circuit

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What are clinical features of SVT?

Hydrops fetalis

IU death

Poor CO/ pulmonary oedema from HF features

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What investigations are important in SVT?

ECG: Narrow complex 250-300 bpm, features of MI if severe HF

WPW syndrome (short PR, delta wave)

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What is the management of SVT?

Restore sinus rhythm

Circulatory/ Respiratory support

Vagal maneouvres

IV adenosine

Electro cardioversion

Maintenance therapy: flecainide/ sotalol

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What are the clinical features of congenital complete heart block?

Rare

Foetal hydrops, IU death, HF

Asymptomatic for years

syncope

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What is CCHB associated with?

Anti-Ro/ Anti-La in maternal serum

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What is the treatment for CCHB?

Endocardial pacemaker

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Which arrhythmias are rare in infants?

Long QT

Afib/ Aflut/ectopic atrial tachycaardia/ VT/ VFib are rare

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What are the clinical features of Long QT and what is associated with Long QT?

Long QT: sudden LOC, late childhood, sudden death- caused by erythromycicn, electrolyte disorders, head injury

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What is suggested if a child has sinus arrhythmias?

Nothing.

Normal, cyclical with respiration

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What is Rheumatic fever caused by?

AI reaction post Group A beta haemolytic streptococcus (GAS)/ Scarlet fever due to anti-M protein antibodies

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What is evidence of preceding GAS infection?

Positive throat culture – but usually negative by the time symptoms occur

Rapid streptococcal antigen test +ve

Elevated/rising streptococcal antibody titre

Recent scarlet fever

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What is the Major criteria in the Jones criteria?

Carditis: tachycardia, murmurs (mitral/aortic regurgitation), pericardial rub,
cardiomegaly, conduction defects

Arthritis: usually affects larger joints, lasting <1 week in a joint but migrating to other
joints over 1-2 months

Subcutaneous nodules: small firm painless nodules seen on extensor surfaces, joints
and tendons

Erythema marginatum: geographical-type rash with red, raised edges and clear centre
mainly on trunk and proximal limbs

Sydenham’s chorea: rapid, involuntary, irregular movements with flowing/dancing
quality

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What does CASES stand for?

Carditis: tachycardia, murmurs (mitral/aortic regurgitation), pericardial rub,
cardiomegaly, conduction defects

Arthritis: usually affects larger joints, lasting <1 week in a joint but migrating to other
joints over 1-2 months

Subcutaneous nodules: small firm painless nodules seen on extensor surfaces, joints
and tendons

Erythema marginatum: geographical-type rash with red, raised edges and clear centre
mainly on trunk and proximal limbs

Sydenham’s chorea: rapid, involuntary, irregular movements with flowing/dancing
quality

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What are the minor criteria in Jones criteria?

Pyrexia

Raised ESR/CRP

Arthralgia (only if arthritis not present as major criteria)

Prolonged PR interval (only if carditis not present as major criteria)

Previous rheumatic fever

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What is PRAPP?

Pyrexia

Raised ESR/CRP

Arthralgia (only if arthritis not present as major criteria)

Prolonged PR interval (only if carditis not present as major criteria)

Previous rheumatic fever

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How do you diagnose Rheumatic fever with the JONES criteria?

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JONES Criteria: evidence of recent strep throat (Increased ISO titre, other streptococcal Abs, Group A strep on throat culture) +

2 majors or 1 major + 2 minors

What investigations might you do for rheumatic fever?

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Bloods: FBC (inc WCC), inc ESR/CRP, rising antistreptolysin O titre

Throat swab: culture for GAS, rapid streptococcal antigen test

ECG: saddle-shaped ST elevation and PR segment depression (features of pericarditis), arrhythmias

Echocardiogram: pericardial effusion, myocardial thickening or dysfunction, valvular dysfunction

What is the initial management for Rheumatic fever?

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bed rest and anti inflamamtory

High does aspirin, antibiotics (amoxicillin), corticosteroids if not rapid resolution

What is the long term (prophylaxis) for rheumatic fever?

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IM benzathine benzylpenicillin every 3-4 weeks until 10 years after last episode or until age 21 or lifelong if severe valve disease

(or
▪ Oral phenoxymethylpenicillin bd
▪ Oral sulfadiazine
▪ Oral azithromycin (penicillin allergy)

Valve replacement if necessary

What is syncope and who gets it?

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LOC due to transient brain oxygen drop (perfusion)

Common in adolescents and benign

Discuss two main causes and presentations of syncope

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Cardiac cause (arrhythmia/ structural)- Symptoms on exercise, FH of sudden unexpected death, palpitations

Neural (stressor e.g. postural, vasovagal, dizziness/ lightheaded/ abnormal vision/ pallor/ sweating) + Maladaptive drop in BP

What investigations would you consider in syncope?

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Check BP, signs of cardiac disease, ECG- corrected QT

What is the management of syncope?

Treat cause

What may cardiomyopathy be due to?

Dilated cardiomyopathy may be inherited, secondary to metabolic disease or may result from a direct viral infection

How would you investigated cardiomyopathy?

Echo

How would you treat cardiomyopathy?

Symptomatic: diuretics, ACEi, carvedilol Myocarditis may improve sponataneously

What are the 5 different types /causes of Pulmonary HTN (pHTN)?

Venous: Idiopathic, post tricuspid shunt, HIV, persistent pulmonary HTN of the newborn Arterial: LH disease, pulmonary stenosis or compression Resp disease: Chronic Obstructive Lung disease/ bronchopulm dysplasia, ILD, Obstructive sleep apnoea Pulmonary thromboembolic disease Pulmonary inflammatory or capillary disease

How do you treat pHTN?

If left untreated and pulmonary vascular bed changes: transplant of heart/ lungs Medication: NO, IV Magnesium sulphate, oral phosphodiesterase inh

What increases your risk of IE?

Increased risk if turbulent flow/ defect

What are the presenting features of IE?

Fever, anaemia, pallor Necrotic skin lesions Splinter haemorrhages/ clubbing Cardiac signs Cerebral infarct Arthralgia/itis Micro Haematuria Retinal infarct Splenomegaly FROM JANE C

What does FROM JANE C mean?

``` Fever Roth Spots Osler’s nodes Murmur Janeway Lesions Anaemia Nail – splinter hemorrhages Emboli Clubbing ```

What investigations do you do for IE?

Multiple blood cultures (3 sets at 3 different sites and times) pre antibiotic Echo (vegetation) Dukes criteria for IE: 2 major or 1 major + 3 minor or 5 minor

How do you treat IE?

MDT Commonly: Streptococcus viridans High dose penicillin + aminoglycoside (gentamicin) for 6w IV Surgical removal and prosthesis

What antibiotics are needed for the different IE organisms?

Aerobic cover ▪ Streptococci → penicillin + ceftriaxone (+/- gentamicin) ▪ Staphylococci → pencillin or vancomycin (if methicillin resistant) ▪ Enterococcus → penicillin + gentamicin ▪ HACEK → ceftriaxone + gentamicin

What may cause HF in Neonates?

Neonate (duct dependent, obstructed systemic circulation) -> hypoplastic L-heart, aortic stenosis, severe coarctation of the aorta, interruption of aortic arch -> i.e. DO NOT CLOSE THE DUCTUS ARTERIOSUS

What does HF present with?

SOB/ poor feeding, chest inf., fatigue Poor weight gain, increased RR, HR, murmur, gallop rhythm, signs of venous congestion, cardiomegaly, hepatomegaly (common), respiratory distress. Low CO, pallor

What investigations do you do for paeds HF (results similar to adult)?

Basic Obs CXR ECG Echo

What is the management of HF?

o Multiple faceted approach with specific aims: 1. Reduce preload: · Diuretics (e.g. furosemide) or GTN 2. Enhance cardiac contractility: · Dopamine; or · Digoxin, dobutamine, adrenaline, milrinone 3. Reduce afterload: · Oral ACE inhibitors · Hydralazine, nitroprusside, alprostadil 4. Improving oxygen delivery · Beta-blockers (e.g. carvedilol) 5. Enhance nutrition o If cyanotic -> prostaglandin infusion (alprostadil / prostaglandin E2)

What may cause HF in Infants?

Infants (defect -> high pulmonary blood flow -> L-to-R shunt) -> persistent VSA, ASD, PDA

What may cause HF in Older Children?

Older children (R- or L-HF)-> Eisenmenger (RHF), Rheumatic HD, cardiomyopathy

What may cause HF in all children generically?

volume overload (anaemia or sepsis); pressure overload (HTN)

Further Cardiac Conditions Flashcards

(43 cards)