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Paediatrics > Paediatric cardiology > Flashcards

Paediatric cardiology Flashcards

1
Q

What are the 8 congenital heart defects

A
  • Ventricular septal defet
  • Patent Ductus Arteriosus
  • Atrial Septal Defect
  • Aortic Stenosis
  • Coarctation of the Aorta
  • Transposiiton of the Great Arteries
  • Tetralogy of Fallot
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2
Q

Aetiology of congenital heart disease

A
  • Drugs → alcohol, amphetamines, cocaine, ecstasy, phenytoin, lithium
  • Infection → TORCH (toxoplasmosis, other agents, rubella, cytomegalovirus, herpes)
  • Maternal → DM, SLE
  • Chromosomal abnormality → trisomy 13, 18, 21
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3
Q

Presentation of CHD

A
  • Feeding, weight, development
  • Cyanosis
  • Tachypnoea, dyspnoea
  • Exercise tolerance
  • Chest pain
  • Syncope
  • Palpitations
  • Joint problems
  • Murmurs
  • Clubbing
  • Dysmorphic features
  • Heart sounds (clicks, split, 3 and 4)
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4
Q

Investigations for CHD

A
  • BP
  • O2 saturations
  • ECG
  • CXR
  • ECHO
  • Cardiac catheter
  • Angiography
  • MRI/
  • Exercise tolerance testing
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5
Q

Principles of treatment

A
  • Fix it immediately
  • Improve situation → balloon valvoplasty, prostaglandin infusion,
  • Replace it
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6
Q

Characteristics of murmurs

A
  • Timing → systole, diastole, continuous
  • Duration → ejection, holo, pan
  • Pitch/ quality → harsh, soft, indeterminate, vibratory, pure frequency
  • Site → URSB, ULSB, LLSB, apex
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7
Q

Define an innocent murmur

A
  • Majority of murmurs
  • 4 main types
  • Not a diagnosis of exclusions
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8
Q

Features of innocent murmur

A
  • Systolic ( continuous in venous hum)
  • No signs of cardiac disease
  • Sofy
  • Vibratory, musical
  • Localised
  • Varies with position, respiration, exercise
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9
Q

Define Still’s murmur

A
  • Left ventricular outflow murmur
  • Age 2-7
  • Soft systolic
  • Apex of left sternal border
  • Increased in supine position and exercise
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10
Q

Define Pulmonary outflow murmur

A
  • Aged 8-10
  • Soft systolic, vibratory
  • Upper left sternal border, well localised, does not radiation
  • Increased in supine position and exercise
  • Often child with narrow chest
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11
Q

Define carotid/ brachiocephalic arterial bruits

A
  • Aged 3-20
  • Systolic harsh murmur
  • Supraclavicular, radiates to neck
  • Increased with exercise, decreased with turning head or extending neck
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12
Q

Define venous hum

A
  • Aged 3-8
  • Soft, indistinct
  • Continuous murmur, diastolic accentuations
  • Supraclavicular
  • Upright position, disappears when lying down
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13
Q

Define ventricular septal defects

A
  • 3 types
    • Subaortic
    • Perimembranous
    • Muscular
  • Left to right shunt
  • Amplatzer or patch closure
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14
Q

Clinical features of VSD

A
  • Pan-systolic murmur on lower left sternal edge → sometimes thrills
  • Diastolic rumble → mitral stenosis
  • Cardiac failures signs → ventricular hypertrophy, pulmonary hypertension
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15
Q

Features of ASD

A
  • Few clinical signs
  • Can spontaneously close
  • Sometimes into adulthood → AF, heart failure, pulmonary hypertension
  • Wide fixed splitting of 2 heart sounds, pulmonary flow murmur
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16
Q

Features of pulmonary stenosis

A
  • Asymptomatic in mild disease
  • Exertional dyspnoea
  • Ejection systolic murmur → upper left sternal border
  • Radiation into back
  • May require ballon valvoplasty
17
Q

Features of aortic stenosis

A
  • Mostly asymptomatic
  • Severe cases → reduced exercise tolerance, exertion chest pain, syncope
  • May have tricuspid aortic valve
18
Q

What changes occur in foetal circulation at birth

A
  • Pulmonary vascular resistance falls
  • Pulmonary blood flow increased
  • systemic vascular resistance increased
  • Ductus arterioles closes
  • Foramen Ovale closes
  • Ductus venous closes
19
Q

Define Patent Ductus Arteriosus

A
  • Common in pre-term babies
  • Treatment with with fluid restriction/ diuretics, prostaglandins inhibitors, surgical ligation
20
Q

Define coarctation of the Aorta

A
  • Narrowing of the aorta at the site of insertion of the ductus arterosus
  • Associated with diffuse arteriopathy and bicuspid aortic valve
  • Typically presents with upper extremity systolic hypertension or murmur
21
Q

Key diagnostic features of coarctation of aorta

A
  • Hypertension young age resistant to treatment
  • Diminished lower extremity pulses
  • Differential BP between upper and lower extremity
  • Systolic ejection murmur
  • Male
  • Genetic syndrome → Turner’s syndrome
  • Claudication
22
Q

Management of coarctation of aorta

A
  • Reopening PDA with prostanglandins
  • Resection with end to end anastomoses
  • Subclavian patch repair
  • Ballon aortoplasty
23
Q

Define transposition of the great arteries

A
  • Swapping of the aorta and pulmonary aorta in its attachments sites onto the heart
  • Blood to the body is sent to the lungs, blood for the lungs is sent to the body
  • Presents with cyanosis
  • Often associated with pulmonary stenosis, coarctation of the aorta and VSD
24
Q

Management of transposition of the Great Arteries

A
  • Reopen ductus arterioles with prostaglandins → allows blood flow from aorta to pulmonary arteries
  • Ballon septostomy
  • Open heart surgery for switch procedure
25
Q

Define tetralogy of fallout

A
  • Syndrome of 4 CHD
    • Pulmonary stenosis
    • Right ventricular hypertrophy
    • Overriding aorta
    • Ventricular septal defet
  • VSD and overriding aorta causes causes RV hypertrophy
  • Presents with murmur, cyanosis and Tet spells
26
Q

Define Tet spell

A
  • Period of worsened symptoms due to worsened right to left shunting
  • Due to increased pulmonary vascular resistance and decreased systemic resistance
27
Q

Treatment of tetralogy of Fallot

A
  • Surgical repair
  • Intracardiac repari
  • Aortopulmonary shunt → temporarily
  • Treat complications → pulmonary regurgitation , RV failure, arrhythmias

Paediatrics (10 decks)

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