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Paediatric Cardiology Flashcards

(70 cards)

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1
Q

3 factors that increase susceptibility to cardiac issues in children

A

Genetics
Teratogenic insult (18-60 days post-conception)
Environmental

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2
Q

Environmental factors that increase susceptibility to cardiac issues in children

A

Drugs, Alcohol, Amphetamines, Lithium, Cocaine, Phenytoin
Infection - TORCH
Maternal - Diabetes mellitus, SLE

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3
Q

Why is diabetes mellitus in the mother a risk factor for cardiac issues in children?

A

Transient cardiomyopathy

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4
Q

Genetic conditions that are associated with cardiac problems in children

A 
Trisomy 13 (90%)
Trisomy 18 (80%)
Trisomy 21 (40%)
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5
Q

What cardiac condition is specifically associated with trisomy 21?

A

Atrioventricular Septal Defect (AVSD)

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6
Q

Turners syndrome 45 X is associated with which cardiac condition?

A

Coarctation of aorta

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7
Q

Noonan syndrome is associated with which cardiac condition?

A

Pulmonary stenosis

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8
Q

Williams Syndrome is associated with which cardiac condition?

A

Supravalvular aortic stenosis

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9
Q

22q11 deletion syndrome (DiGeorge) is associated with ?

A

Behavioural phenotype

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10
Q

What occurs to cause central cyanosis?

A

Right to left shunt

Decreased amount of oxygen in the body

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11
Q

Presentation of a child with cardiac problems

A 
Breathless and sweating during feed
Tachycardic
Tachypnoea
Hepatomegaly
- three signs of heart failure
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12
Q

What kind of flow is predicted in a baby’s heart and why?

A

Predictably a turbulent flow due to size/dimensions of heart and high heart rate

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13
Q

Aspects of history in children with suspected heart problems

A 
Feeding issues
Weight and development
Tachypnoea, dyspnoea
Palpitations
Chest pain (mostly MSK in children)
Exercise tolerance
Syncope
Joint problems
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14
Q

Examination of child with suspected heart problems

A 
Weight and height
Dysmorphic features
Cyanosis
Clubbing
Tachy/dyspnoea
Pulses - apex/femoral
- radial femoral delay
- apex extending on left indicates hypertrophy
Heart sounds
Murmurs
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15
Q

An apex beat radiating to the left indicates what change in the heart?

A

Hypertrophy

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16
Q

Which heart sounds do we listen for in examination of a child?

A

Click
Split
3rd and 4th

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17
Q

Investigations in a child with suspected heart problems

A 
Blood pressure
Oxygen saturations
Arterial BG
ECG
Chest X ray
ECHO
Catheter
Angiography
MRI/A
Exercise testing
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18
Q

Possible procedures for cardiac issues in a child

A

Medication (palliative)
Balloon valvoplasty
Blalock Taussig Shunt
Transplant

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19
Q

Murmurs

A 
Timing - Systole/Diastole/continuous
Duration - Early/Middle/Late
Pitch/quality
Most are innocent
Systolic
Soft
Vibratory/musical
Localised
Vary with position, respiration and exercise
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20
Q

Describe most common murmur

A

Systolic

Soft

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21
Q

Features of Still’s/ Left ventricle outflow murmur

A

Systolic
Soft
Left sternal border
Increases on lying down, exercise

Presents in 2-7 years old

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22
Q

When does a still’s murmur most commonly present

A

Children 2-7 years old

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23
Q

Features of pulmonary outflow murmur

A

Upper left sternal border

Does not radiate to the back

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24
Q

Features of carotid/brachiocephalic bruit

A

Increases with exercise

Decreases when turning head

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25
Features of a venous hum and which patients most likely to present
``` 3-8 years old Soft, indistinctive Diastole Supraclavicular Decreases on lying down ```
26
3 types of ventricular septal defect
Muscular Subaortic Perimembranous
27
What shunt occurs in ventricular septal defect?
Left to right Left ventricle has high pressure Acyanotic defect- doesn't affect oxygen
28
Consequence of large ventricular septal defect
Heart failure Biventricular hypertrophy Pulmonary hypertension
29
What is eisenmenger syndrome?
Fluid overload Laying down of cells increases pulmonary vascular resistance ``` Right ventricular hypertrophy Pressure increase Pulmonary arteries Further irritation Cycle of resistance increase ```
30
Investigation for eisenmenger syndrome
Doppler - jet during systole
31
Treatment of eisenmenger syndrome/ ventricular septal defect
``` Closure - transcatheter, Amplatzer If too large Open heart surgery - left atrium accessed via mitral valve - pericardium used for patch closure ```
32
Name of closure device for ventricular septal defect
Amplatzer
33
Mechanism of healing from ventricular septal closure
Endocardium grows over | IV septum immobilised for life but no consequence
34
Signs or symptoms of atrial septal defect
No signs | Incidental finding in adult with A fib, heart failure or pulmonary hypertension
35
Features of atrial septal defect
Wide fixed splitting of second heart sound, pulmonary flow murmur Left to right shunt (acyanotic)
36
Investigation for atrial septal defect
Doppler | Right atrium visibly larger, can see shunt
37
Features of atrial septal defect associated with Trisomy 21
Mitral and tricuspid valve fusion | Complete AVSD
38
Symptoms of mild pulmonary stenosis
Asymptomatic
39
Symptoms and signs of moderate to severe pulmonary stenosis
Exertional dyspnoea Fatigue Ejection Systolic murmur of upper left sternal border Crescendo decrescendo after first heart sound
40
Treatment for pulmonary stenosis
Balloon valvoplasty
41
Signs of severe aortic stenosis
``` Other forms asymptomatic Exercise tolerance reduced Chest pain Syncope Ejection systolic murmur Upper Right Sternal Border radiates to carotids ```
42
Treatment for aortic stenosis
Balloon Aortic Valvoplasty via femoral artery
43
Treatment for Patent Ductus Arteriosus
Fluid restriction/diuretics Surgical ligation Prostaglandin inhibitors Common in preterm babies Term babies spontaneous closure - not prostaglandin sensitive
44
Investigations coarctation of aorta
MRI | US
45
Treatment coarctation of aorta
Reopen ductus arterosus with prostaglandin E1 or E2 Resection with end to end anastomosis Subclavian patch repair Balloon aortoplasty
46
Treatment Transposition of Great arteries
``` Venous catheter Prostaglandins Rashkind balloon Atrial Sepostomy -Catheter via femoral vein to right atrium Switch procedure -Great arteries placed on appropriate ventricle -Cut aorta above coronary arteries -Plug into aorta ```
47
Fallot's tetralogy
Stenosis causes overflow obstruction Shunt increased - become more cyanotic Bootshaped heart - right ventricle hypertrophy Full correction at 6 months
48
Features of a venous hum and which patients most likely to present
``` 3-8 years old Soft, indistinctive Diastole Supraclavicular Decreases on lying down ```
49
3 types of ventricular septal defect
Muscular Subaortic Perimembranous
50
What shunt occurs in ventricular septal defect?
Left to right Left ventricle has high pressure Acyanotic defect- doesn't affect oxygen
51
Consequence of large ventricular septal defect
Heart failure Biventricular hypertrophy Pulmonary hypertension
52
What is eisenmenger syndrome?
Fluid overload Laying down of cells increases pulmonary vascular resistance ``` Right ventricular hypertrophy Pressure increase Pulmonary arteries Further irritation Cycle of resistance increase ```
53
Investigation for eisenmenger syndrome
Doppler - jet during systole
54
Treatment of eisenmenger syndrome/ ventricular septal defect
``` Closure - transcatheter, Amplatzer If too large Open heart surgery - left atrium accessed via mitral valve - pericardium used for patch closure ```
55
Name of closure device for ventricular septal defect
Amplatzer
56
Mechanism of healing from ventricular septal closure
Endocardium grows over | IV septum immobilised for life but no consequence
57
Signs or symptoms of atrial septal defect
No signs | Incidental finding in adult with A fib, heart failure or pulmonary hypertension
58
Features of atrial septal defect
Wide fixed splitting of second heart sound, pulmonary flow murmur Left to right shunt (acyanotic)
59
Investigation for atrial septal defect
Doppler | Right atrium visibly larger, can see shunt
60
Features of atrial septal defect associated with Trisomy 21
Mitral and tricuspid valve fusion | Complete AVSD
61
Symptoms of mild pulmonary stenosis
Asymptomatic
62
Symptoms and signs of moderate to severe pulmonary stenosis
Exertional dyspnoea Fatigue Ejection Systolic murmur of upper left sternal border Crescendo decrescendo after first heart sound
63
Treatment for pulmonary stenosis
Balloon valvoplasty
64
Signs of severe aortic stenosis
``` Other forms asymptomatic Exercise tolerance reduced Chest pain Syncope Ejection systolic murmur Upper Right Sternal Border radiates to carotids ```
65
Treatment for aortic stenosis
Balloon Aortic Valvoplasty via femoral artery
66
Treatment for Patent Ductus Arteriosus
Fluid restriction/diuretics Surgical ligation Prostaglandin inhibitors Common in preterm babies Term babies spontaneous closure - not prostaglandin sensitive
67
Investigations coarctation of aorta
MRI | US
68
Treatment coarctation of aorta
Reopen ductus arterosus with prostaglandin E1 or E2 Resection with end to end anastomosis Subclavian patch repair Balloon aortoplasty
69
Treatment Transposition of Great arteries
``` Venous catheter Prostaglandins Rashkind balloon Atrial Sepostomy -Catheter via femoral vein to right atrium Switch procedure -Great arteries placed on appropriate ventricle -Cut aorta above coronary arteries -Plug into aorta ```
70
Fallot's tetralogy
Stenosis causes overflow obstruction Shunt increased - become more cyanotic Bootshaped heart - right ventricle hypertrophy Full correction at 6 months

Paediatrics (10 decks)

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