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paeds cardio Flashcards

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1
Q

continuous blowing noise heard just below the clavicles

A

venous hum

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2
Q

Low-pitched sound heard at the lower left sternal edge

A

stills murmur

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3
Q

features of innocent murmurs

A

Soft
Short
Systolic
Symptomless
Situation dependent, particularly if the murmur gets quieter with standing or only appears when the child is unwell or feverish

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4
Q

ddx for Pan systolic murmur

A

Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect

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5
Q

ddx for ejection systolic murmur

A

Aortic stenosis
Pulmonary stenosis (+ tetralogy of fallot)
ASD
Hypertrophic obstructive cardiomyopathy
coarctation and bicuspid aortic valve (both in turners)

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6
Q

when can splitting of the second heart sound be normal

A

can be normal with inspiration

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7
Q

Fixed splitting of second heart sound indicates?

A

ASD

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8
Q

Causes of PDA

A
  • genetic
  • maternal rubella
  • prematurity
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9
Q

Pulse character in PDA

A

large volume, bounding, collapsing pulse

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10
Q

continuous crescendo-decrescendo “machinery” murmur that may continue during the second heart sound, making the second heart sound difficult to hear

A

PDA

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11
Q

Diagnostic investigation heart murmurs

A

echocardiogram

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12
Q

Management isolated PDA

A

indomethacin or ibruprofen if symptomatic

may choose to monitor and do trans-catheter or surgical closure if still present at 1 year

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13
Q

What do you do to keep PDA open

A

prostaglandin E1

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14
Q

ddx for diastolic murmurs

A

early diastolic:
- aortic regurg
- pulmonary regurg

mid diastolic:
- mitral stenosis

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15
Q

Most common ASD

A

Ostium secondum

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16
Q

Complications ASD

A

Stroke in the context of venous thromboembolism (see below)
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right sided heart failure
Eisenmenger syndrome

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17
Q

mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border with a fixed split second heart sound

A

ASD

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18
Q

Management ASD

A

ASDs can be corrected surgically using a transvenous catheter closure (via the femoral vein) or open heart surgery.

Anticoagulants (such as aspirin, warfarin and NOACs) are used to reduce the risk of clots and stroke in adults.

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19
Q

What is ebsteins anomaly

A

tricuspid valve is set lower in the right side of the heart (towards the apex), causing a bigger right atrium and a smaller right ventricle. This leads to poor flow from the right atrium to the right ventricle, and therefore poor flow to the pulmonary vessels. It is often associated with a right to left shunt across the atria via an atrial septal defect.

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20
Q

ECG wolff-parkinson white

A

short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*

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21
Q

Evidence of heart failure (e.g. oedema)
Gallop rhythm heard on auscultation characterised by the addition of the third and fourth heart sounds
Cyanosis

A

ebstein’s anomaly

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22
Q

what can ebstein’s anomaly cause

A

wolff-parkinson white

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23
Q

Management ebsteins anomaly

A

Medical management includes treating arrhythmias and heart failure. Prophylactic antibiotics may be used to prevent infective endocarditis. Definitive management is by surgical correction of the underlying defect.

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24
Q

Causes ebsteins anomaly

A

lithium use in pregnancy

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25
ECG ASD caused by ostium secundum
RBBB with RAD
26
ECG ASD caused by Ostium primum
RBBB with LAD, prolonged PR interval
27
Causes VSD
congenital VSDs are often association with chromosomal disorders: Down's syndrome Edward's syndrome Patau syndrome cri-du-chat syndrome congenital infections acquired causes post-myocardial infarction
28
failure to thrive, pan systolic murmur left lower sternal border. There may be a systolic thrill on palpation.
VSD. louder in smaller defects
29
Management VSD
- w&w - surgical closure: trans-catheter or open heart - antibiotic prophylaxis
30
Cardiac assocations downs syndrome
- endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects) ventricular septal defect (c. 30%) secundum atrial septal defect (c. 10%) tetralogy of Fallot (c. 5%) isolated patent ductus arteriosus (c. 5%)
31
Examination findings pulmonary hypertension
Right ventricular heave: the right ventricle contracts forcefully against increased pressure in the lungs Loud P2: loud second heart sound due to forceful shutting of the pulmonary valve Raised JVP Peripheral oedema
32
Complications VSD
- aortic regurg - eisenmengers - pulmonary hypertension - infective endocarditis
33
associations coarctation
more common in males Turner's syndrome bicuspid aortic valve berry aneurysms neurofibromatosis
34
features of coarctation
weak femoral pulses radio-femoral delay ejection/mid systolic murmur heard at left infraclavicular space radiating to interscapular area apical click from the aortic valve
35
management coarctation
1. prostaglandin E to keep PDA open 2. Surgery
36
Options for management congenital aortic stenosis
Limit exercise, regular follow ups and ECG Percutaneous balloon aortic valvoplasty Surgical aortic valvotomy Valve replacement
37
Associations congenital pulmonary stenosis
Tetralogy of Fallot William syndrome Noonan syndrome Congenital rubella syndrome
38
Complications congenital aortic stenosis
Left ventricular outflow tract obstruction Heart failure Ventricular arrhythmia Bacterial endocarditis Sudden death, often on exertion
39
Management pulmonary stenosis
w&w balloon valvuloplasty via a venous catheter
40
4 things in tetralogy of fallot?
PROVE Pulmonary stenosis Right ventricular hypertrophy Overriding of the aorta VSD Ejection systolic murmur
41
Risk factors for ToF
RAID Rubella infection Alcohol consumption in pregnancy Increased age of the mother (over 40 years) Diabetic mother
42
“boot shaped” heart
right ventricular hypertrophy - ToF sign
43
Pathophysiology tet spells
Physically exertion --> generating a lot of carbon dioxide --> vasodilaton --> systemic vasodilation and therefore reduces the systemic vascular resistance --> Blood flow will choose the path of least resistance, so blood will be pumped from the right ventricle to the aorta rather than the pulmonary vessels, bypassing the lungs can also occur with increased pulmonary vascular resistance
44
Presentation tet spells
precipitated by waking, physical exertion or crying. The child will become irritable, cyanotic and short of breath. Severe spells can lead to reduced consciousness, seizures and potentially death.
45
Management tet spell
1. position with knees to chest to increase systemic vascular resistance 2. O2 3. beta bockers to decrease pulmonary vascular resistance 4. IV fluids can increase pre-load Morphine can decrease respiratory drive, resulting in more effective breathing. Sodium bicarbonate can buffer any metabolic acidosis that occurs. Phenylephrine infusion can increase systemic vascular resistance.
46
In what conditions may you want to keep PDA open?
- coarctation - tetralogy of fallot - transposition of the great arteries
47
Management ToF
1. Prostaglandin E1 infusion 2. open heart surgery
48
Management transposition of the GA
1. prostaglandin E1 2. Balloon septostomy 3. Open heart surgery
49
When does ToF present?
presents at around 1-2 months, although may not be picked up until the baby is 6 months old
50
most common cause infective endocarditis
Staphylococcus aureus
51
pathogen infective endocarditis after dental procedure
Streptococcus viridans
52
pathogen infective endocarditis up to 2 months after valve replacement
coagulase-negative Staphylococci such as Staphylococcus epidermidis
53
non infective causes endocarditis
systemic lupus erythematosus (Libman-Sacks) malignancy: marantic endocarditis
54
inheritance Hypertrophic obstructive cardiomyopathy
autosomal dominant
55
Management hypertrophic obstructive cardiomyopathy
Amiodarone Beta-blockers or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis*
56
Pathophysiology hypertrophic obstructive cardiomyopathy
Usually due to a mutation in the gene encoding β-myosin heavy chain protein
57
Echo findings hypertrophic obstructive cardiomyopathy
Echo findings include MR, systolic anterior motion (SAM) of the anterior mitral valve and asymmetric septal hypertrophy mitral regurgitation (MR) systolic anterior motion (SAM) of the anterior mitral valve leaflet asymmetric hypertrophy (ASH)
58
ECG pericarditis
the changes in pericarditis are often global/widespread, as opposed to the 'territories' seen in ischaemic events 'saddle-shaped' ST elevation PR depression: most specific ECG marker for pericarditis
59
Management pericarditis
NSAIDs Colchicine
60
chest pain: may be pleuritic. Is often relieved by sitting forwards other symptoms include non-productive cough, dyspnoea and flu-like symptoms
pericarditis
61
cyanotic CHDs
Tetralogy of fallot Transposition of great vessels (TGA) Tricuspid abnormalities eg ebsteins Tricuspid atresia Total anomalous pulmonary venous return Truncus arteriosus
62
Most common cardiac abnormality in turners
bicuspid aortic valve (ejection systolic murmur)
63
Murmurs ebsteins anomaly
tricuspid regurgitation (pan-systolic murmur) and tricuspid stenosis (mid-diastolic murmur) gallop rhythm, fixed splittng of second heart sound if ASD
64
murmur grades
One- Very faint. Heard by an expert in optimum conditions Two - Heard by a non-expert in optimum conditions Three- Easily audible, no thrill Four- A loud murmur, with a thrill Five -Very loud, often heard over a wide area, with thrill Six - Extremely loud, heard without a stethoscope
65
management SVT
ABCDE Cardioversion: - syncronised eg defib - adenosine - amiadarone before 3rd shock with appropriate sedation + analgesia (e.g. IM/intranasal ketamine if delay in IV access)
66
examples of vagal manourvres SVT
Vagal maneuvers – For infants, apply bag containing ice water to the face above the nose and mouth for 15 to 30 seconds. Do not obstruct ventilation. In older children, bearing down or blowing into an occluded straw for 15 to 20 seconds provides vagal stimulation.
67
define SVT in children
Infant > 220 min-1 Child > 180 min-1 Abrupt onset
68
Another name for wolff-parkinson white syndrome
AV reciprocating/bundle of kent re-entry point is an accessory pathway
69
pathophysiology SVT
Early depolarisation --> shortened PR interval and narrow QRScomplex
70
what is considered a narrow QRS?
<0.12 seconds

Phase 3a topics (39 decks)

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