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Paeds Cardio Flashcards

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1
Q

What is Ohms law?

A

Flow (Q) = Pressure(P)/Resistance(R)

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2
Q

What is HbF?

A

Foetal haemoglobin-has higher affinity for O2

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3
Q

Describe the flow of foetal circulation from placenta to right atrium

A

Placenta->Umbilical vein->Portal vein->Liver->Hepatic veins->Inf. vena cava->R. atrium

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4
Q

Describe the flow of foetal circulation from right atrium to aorta

A

R. atrium either to:
- r ventricle->pulmonary artery->ductus arteriosus->aorta

or through patent foramen ovale->l atrium->l ventricle->aorta

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5
Q

What is a acyanotic shunt?

A

Blood shunt from left to right

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6
Q

What is a cyanotic shunt?

A

Shunt from right to left

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7
Q

What are the 5 cyanotic heart diseases?

A

5 T’s:
Transposition of great arteries
Tetralogy of Fallot
Truncus arteriosus
Total anomalous pulmonary venous connection
Tricuspid valve abnormalities

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8
Q

Name the 4 types of acyanotic heart disease

A

Ventricular/atrial septal defect
Patent ductus arteriosus
Pulmonary/aortic stenosis
Coarctation of aorta

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9
Q

Describe the flow of foetal circulation from aorta back to the placenta

A

Aorta->internal iliac arteries->umbilical arteries->placenta

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10
Q

What are the 4 key pathologies of tetralogy of fallot?

A

Ventricular septal defect (VSD)
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

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11
Q

What is an overriding aorta?

A

Entrance to the aorta is placed further to the right than normal, above the ventricular septal defect.

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12
Q

What does an overriding aorta cause?

A

When the right ventricle contracts, squeezing blood upwards, the aorta is in the direction of travel of that blood, causing deoxygenated blood to enter the aorta, bypassing the lungs.

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13
Q

In TofF how does pulmonary stenosis cause ventricular hypertrophy?

A

Encourages blood to flow through the VSD and into the aorta rather than through the pulmonary valve into the pulmonary vessels. The increased strain on the right ventricle causes right ventricular hypertrophy

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14
Q

Which of the 4 key pathologies determines the severity of TofF?

A

Severity of pulmonary stenosis

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15
Q

How does TofF present?

A

Most picked up on antenatal scans but at birth presents as:
Shortness of breath
Cyanosis
Finger clubbing
Poor feeding
Poor weight gain
Tet spells (intermittent episodes of cyanosis)

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16
Q

What murmur is heard with TofF?

A

Ejection systolic murmur heard loudest in the pulmonary area (second intercostal space, left sternal border).

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17
Q

How would you investigate TofF?

A

Echo confirms diagnosis
Doppler shows direction of blood flow
CXR may show characteristic “boot-shaped” heart due to right ventricular thickening.

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18
Q

How do you manage TofF?

A

Prostaglandin E1 infusion to maintain the ductus arteriosus in neonates
Stent to keep ductus arteriosus open
Total surgical repair=definitive Tx

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19
Q

What are tet spells?

A

Intermittent cyanotic episodes caused by a temporary worsening of the right-to-left shunt

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20
Q

What happens in tet spells?

A

The child becomes irritable, cyanotic and short of breath. Severe spells can lead to reduced consciousness, seizures and potentially death.

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21
Q

How do you manage tet spells? (non-medical)

A

Older children=squat
Younger children=knees to chest position
Increases systemic vascular resistance->blood enters pulmonary vessels

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22
Q

How do you manage tet spells? (medical)

A

Oxygen
IV morphine (decreases respiratory drive and pulmonary vascular resistance)
IV fluids (increases circulating volume)
IV beta blockers (e.g., propranolol)
Phenylephrine infusion

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23
Q

What are the 3 foetal shunts?

A

Ductus venosus
Foramen ovale
Ductus arteriosus

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24
Q

What does the ductus venosus connect?

A

Umbilical vein to the inferior vena cava, allowing blood to bypass the liver

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25
What does the foramen ovale connect?
Right atrium with the left atrium, allowing blood to bypass the right ventricle and lungs
26
What does the ductus arteriosus connect?
Pulmonary artery with the aorta, allowing blood to bypass the lungs.
27
What do you use to keep shunts open?
Prostaglandins
28
What happens to the heart in the first breaths after birth?
Alveoli expand=decreased pulmonary vascular resistance Causes fall in pressure in r ventricle + atrium theerfore more pressure in left atrium = atrial septum squashed + closes foramen ovale
29
What is transposition of the great arteries?
Swapped attachments of the aorta and the pulmonary trunk
30
What happens to blood flow in transposition of the great arteries?
The right ventricle pumps blood into the aorta and the left ventricle pumps blood into the pulmonary vessels. Blood from the systemic venous system drains into the right side of the heart and is pumped straight back into the aorta. Blood from the pulmonary veins drains into the left side of the heart and is pumped straight back into the pulmonary arteries. These two separate circulations do not mix.
31
How does T of the GA affect foetal development?
Typically normal, as gas and nutrient exchange happens in the placenta
32
What happens to a newborn with T of the GA?
Life-threatening cyanosis
33
How is T of the GA often diagnosed + managed in pregnancy?
Dx at antenatal scans Monitor closely, arrangements for specialist Mx immediately after birth
34
What other heart condition can improve immediate survival rates for babies with T of the GA?
A patent ductus arteriosus or ventricular septal defect can initially compensate by allowing blood to mix between the systemic circulation and the lungs.
35
How is T of the GA managed?
Prostaglandin E2 infusion to maintain ductus arteriosus Balloon septostomy into foramen ovale to maintain connection Definitive Mx=arterial switch op performed a few days after birth
36
What is truncus arteriosus?
Congenital heart condition with no separation of the aorta + pulmonary artery = oxygenated + deoxygenated blood is combined
37
What other congenital heart condition does TA often occur with?
VSD (ventricular septal defect)
38
How does TA affect blood flow?
Blood flows into lungs + rest of body is cyanotic
39
How is TA treated?
Surgery to: Separating the pulmonary arteries from the aorta Attaching the pulmonary arteries to the right ventricle using artificial tubes and valves Repairing the trunk so it functions as a separate aorta Applying a patch to close the ventricular septal defect
40
What is the life expectancy + long-term affects of TA?
20yr survival of 80% Need long-term follow up w/ congenital specialist + may need valve repairs in future
41
What is TAPVR?
Total anomalous pulmonary venous return = pulmonary veins from lungs take abnormal path back to heart, requires surgical repair
42
Name 4 types of tricuspid valve abnormality
Tricuspid regurgitation-most common Tricuspid stenosis Tricuspid atresia Ebstein's anomaly
43
What is Ebstein's anomaly?
Congenital heart condition where the tricuspid valve is set lower in the right side of the heart = bigger r atrium + smaller r ventricle
44
What happens with the tricuspid valve in Ebstein's anomaly?
Tricuspid regurg
45
What other cardiac defects is Ebstein's associated with?
ASD (atrial septal defect) + r->l shunt WPW syndrome Supraventricular tachycardia
46
How does Ebstein's normally present?
May be asymptomatic until adolescence or adulthood. It may present with: Arrhythmias Heart failure (e.g., shortness of breath and oedema) Collapse/cardiac arrest Cyanosis
47
How do you Dx Ebstein's?
Echo
48
How do you Mx Ebstein's?
Medical Mx for arrhythmias + HF Surgical valve repair/replacement
49
What is PDA?
Patent ductus arteriosus = failure of connection between pulmonary artery + aorta to close after birth
50
Name 3 RF for PDA
Prem babies Babies with genetic condition e.g Down's Maternal diabetes/rubella
51
How do PDA's present?
Small=often asymptomatic Larger= Shortness of breath Difficulty feeding Poor weight gain Lower respiratory tract infections
52
What murmur is heard with PDA?
Continuous crescendo-decrescendo “machinery” murmur
53
How do you Dx PDA?
Echo
54
How do you Mx PDA?
Medical closure w/ NSAIDs e.g. ibuprofen, paracetamol (inhibit prostaglandins) Surgery to close
55
How is the ductus arteriosus maintained in pregnancy?
Prostaglandin E2
56
57
What is an ASD?
Atrial septal defect-hole in the septum between the two atria, allowing blood to flow between them
58
Name the 2 walls that grow between the atria in utero
Septum primum + septum secundum
59
What do the septum primum + secundum fuse with to form the 2 separate atria?
Endocardial cushion
60
What does an ASD do to blood flow + lung blood supply?
Creates shunt which allows blood to flow from higher pressure in l atrium to r atrium Blood flow to lungs continues + it gets oxygenated-no cyanosis
61
What effects does an ASD have on the right side of the heart?
Increased blood flow to r side = right-sided overload, increased pulmonary pressure + r heart strain->r HF
62
What condition can develop with a severe ASD/VSD if pulmonary pressure starts to exceed systemic pressure?
Eisenmenger syndrome-changes direction of shunt to right->left + development of cyanosis
63
Name the 3 types of ASD + most common
*Patent foramen ovale Ostium secundum-secundum fails to close Ostium primum-primum fails to close
64
Name 4 complications of ASD
Stroke with VTE A fib/flutter Pulmonary HTN + r sided HF Eisenmenger syndrome
65
What murmur does an ASD cause?
Mid-systolic, crescendo-decrescendo murmur loudest Fixed split 2nd heart sound
66
How can ASDs be detected?
Antenatal scans Newborn exams
67
How can ASD present?
Can be asymptomatic in childhood or present w/: Shortness of breath Difficulty feeding Poor weight gain Lower respiratory tract infections OR present in adulthood w/ dyspnoea/HF/stroke
68
How do you manage a VSD/ASD?
Active monitoring (small defects can close on own) Percutaneous transvenous catheter closure Open-heart surgery
69
What is a VSD?
Ventricular septal defect = congenital hole in septum between l + r ventricles
70
What happens to blood flow in VSD?
Higher pressure in l ventricle than r ventricle so blood shunt from l->r causing r sided overload->r HF + pulmonary hypertension No cyanosis as blood still going to lungs + getting oxygenated
71
Describe the presentation of a VSD
Initially asymptomatic, can present as adult OR may present in infants as: Poor feeding Dyspnoea Tachypnoea Failure to thrive
72
What murmur would you hear with a VSD?
Pan-systolic murmur May be palpable systolic thrill
73
Name 3 causes of a pan-systolic murmur
VSD Mitral regurg Tricuspid regurg
74
What is Eisenmenger syndrome?
When blood flows from the right to the left side of the heart across a structural heart lesion, bypassing the lungs
75
Name 3 causes for Eisenmenger syndrome
ASD VSD PDA
76
Name 4 signs of pulmonary HTN
Right ventricular heave (the right ventricle contracts forcefully against increased pressure in the lungs) Loud P2 (forceful shutting of the pulmonary valve) Raised JVP Peripheral oedema
77
Name 4 findings on exam for a r->l shunt + chronic hypoxia
Cyanosis Finger clubbing Dyspnoea (shortness of breath) Plethoric complexion (reddish skin related to polycythaemia)
78
How do you manage Eisenmenger syndrome?
Mx for underlying defect Heart-lung transplant = only definitive Tx
79
What affect does Eisenmenger have on morbidity + mortality?
Reduced life expectancy by 20yrs Causes of death: HF, infection, VTE, haemorrhage
80
What is rheumatic fever?
Autoimmune condition triggered by strep bacteria, it is a multi-system disorder that affects the joints, heart, skin and nervous system
81
What bacteria causes rheumatic fever?
Group A beta-haemolytic streptococcal,
82
What kind of immune reaction happens with rheumatic fever?
Type 2 hypersensitivity reaction as antibodies fight strep infection but also target own cells e.g. muscle cells in myocardium
83
How does rheumatic fever present?
Typically presents 2-4wks post-strep infection e.g. tonsillitis with: Fever Joint pain Rash Shortness of breath Chorea Nodules
84
What affect does rheumatic fever have on joints?
Causes migratory arthritis-hot + swollen joints, different joints affected at different times
85
What affect does rheumatic fever have on the heart?
Carditis/percarditis-> Tachy/bradycardia Murmurs HF
86
What affect does rheumatic fever have on skin?
Subcutaneous nodules-firm + painless Erythema marginatum rash-pink rings on torso + limbs
87
How does rheumatic fever affect the nervous system?
Chorea- irregular, uncontrolled and rapid movements of the limbs (St Vitus' dance/Sydenham chorea)
88
How can you assess rheumatic fever?
Throat swab ASO antibody titres Echo/ECG/CXR to assess heart involvement
89
What criteria is used to diagnose rheumatic fever?
Jones criteria
90
What are ASO + what are they useful for?
Anti-streptococcal antibodies-indicate recent strep infection
91
What are the major Jones criteria?
J – Joint arthritis O – Organ inflammation, such as carditis N – Nodules E – Erythema marginatum rash S – Sydenham chorea
92
How do you manage rheumatic fever?
Phenoxymethylpenicillin (penicillin V) for 10 days NSAIDs for joint pain Aspirin/steroids for carditis Prophylactic Abx
93
Name 3 complications of rheumatic fever
Recurrence of rheumatic fever Valvular heart disease, most notably mitral stenosis Chronic heart failure
94
What is paediatric aortic stenosis?
Congenital narrow opening in the aortic valve, restricting blood flow from l ventricle to aorta
95
How does paediatric aortic stenosis present?
Depend on severity of narrowing, can be asymptomatic or can have: Fatigue Shortness of breath Dizziness Fainting Worse on exertion
96
How might severe paediatric stenosis present?
Heart failure within months of birth
97
What murmur is heard with aortic stenosis?
Crescendo-decrescendo ejection systolic murmur that radiates to carotids + is heard loudest in aortic area (second intercostal space, right sternal border)
98
How would you manage a valve stenosis?
Percutaneous balloon aortic valvuloplasty (inflating a balloon to stretch the valve via a catheter) Surgical aortic valvotomy (open surgery via a midline sternotomy incision to widen the aortic valve) Valve replacement
99
What is paediatric pulmonary valve stenosis?
Congenital narrow opening of pulmonary valve, caused by abnormal development-thickening/fusion
100
Name 4 conditions that congenital pulmonary valve stenosis may be associated with
Tetralogy of Fallot William syndrome Noonan syndrome Congenital rubella syndrome
101
What murmur would you hear with pulmonary stenosis?
Ejection systolic murmur heard loudest at the pulmonary area (second intercostal space, left sternal border)
102
How might pulmonary stenosis present?
Asymptomatic OR: Fatigue on exertion Shortness of breath Dizziness Syncope (fainting)
103
Name 4 cardiac signs on exam with pulmonary stenosis
Palpable thrill in the pulmonary area Right ventricular heave (due to right ventricular hypertrophy) Raised JVP with giant a waves Widely split second heart sound
104
What is the most common paediatric arrhythmia?
SVT-supraventricular tachycardia
105

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