Paeds- Cardio Flashcards
(69 cards)
1
Q
give some examples of congenital heart diseases (the 3 categories + examples)
A
- holes/ connections- ASD, PDA, VSD, AVSD
- narrowing/ stenosis- aortic coarctation, AS, PS
- complex (right to left shunt)- transposition of great arteries, tetralogy of fallot
2
Q
which is the only type of congenital heart disease to cause cyanosis?
A
right-to-left shunts (transposition of great arteries, tetralogy of fallot)
3
Q
if you suspect a CHD in a patient, what features indicate that there is acute decompensation of the heart?
A
poor feeding, dyspnoea, tachycardia, hepatomegaly, cool peripheries, acidosis on ABG, pulmonary venous congestion
4
Q
aetiology of Atrial Septal Defects
A
- foetal alcohol syndrome
5
Q
give 3 types of ASD
A
- ostium secundum
- ostium primum
- AVSD
6
Q
clinical features of ASD
A
- Asymptomatic when younger
- fixed, widely split S2
- ejection systolic murmur in pulmonary area
in older children- arrhythmia, recurrent chest infections + wheeze
7
Q
how would you investigate a patient with a suspected ASD?
A
- chest radiograph
- ECG
8
Q
what would you expect to find on a chest radiograph in a patient with an ASD?
A
CM, globular heart
9
Q
what would you expect to find on an ECG in a patient with an ASD?
A
RVH+/- RBBB, or superior QRS axis
10
Q
how is an ASD managed?
A
- cardiac catheterisation
- surgical correction
11
Q
symptoms of a patent ductus arteriosis
A
- RARE to have symptoms- unless large defect- leads to CCF and Pulmonary HTN
- poor feeding, failure to thrive
- tachypnoea
- oedema
12
Q
clinical signs of a patient ductus arteriosis
A
- large, bounding, collapsing pulse
- CLASSICAL CONTINUOUS MACHINERY MURMUR IN PULMONARY AREA
- heavy apex beat
- left subclavicular thrill
- loud s2
- Gallop rhythm
13
Q
why is an echocardiogram done in a patient with a suspected PDA?
A
to ensure that there is no duct dependant circulation- pulmonary atresia
14
Q
how is a PDA managed?
A
- coil/ occlusion device induced by cardiac catheter
- ibuprofen/ indomethacin (prostaglandin inhibitors) to close
- if persistent (>1 year), endovascular surgery
15
Q
what is there a high risk of in VSD?
A
endocarditis
16
Q
clinical features of a VSD
A
- mild
if symptomatic- poor feeding, failure to thrive, tachypnoea, oedema
17
Q
what would be found on examination of a patient with a VSD?
A
- active pre-cordium
- thrill
- gallop rhythm
- harsh loud pansystolic murmur heard on low left sternal edge
18
Q
what would be found on a CXR in a patient with a VSD?
A
cardiomegaly
enlarged PA
pulmonary oedema
19
Q
what would an ECG of a patient with a VSD find?
A
ventricular hypertrophy and strain
20
Q
can a VSD close spontaneously?
A
yes- if it is small and muscular (20% close by 9 months)
21
Q
how is a large VSD managed?
A
- increase calorie output
- heart failure- diuretics
- surgery
22
Q
in what condition are AVSD’s common?
A
Downs
23
Q
anatomically, what is a complete AVSD?
A
5-leaflet valve between the atria and the ventricle
24
Q
clinical features of an AVSD
A
- presents at antenatal US scan
- cyanosis at birth, HF at 2-3 weeks
- no murmur
- poor feeding, failure to thrive, tachypnoea, hepatomegaly, oedema, thrill, gallop rhythm
25
how is an AVSD managed?
- treat HF medically
| - surgical repair at 3-6 months
26
describe coarctation of the aorta
arterial duct tissue encircling the aorta at the point it inserts into duct, this consequently:
- constricts aorta when duct closes
- obstructs LV outflow
27
how does aortic coarctation present clinically
- circulatory collapse at day 2 !!
- weak/ absent femoral pulses
- RF delay
- 4 limb BP- upper and lower BP different
- EJECTION SYSTOLIC MURMUR
- HF and HTN
- Metabolic acidosis
28
how does aortic coarctation present on a CXR?
- CM
- figure '3' sign
- rib notching
29
how is aortic coarctation managed?
surgery by age of 5
30
describe aortic stenosis
aortic valve leaflets partly fused together- restricts LV outflow
31
clinical features of aortic stenosis
- asymptomatic
- ejection systolic murmur
- carotid thrill in suprasternal region
32
in aortic stenosis, where is the ejection systolic murmur heard?
upper right sternal edge
33
how does aortic stenosis present on an ECG?
V2- deep S, tall R
V6- Down going T wave
34
how is aortic stenosis managed?
- ballon valvotomy
- ballon dilation in older children
- valve replacement
35
describe pulmonary stenosis
PV leaflets partly fused together, restricting flow from the RV
36
Clinical features of pulmonary stenosis
asymptomatic
ejection systolic murmur in ULSE
thrill
right ventricular heave
37
how does pulmonary stenosis present on ECG?
upright T wave due to RV hypertrophy
38
how is pulmonary stenosis managed?
transcatheter balloon dilatation
39
describe transposition of the great arteries
- aorta connected to RV, pulmonary artery connected to LV
| - so oxygenated blood goes to lungs, deoxygenated to body- incompatible with life
40
how does transposition of the great arteries present clinically?
- cyanosis profound + life threatening
- presents on day 2- ductal closure leads to reduction in mixing of saturated and desaturated blood
- 2nd heart sound loud and single
- acidosis
41
how should a patient with suspected transposition be investigated?
- check for 22q deletion
| - radiography- narrow upper mediastinum- 'egg on side' cardiac shadow
42
how is transposition managed and treated?
- maintain patency of ductus arteriosus with prostagladin infusion
- balloon atrial septostomy- hole between atria
- surgery- arterial switch
43
what 4 clinical features are present in the tetralogy of fallot?
- large VSD
- overriding aorta
- sub-pulmonary stenosis
- RVH
44
signs and symptoms of the tetralogy of fallot?
- cyanotic
- sudden, short severe exacerbations causing distress and pallor due to hypoxia
- breathless
- irritability
- easy tiring on breast feeding
45
what is the tetralogy of fallot associated with?
Downs and 22q deletions
46
what findings would be found on investigation in a patient with tetralogy of fallot?
- radiograph- small heart, boot shaped apex
- harsh ejection systolic murmur in LLSE
- echo-cardinal features
47
how is tetralogy of fallot managed?
- close VSD
- relieve RV outflow tract obstruction
- shunt to increase pulmonary blood flow
48
what is Ebstein's abnormality?
posterior leaflets of the tricuspid valve are displaced anteriorly towards apex of RV
49
what causes Ebstein's abnormality?
lithium in pregnancy (bipolar mother)
50
what are the 3 consequences of Ebsteins abnormality?
- tricuspid regurg (pan-systolic murmur)
- tricuspid stenosis (mid-diastolic murmur)
- RA enlargement
51
what is Kawasaki's disease?
idiopathic self limiting systemic vasculitis
52
epidemiology of Kawasaki's
- 6 months- 5 years
| - asian origin
53
what is the major complication of Kawasaki's disease?
coronary artery aneurysm formation
54
how does Kawasaki's disease present clinically? (pneumonic)
MYHEART
- My= Mucosal involvement (strawberry tongue, inflamed mucosa, mouth and lips)
- Hand and feet swelling
- Eyes- non - purulent bilateral conjunctivitis
- Adenopathy (lymph)- cervical
- Rash- truncal and polymorphic
- Temperature/ fever
55
describe the 3 phases of Kawasaki's disease
- acute febrile (1-2 weeks)- MYHEART
- subacute (4-6) - development of coronary aneurysms
- convalescent (6-12) - resolution of clinical signs and normalisation of inflammatory markers
56
differential diagnosis of Kawasaki's disease
```
measles
rubella
infectious mononucleosis
parvovirus B19
bacterial infection
```
57
how is Kawasaki's disease diagnosed and what tests and results are indicative of a diagnosis?
- clinical
- raised ESR, CRP, AST, A1-antitrypsin, platelets, bilirubin
- ECG- abnormalities
- ECHO- essential- reveals dilation and aneurysms of coronary arteries
58
How is Kawasaki's disease treated?
- high dose aspirin
- IV immunoglobulin (add prednisolone if ineffective)
aspirin and immunoglobulins used to reduce risk of coronary artery aneurysms !
59
clinical signs of infective endocarditis
```
fever
splenomegaly
clubbing
splinter haemorrhages
anaemia
rash
HF
microscopic haematuria
NEW MURMUR
```
60
how is infective endocarditis treated?
BLIND- after 3 cultures- benzylpenicillin + gentamicin
61
what is infective endocarditis ?
infection of the valves/ endocardium, causing destruction due to infective organisms forming vegetation
62
how does subacute bacterial endocarditis present differently to infective endocarditis?
presents with more non-specific symptoms that may have lasted for more than 2 weeks
63
what is rheumatic fever?
systemic febrile illness- cross -sensitivity reaction to group A- B- haemolytic strep
64
what is the Jones diagnostic criteria (definition)?
used to diagnose rheumatic fever; must have 2 major or 1 major + 2 minor criteria
- plus evidence of preceding strep infection (scarlet fever/ throat swab/ high serum ASO titre)
65
what are the Major criteria in the Jones diagnostic criteria for RF?
```
J – Joint arthritis
O – Organ inflammation, such as carditis
N – Nodules
E – Erythema marginatum rash
S – Sydenham chorea
```
66
what are the minor criteria in the Jones diagnostic criteria for RF?
FEAR!
Fever
ECG Changes (prolonged PR interval) w/o carditis
Arthralgia without arthritis
Raised inflammatory markers (CRP and ESR)
67
what is a MacCallum Plaque?
plaque found at the base of the posterior mitral leaflet in Rheumatic fever
68
how is RF treated?
- rest
- aspirin
- Benzylpenicillin then Phenoxymethylpenicillin
- If Sydenhams Chorea present= prednisolone
69
How does rheumatic fever present symptomatically?
```
Fever
Joint pain (migratory- appears to move from joint to joint)
Rash
Shortness of breath
Chorea
Nodules
```
sx present 2-4 weeks after initial infection
