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Specialties > Paeds Written - CARDIO > Flashcards

Paeds Written - CARDIO Flashcards

1
Q

How can Acyanotic defect cause cyanosis?

A

Cause pulmonnary HTN
If pulmonary pressure > systemic pressure –> reversal of blood flow ‘Eisenmenger syndrome’
Causes cyanosis

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2
Q

How does cyanosis occur in cyanotic heart defects?

A

Deoxygenated blood bypasses lungs & returns to body

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3
Q

Cyanotic heart conditions

A

Tetralogy of Fallot

Transposition of great vessels/arteries

Tricuspid atresia

(+ Truncus arteriosus, Total anomalous pulmonary venous return, Hypoplastic left heart)

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4
Q

Acyanotic heart conditions

A

Ventricular septal defect

Atrial septal defect

Patient ductus arteriosus

Coarctation (of aorta)

Aortic stenosis

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5
Q

Qualities of innocent murmurs

A 
Soft blowing - pulmonary area
Short buzzing - aortic area
Vary with posture
No radiation
No diastolic component
No thrill
No added heart sounds
Asymptomatic
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6
Q

What is Still’s murmur?

A

Innocent murmur
low pitched sound
heart at lower left sternal edge

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7
Q

Pathophysiology of PDA

A

Failure of ductus arteriosus to close as normal with first breaths

Remains patent –> too much blood delivered to lungs

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8
Q

Risk factors for PDA

A

Premature
Birth at high altitude
Maternal rubella (in 1st trimester)

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9
Q

Signs O/E with PDA

A 
Left supraclavicular thrill?
Continuous machinery murur
Large volume bounding collapsing pulse
Wide pulse pressure
Heaving apex beat
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10
Q

Tx for PDA

A 
Indomethacin or Ibuprofen
2nd line (or large duct) = open or keyhole surgery

EXCEPTION: if associated with another (duct-dependent) congenital cardiac defect, prostaglandin E1 given to keep open until after surgery

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11
Q

Main features of Tetralogy of Fallot

A

Ventricular septal defect
Right ventricular hypertrophy
Right ventricular outflow obstruction (pulmonary stenosis)
Overriding aorta

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12
Q

Associations with Tetralogy of Fallot

A

22q11.1 deletion syndrome (Di George)

Down’s syndrome

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13
Q

Presentation of Tetralogy of Fallot

A

Hypercyanotic ‘tet’ spells

  • in 1st month of life
  • may cause LOC
  • Triggered by crying, breathing deeply/rapidly
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14
Q

Signs O/E in Tetralogy of Fallot

A

Mid systolic ejection murmur (from pulmonary stenosis)

Right parasternal heave (RV hypertrophy)

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15
Q

Ix findings in Tetralogy of Fallot

A

CXR –> boot shaped heart

ECG –> RV hypertrophy

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16
Q

Management of Tetralogy of Fallot

A

Prolonged hyper cyanotic spells:

  • Propanolol
  • Morphine
  • Fluids

Definitive = surgical repair
- 2 stage repair if small pulmonary artery

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17
Q

Presentation of atrial septal defect

A

Mostly asymptomatic - many found in adulthood

SOB
Lethargy
Poor appetite & growth
Increases respiratory infections

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18
Q

Signs O/E in Atrial Septal Defect

A

Ejection systolic murmur over pulmonary area

Fixed (wide) splitting of 2nd heart sound

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19
Q

Signs O/E in ventricular septal defect

A

Mild = none

Larger:
Holosystolic (pansystolic) murmur at lower left sternal edge
Palpable thrill
Mid-diastolic low pitched rumble at apex
Parasternal heave
Displaced apex beat

Signs of Heart failure

  • peripheral oedema
  • ascites
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20
Q

Complications/risks in child with VSD

A

Infective endocarditis
Pulmonary HTN
Aneurysm of ventricular septum

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21
Q

Tx required for VSD

A

No intervention UNLESS haemodynamic instability –> surgical correction

+/- Infective endocarditis prophylaxis if high risk

22
Q

Most common heart condition seen in children with Down syndrome?

A

Atrioventricular septal defect (AVSD) aka Endocardial cushion defect

23
Q

Presentation of ATRIOVENTRICULAR SEPTAL DEFECT (AVSD)

A

Cyanosis
Heart failure after few weeks of life
Usually no murmur

24
Q

Presentation / signs of Transposition of Great Arteries

A

Severe cyanosis within first days of life (as ductus arteriosus closes)

Loud S2

No murmur

25
Q

Diagnostic Ix for Transposition of Great Arteries

A

Nitrogen washout / hyperoxia test
- pO2 < 15kPa after 10 mins of 100% O2 = cyanotic congenital heart disease

CXR –> egg on string appearance (narrow upper mediastinum), increased pulmonary markings

26
Q

Management of Transposition of Great Arteries

A

Alprostadil (prostaglandin E1) - maintain ductus arteriosus

Balloon atrial septoplasty - pulls atrial septum down to allow mixing

Definitive surgical correction - arterial switch

27
Q

Side effect of Prostaglandin E1 Tx in neonates?

A

Apnoea

- may need intubation

28
Q

Tricuspid atresia signs & symptoms

A 
Cyanosis
SOB
Shortly after birth --> over weeks
Prominent first heart sound
Pansystolic murmur - from VSD

+/- ejection systolic from pulmonary stenosis, continuous from PDA

29
Q

Risk factor/association with Epstein’s anomaly

A

Lithium use in pregnancy

30
Q

Signs O/E for Ebstein’s anomaly

A

Split 1st and 2nd heart sound

Cardiomegaly

31
Q

(Isolated) pulmonary & aortic stenosis key signs/symptoms

A

Both = ejection systolic murmur + NO cyanosis

Aortic = carotid thrill
Pulmonary = no thrill, harsh murmur at left sternal edge
32
Q

Treatment of aortic/pulmonary stenosis

A

Trans-catheter balloon dilatation

33
Q

Signs/symptoms of coarctation of aorta

A

Asymptomatic OR

Ejection systolic murmur
High BP in arms, low BP in legs
Absent femoral pulses - other pulses normal
Rib notching (from large collateral intercostal arteries forming)

34
Q

Management of coarctation of aorta

A

Relies on ductus arteriosus so
unwell infant –> A-E + prostaglandin E1

Well infant –> surgical repair OR balloon angioplasty +/- stenting

35
Q

Key features of Hypoplastic left heart

A

Mitral and/or aortic valve narrowing or complete block

Left ventricle very underdeveloped

Aorta small & underdeveloped

Atrial septal defect

36
Q

Presentation of Hypoplastic left heart

A

Well at birth THEN

breathless & ill soon after

37
Q

Management of hypoplastic left heart

A

Keep ductus arteriosus open - prostaglandin E1

Multiple operations
- improve QOL but no curative surgery

38
Q

Most common childhood arrhythmia?

A

Supraventricular tachycardia

39
Q

Treatment of SVT in children

A

Cardio-resp support

  • correct tissue acidosis
  • positive pressure ventilation if needed

Vagal stimulating manoeuvre e.g. ice pack to face

IV adenosine

Electrical cardioversion + maintenance therapy (flecainamide, sotalol) once sinus rhythm restored

40
Q

Treatment options for recurrent SVT

A

Percutaneous Radiofrequency ablation (RFA)

Cryoablation of accessory pathway

41
Q

Presentation of rheumatic fever

A

Latent interval 2-6 weeks after pharyngeal infection

PPE Sx

  • polyarthritis
  • pericarditis
  • erythema marginatum (map-link outlines)

Sydenham’s chorea 2-6 months later

42
Q

Criteria for diagnosis rheumatic fever

A

Jones’ Criteria

Evidence of recent strep throat

  • raised ISO titre
  • other strep Ab
  • group A strep on throat culture

AND

  • 2 majors
  • 1 major +2 minors
43
Q

Major criteria for rheumatic fever

A

CASES

Carditis
Arthritis
Subcutaneous nodules
Erythema marginatum
Sydenham's chorea
44
Q

Minor criteria for Rheumatic fever

A

FRAPP

Fever
Raised ESR/CRP
Arthralgia
Prolonged PR interval
Previous RF
45
Q

Treatment of rheumatic fever

A

Bed rest + anti-inflammatories

High dose aspirin

Abx (if evidence of persistent infection) - amoxicillin

Corticosteroids (if fever + inflammation does not resolve rapidly)

46
Q

Long term /prophylactic Tx of rheumatic fever

A

monthly benzathine penicillin injections

  • until 10 years after last episode OR 21yo
  • lifelong if severe valve disease

+/- Surgical Tx - valve repair, replacement

47
Q

Signs/Sx of Infective Endocarditis

A

Fever, anaemia, pallor

Thrombotic:

  • Necrotic skin lesions - infected emboli
  • Splenomegaly
  • Retinal infarcts
  • Microscopic haematuria
  • Splinter haemorrhages
  • Neuro signs (from cerebral infarct)
Janeway lesions
Osler nodes
Clubbing
New heart murmur
Arthritis or arthralgia
48
Q

Management of infective endocarditis

A

IV Abx

  • beta lactam + aminoglycoside
  • e.g. amoxicillin + gentamicin
  • 6 weeks

+/- Surgical removal of prosthetic material

49
Q

Features of heart failure in child

A

Poor feeding, faltering growth
Recurrent chest infections
Fatigue
Sweating

Tachypnoea
Gallop rhythm
Cardiomegaly
Hepatomegaly

50
Q

Principles of managing heart failure

A

Reduce preload - diuretics

Enhance cardiac contractility - dopamine OR digoxin, adrenaline, dobutamine

Reduce after load - ACEi, hydralazine

Improve oxygen delivery - beta blocker e.g. carvedilol

Enhance nutrition

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