W8 - Cardiovascular disease in Childhood Flashcards by Elen Price

what are the 2 types of congenital cardiac heart disease

acyanotic
cyanotic

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what type of congenital cardiac disisease is most common

acyanotic (85%)

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what are some examples of acyanotic congenital heart defects that cause increased pulmonary flow

ASD, VSD, AVSD, PDA

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what are some examples of acyanotic congenital heart defects that cause obstruction

Pulmonary stenosis, Aortic stenosis, Coarctation

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what are some examples of cyanotic congenital heart defects

Tetralogy of Fallot, Tricuspid Atresia, Transposition of GA, TAPVD, Truncus, HLHS

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what are some symptoms of congenital heart disease

Symptoms of heart failure
Cyanosis, SaO2 <96%
Abnormal pulses
Hyperactive precordium
Abnormal heart sounds
Murmur ≥3/6
harsh diastolic, pansystolic, or continuous
ejection click

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how does neonatal heart disease tend to present

Death
Cyanosis
Heart failure
Abnormal Neonatal Examination
- Murmur and/or Pulses

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what are some signs and symptoms of heart failure

Poor feeding
Tachypnoea, respiratory distress
Sweating, clammy skin, poor perfusion
Pallor, cyanosis
Tachycardia, hyperactive praecordium
Gallop rhythm
Oedema, hepatomegaly

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what is the most common acyanotic lesion

Ventricular septal defect

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what are the next most common acyanotic lesions (all 10%)

Patent Arterial Duct
Pulmonary stenosis
Coarctation of the aorta
Atrial Septal Defect
Aortic Stenosis

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what conditions have the pathophysiology of a volume overload

ASD
VSD
AVSD
Patent Ductus Arteriosus

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what conditions have the pathophysiology of a pressure overload

Aortic stenosis
Pulmonary stenosis
Coarctation

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describe foetal circulation

go through
will be in OSCE and EoY

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what is the management of ventricular septal defect

nothing - can close on its own if not too big and child is asymptomatic

may need surgery if too big or symptomatic

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what is the pathophysiology of ventricular septal defect

↑ blood flow through LV

LV enlargement

↑ pulm blood flow

High pulmonary blood flow causes pulmonary hypertension

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what is the presentation of atrial septal defect

Usually asymptomatic, though may have symptoms of high pulmonary blood flow

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what is the management of atrial septal defect

surgery or devise closure

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what is the pathophysiology of atrial septal defect

Left to right Shunt

↑ blood flow across tricuspid valve -> MDM

↑ blood flow across pulmonary valve -> ESM and wide, fixed splitting S2

↑ flow through RV -> RV enlargement

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in what condition is Complete Atrio-Ventricular Septal Defect ( AVSD) most common

downs syndrome

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when does AVSD need to be repaired by

before 6 months of age

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what is the pathophysiology of complete AVSD

Large left to right shunt -> early development of heart failure

RV pressure never falls so murmur is ejection systolic across pulmonary valve

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what is aortic coarctation

Narrowing of aorta causing reduced flow to systemic circulation

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what is the characteristic featuer of coarctation of the aorta

ABSENT FEMORAL PULSES

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what are some symptoms and signs of coarctation of the aorta

Poor feeding & weight gain, SOB
Hypertensive in arm
ABSENT FEMORAL PULSES

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what type of murmur is heard on coarctation of the aorta

Ejection systolic murmur radiates to back

what is the treatment for coarctation of the aorta

PGE1 infusion to reopen ducts, anti-failure Rx, inotropes, diuretics. Needs urgent surgical resection & end to end anastomosis

what is the pathophysiology of coarctation of the aorta

Neonatal collapse – circulatory collapse, resp distress, severe acidemia ↑ proximal pressure -> may affect heart and brain ↓ distal pressure -> poor renal flow compounds hypertension

which gender is more likely to have Aortic valve stenosis

M:F = 3:1

what symptoms do you present with in Aortic valve stenosis

normally asymptomatic Can present in cardiac failure +/-collapse, weak pulses, pale cool skin – severe/critical AS in newborn Older child angina, syncope, exertional dyspnoea/chest pain Mild stenosis worsens with time in sig number of pts

what heart sounds can you hear in Aortic valve stenosis

Harsh ejection systolic murmur Ejection click with valvular AS Systolic thrill suprasternal notch or over carotid arteries

what is the treatment of Aortic valve stenosis

Balloon valvuloplasty or surgery

what kind of murmur can be heard in Pulmonary valve stenosis

Ejection systolic murmur radiating to axilla

what signs and symptoms do people with Pulmonary valve stenosis present with

Often asymptomatic Severity can improve or worsen May present in heart failure/cyanosis

what is the treatment for Pulmonary valve stenosis

Balloon valvuloplasty or surgery

how would tetrology of fallot present

Cyanotic failing to thrive Soft ejection or pan systolic murmur low O2 sats

what are the 4 feature of tetralogy of fallot

Pulmonary Stenosis Overriding aorta Ventricular Septal Defect Right Ventricular Hypertrophy

what would you hear on heart sounds for Tetralogy of Fallot

Harsh ejection systolic murmur and right ventricular heave

what would you see on Chest XR for tetrallogy of fallot

Boot shaped heart, decreased pulm markings

what are Tetralogy of Fallot “Hypercyanotic spells”

Muscle spasm below pulmonary valve leads to marked reduction in pulmonary blood flow Cry/Rapid & deep breathing, irritability -> pallor -> cyanosed+++ -> arrest Spells occurs after crying, feeding – peaks 2-4months

what is the treatment for “Hypercyanotic spells”

Educate Knees to chest or over your shoulder Supplemental O2 + Morphine 0.2 mg/kg SC/IM to suppress the resp centre and abolish hyperpnea Acidosis treatment with sodium bicarbonate oral Propranolol pending surgery

what are the 3 types of syndromes with cardiac disease

Aneuploidies Single gene Non-genetic syndromes

what type of syndrome is downs syndrome

aneuploides

what are the feature of downs syndrome

Mental retardation / Learning difficulties Developmental Delay Floppiness GI anomalies Conductive deafness Duodenal atresia, Hirschsprung, Leukaemia,

what are the types of cardiac abnormality associated with downs syndrome

VSD, AVSD, ASD Mainly AVSD

with is patau's syndrome

trisomy 13

how does pataus syndrome present

extra fingers and toes cleft lip

what is edwards syndrome

trisomy 18

what is the mortality of edwards syndrome

90-95% mortality by 1 year

what cardiac defects are associated with edwards syndrome

VSD ASD polyvalvar anomalies

what cardiac conditions are associated with turners syndrome

Valvar aortic stenosis 15% Coarctation of the Aorta 5-10%

how does tuners syndrome present

Lymphoedema in infants Short stature in children Primary amenorrhoea Webbed neck, low hairline, low ears Dystrophic nails Renal (horseshoe, arterial and ureteral abnormalities)

what cardiac defect is associated with noonans (single gene defect)

Pumonary valve stenosis

what cardiac defect is associated with williams (single gene defect)

Supra valvar aortic stenosis

what cardiac defects are associated with marfans

AR dilatation, dissection

what cardiac defects are associated with di georges

VSD, ASD, Fallot’s Tetralogy

what are the features of noons syndrome

Pulmonary stenosis, Hypertrophic cardiomyopathy

what are the features of williams syndrome

Pulmonary artery branch stenosis Supra valvar aortic stenosis

what are the features of marfans syndrome

MV prolapse Aortic root problems

what are the features of di georges syndrome

Fallot’s tetralogy, Truncus arteriosus, Arch abnormalities

what is charge association

Coloboma Heart defect Atresia (Choanal) Retardation (mental) Genital Ear autosomal dominant

what is Vacteral association

Vertebral defects, Anal atresia, Cardiac abnormalities Tracheo – Esophageal fistula Renal Limb abnormalities VSD, PDA, Tetralogy TGA all reported

what heart defects are associated with foetal alcohol syndrome

VSD or ASD

what are some features of foetal alcohol syndrome

Microcephaly, small maxilla, up-turned nose smooth philtrum and upper lip, small eyes, prominent epicanthic folds

how do you treat a 'blue baby'

O2 sats CXR ABG Hyperoxia test ECG urgent ECHO

what 2 conditions can cause a heart disease

Kawasaki disease Rheumatic Heart disease

Which of the following is the approximate percentage of paediatric chest pain that is cardiac in origin? 80% 50% 20% 1% <0.01%

Which of the following factors increases the likelihood that chest pain is cardiac in origin? A. Family history of acute MI at 55 years of age B. Past history of repaired Tetralogy of Fallot C. Syncopal episode while swimming D. Past medical history of asthma E. ‘Crushing’ chest pain exacerbated by exercise

B C E

whats this

what are some red flags for cardiac disease

Exertional chest pain Exertional syncope palpitations FHx - familial hypercholesterolemia genetic disorders (Marfan’s) Kawasaki disease

W8 - Cardiovascular disease in Childhood Flashcards

(70 cards)