29. Peadiatric Cardiology Flashcards
What are the main classes of disorders in paediatric cardiology
Genetic
Acquired
Arrhythmias (mostly supraventricular tachycardia’s)
What are some congenital conditions?
Marfans
Long QT syndrome
Cardiomyopathy
What are some examples of acquired heart disease?
Kawasaki
Rheumatic Fever
Bacterial endocarditis
What are the common congenital conditions of the heart
Ventricular Septal Defect (VSD) Patent Ductus Arteriosus (PDA) Atrial Septal Defect (ASD) Pulmonary Stenosis Aortic Stenosis Coarctation of the Aorta Transposition of Great Arteries Tetralogy of Fallot
What cause a higher rate of developmental abnormalities of the heart?
Drugs/toxins- alcohol, amphetamines
Infections- rubella, herpes
Maternal pal- diabetes, SLE
What are the common trisomy that cause heart defects?
Trisomy 13- Patau syndrome
Trisomy 18- Edwards
Trisomy 21- Down’s (atrio-ventricular septal defect)
What genetic conditions cause heart defects
Turner’s- co-arctation of aorta
Noonan- pulmonary stenosis
Williams- supravalvular aprtic stenosis
22q11 deletion syndrome
What do you look for on the history of the disease
Cyanosis Feeding weight and developmental Tachypnoea, dyspnoea Exercise tolerance Chest pain Syncope Palpitation Joint problems Chest pain (usually MSK not heart)
How does heart failure present in children?
Shortness of breath
Hepatomegaly
Tachycardia
What are the most common referrals to the cardiology clinic?
Murmurs
How do you examine a child with a suspected heart problem
Weight and height Dysmorphic Cyanosis Clubbing- May also be IBD, respiratory problems Tachy/dyspnoea Pulses/apex- femoral pulses Heart sounds Murmurs
How do you investigate a child with a cardiac defect?
BP, ECG CXR ECHO Angiography Holster monitoring MRI angiogram Exercise testing
What are the treatment principles of peadiatric cardiology?
Can we fix it?- yes! Well fix it then
Can we fix it?- no- well make it better then (medication, palliative surgery)
Can we fix it?- no- we can’t make it better either, replace it
What are the common features of innocent peadiatric heart murmurs?
Systolic murmurs No other signs of cardiac disease Soft murmurs Musical quality (buzz, hmmmm) Localised Varies with position, respiration, exercise
What is a still’s murmur?
2-7 year’s
Soft systolic vibratory musical murmur
Apex, left sternal border
Increases in supine position and with exercise
What is a pulmonary outflow murmur?
8-10 years
Soft systolic, vibratory
Upper left sternal border. Well localised, no radiating to back
Increases in supine exercise
What is a carotid/brachiocephalic arterial bruits?
Occurs at age 2-10 years
Radiates to neck
Increased with exercise
Decreases when yiu turn neck to the side
What is the venous hum?
3-8 years
Soft indistinct
Supraclavicular
Occurs upright, disappears lying down
What are the different types of ventricular septal defects?
Subaortic
Perimembranous
Muscular
Closer to the apex the more worrying it is
Shunts are L->R
What are the clinical presentations of ventrosepticular defects
Pansystolic murmer
LL sternal edge
Early systolic murmurs
Diastolic rumble due to relative mitral stenosis
Signs of cardiac failure in large VSD’s- leads to hypertrophy and pulmonary hypertension
