5. Paediatric Cardiology Flashcards
What are the 8 Commonest Congenital Heart Disease Lesions?
- Ventricular Septal Defect (VSD)
- Patent Ductus Arteriosus (PDA)
- Atrial Septal Defect (ASD)
- Pulmonary Stenosis
- Aortic Stenosis
- Coarcation of the Aorta
- Transposition of the Great Arteries
- Tetralogy of Fallot
What is the Aetiology of Congenital Heart Defects?
- Genetic Susceptibility (Chromosomal Abnormalities)
2. Teratogenic Insult (Environmental Factors)
What are the Genetic Susceptibility (Chromosomal Abnormalities) Factors which contribute to Congenital Heart Defects?
- a) Trisomy 13 (VSD & ASD)
- b) Trisomy 18 (VSD & PDA)
- c) Trisomy 21 (AVSD)
- Turner - Co-Arctation of the Aorta
- Noonan - Pulmonary Stenosis
- Williams - Supraventricular AS
- 22q11 Deletion Syndrome
What are the Teratogenic Insult (Environmental) Factors which contribute to Congenital Heart Defects?
- Drugs - Alcohol / Cocaine / Ecstacy / Lithium
- Infections - TORCH (Toxoplasmosis / Rubella / CMV / Herpes)
- Maternal - Diabetes / Systemic Lupus Erythomatous
What needs to be asked about in a Congenital Heart Defect History?
- Feeding / Weight / Development
- Cyanosis
- Tachypnoea / Dyspnoea
- Exercise Tolerance
- Chest Pain
- Syncope
- Palpitation
- Joint Problems
What needs to be looked for in a Congenital Heart Defect Examination?
- Weight / Height
- Dysmorphic Features
- Cyanosis
- Clubbing
- Tacypnoea / Dyspnoea
- (Femoral) Pulses / Apex Beat
- Heart Sounds / Murmurs
What Investigations should be done if a Congenital Heart Defect is suspected?
- Blood Pressure
- O2 Saturation / ABG
- ECG / Echocardiogram / Angiography
- MRI / Chest X-Ray
- Catheter
- Exercise Tolerance
What are the Different Classifications of Murmurs?
- Cardiac Cycle Timing - Systole / Diastole / Continuous
- Duration:
- a) Early / Mid / Late
- b) Ejection / Holo/ Pan Systolic
- Pitch / Quality:
- a) Harsh / Mixed Frequency (Turbulence)
- b) Soft / Intermittent
- c) Vibratory / Pure Frequency (Laminar Flow)
What are the Murmur Sites?
- Upper Right Sternal Border
- Upper Left Sternal Border
- Lower Left Sternal Border
- Apex
What are the 4 Types of Innocent Murmurs?
- Left Ventricular Outflow Murmur (Still’s Murmur)
- Pulmonary Outflow Murmur
- Carotid / Brachiocephalic Arterial Bruits
- Venous Hum
What are the Common Features of Innocent Murmurs?
- Systolic Murmur
- No other Signs of Cardiac Disease
- Soft Murmur - Grade 1/6 or 2/6
- Vibratory / Musical
- Localised
- Varies with Position / Respiration / Exercise
What are the Specific Features of a Left Ventricular Outflow Murmur (Still’s Murmur)?
- Common Presentation Age = 2-7 years old
- Described as Soft Systolic / Vibratory / “Twangy”
- Heard in the Apex / Left Sternal Border
- Increases in Supine Position and with Exercise
- Between S1 and S2
What are the Specific Features of a Pulmonary Outflow Murmur?
- Common Presentation Age = 8-10 years old
- Described as Soft Systolic / Vibratory
- Heard in the Upper Left Sternal Border - Well Localised / Not Radiating to the Back
- Increases in Supine Position with Exercise
- Heard Between S1 and S2
Note - Often Children with a Narrow Chest
What are the Specific Features of a Carotid / Brachiocephalic Arterial Bruit?
- Common Presentation Age = 2-10 years old
- Described as 1/6-2/6 Systolic / Harsh
- Heard in Upper Supraclavicular - Radiating to Neck
- Increases with Exercise
- Decreases on Turning Head / Extending Neck
- Heard Between S1 and S2
What are the Specific Features of a Venous Hum?
- Common Presentation Age = 3-8 years old
- Described as Soft / Indistinct / Continuous Murmur (Sometimes with Diastolic Accentuation)
- Heard in Upper Supraclavicular
- Only heard in the Upright Position - Disappears on Lying Down
- Heard Between S2 and S1, and S1 and S2
What are the 3 Main Types of Ventricular Septal Defects?
- Subaortic
- Perimembranous
- Muscular
What is the Clinical Presentation of a Ventricular Septal Defect?
- Pansystolic Murmur at the Lower Left Sternal Edge
- Early Systolic Murmur - in Very Small VSD’s
- Diastolic Rumble due to Relative Mitral Stenosis - in Very Large VSD’s
- Signs of Cardiac Failure - in Large VSD’s
- Bivertricular Hypertrophy - Eventually
- Pulmonary Hypertension - Eventually
How is a Ventricular Septal Defect closed?
- Amplatzer Device
2. Patch Closure
What are the Features of Atrial Septal Defects?
- Few Clinical Signs in Early Childhood
- May Spontaneously Close
- Sometimes detected in Adulthood - Atrial Fibrillation / Heart Failure / Pulmonary Hypertension
- Wide, Fixed, Splitting of 2nd Heart Sound
- Pulmonary Flow Murmur
What is Atrioventriculo-Septal Defect?
And what is it associated with?
Singular AV Valve with Ostium Primium ASD and High VSD
Associated with Trisomy 21
What are the Clinical Features of Pulmonary Stenosis?
- Asymptomatic in Mild Stenosis
- Exertional Dyspnoea in Moderate - Severe Stenosis
- Exertional Fatigue in Moderate - Severe Stenosis
- Ejection Systolic Murmur in the Upper Left Sternal Border, with Radiation to the Back
What are the Clinical Features of Aortic Stenosis?
- Mostly Asymptomatic
- Reduced Exercise Tolerance (Exertional Chest Pain / Syncope) if Severe
- Ejection Systolic Murmur in the Upper Right Sternal Border, with Radiation into the Carotids
What are the Changes in the Foetal Circulation at Birth?
- Pulmonary Vascular Resistance Falls
- Pulmonary Blood Flow Rises
- Systemic Vascular Resistance is Increased
- Ductus Arteriosus Closes
- Foramen Ovale Closes
- Ductus Venosus Closes
What are the Features of Patent Ductus Arteriosus (Botalli)?
- Abnormal Blood Flow between the Aorta and the Pulmonary Artery
- Very Common in Pre-Term Infants
- In-Term Babies - good chance of Spontaneous Closure
- Treatment with Fluid Restriction / Diuretics / Prostaglandin Inhibitors (Ibuprofen) / Surgical Ligation
What is the Management of Co-Arctation of the Aorta?
- Reopen Patent Ductus Arteriosus with Prostaglanding E1 / E2
- Resection with End-to-End Anastomosis
- Subclavian Patch Repair
- Balloon Aortoplasty
