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Toni's Paeds > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What is Patent Ductus Arteriosus

A

Failure of ductus between aorta and pulmonary artery to close
Left to right shunt
Bounding pulse, systolic murmur
If more severe -> HF : desaturation and respiratory distress
If symptomatic -> indomethacin or surgical ligation

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2
Q

What is Tetralogy of Fallot

A

An overriding aorta
Right ventricular outflow tract obstruction
Ventricular septal defect
Right ventricular hypertrophy

Assoc with: Noonan’s, Down’s,

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3
Q

Congenital heart disease:
L –> R shunt
Breathless

A

Ventricular Septal Defect
Persistent Ductus Arteriosus
Atrial Septal Defect

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4
Q

Congenital heart disease
R –> L shunt
Blue

A

Tetralogy of Fallot

Transposition of the Great Arteries

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5
Q

Outflow obstruction in well child

Asymptomatic with murmur

A

Pulmonary stenosis
Aortic stenosis
Adult type coarctation if aorta

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6
Q

Outflow obstruction in sick neonate

Collapsed with shock

A

Coarctation of the aorta

Hypo plastic left heart syndrome

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7
Q

Innocent murmurs

A

aSymptomatic
Soft blowing murmur
Systolic murmur only
left Sternal edge

No parasternal thrill
No radiation

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8
Q

Heart failure symptoms

A

Breathlessness
Sweating
Poor feeding
Recurrent chest infections

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9
Q

Heart failure signs

A 
Tachypnoea
Tachycardia
Murmur
Cardiomegaly
Hepatomegaly
Cool peripheries
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10
Q

Neonatal cause of heart failure

A 
Obstructed (duct dependent) systemic circulation:
Hypoplastic left heart syndrome
Critical aortic valve stenosis
Severe coarctation of the aorta
Interruption of aortic arch
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11
Q

Causes of heart failure in infants

A

High pulmonary blood flow:
Ventricular septal defect
Atrioventricular septal defect
Large persistent ductus arteriosus

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12
Q

Causes of heart failure in children

A

Right or left heart failure:
Eisenmenger syndrome: RHF
Rheumatic heart disease
Cardiomyopathy

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13
Q

Loud pansystolic murmur
Lower left sternal edge
Quiet pulmonary second sound

A

Small ventricular septal defects
Smaller than the diameter of the aortic
Up to 3 mm

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14
Q

Soft pansystolic murmur
Apical mid diastolic murmur
Tachypnoea
Tachycardia

A

Large ventricular septal defect

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15
Q

Continuous murmur
Beneath L clavicle
Increased pulse pressure
Collapsing/ bounding pulse

A

Patent Ductus Arteriosus

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16
Q

Hyperoxia / Nitrogen Washout Test

A

Differentiates betw resp and cardiac causes of cyanosis
10 mins 100% Oxygen = max saturation of pulm circulation

Cyanosis improves: resp cause
No improvement: R -> L shunt

17
Q

Severe cyanosis
Hypercyanotic spells + irritability
Loud harsh ejection systolic murmur, left sternal edge from day 1

A

Tetralogy of Fallot

18
Q

What is Eisenmenger syndrome

A

Large L->R shunt / common mixing = high pulm blood flow
Untreated -> thick walled pulm arteries = incr resistance to flow
Shunt reduces -> fewer symptoms
Shunt reversal at 10-15yrs = blue
-> R heart failure

19
Q

What is Tricuspid Atresia

A 
Only L ventricle effective
R ventricle small + non functional
Common mixing in L atria
Cyanosis if duct dependent
Blalock-Taussig shunt: subclavian -> pulm artery = early palliation
20
Q

Signs of aortic stenosis

A

Slow rising pulse
Carotid thrill
Ejection systolic murmur at right sternal edge -> carotid
Delayed soft aortic second sound
Apical ejection click
Reduced exercise tolerance, chest pain/ syncope on exertion

21
Q

Signs of pulmonary stenosis

A

Ejection systolic, upper L sternal edge
Ejection click, upper L sternal edge
r ventricular impulse with ventricular hypertrophy

22
Q

Adult type coarctation

A

Not duct dependent
Severity increases with age
Asymptomatic
L ventricular hypertrophy

23
Q

Signs of adult type coarctation of aorta

A 
Ejection systolic
Upper sternal edge
Radio femoral delay
Systemic htn in R arm
CXR: rib notching, 3 sign
24
Q

Baby in shock
Absent femoral pulses
Severe metabolic acidosis

A

Coarctation of aorta

Arterial duct tissue encircle aorta
Closure-> constriction of aorta

25
Q

What is Interruption of the Aortic Arch

A

No connection betw proximal aorta and arch distal to ductus
Dependent on VSD and R->L shunt via duct
Collapse
Absent femorals and left brachial pulse

26
Q

What is Hypoplastic Left Heart Syndrome

A 
Underdeveloped L side of heart
Oft with coarctation of aorta
Collapse
Absence of all peripheral pulses
Norwood procedure
27
Q

What is supraventricular tachycardia

A 
Most common arrhythmia
250-300 bpm
'Re-entry tachycardia'
Poor cardiac output + pulm oedema
HF symptoms
Cause of hydrops
28
Q

Managing supraventricular tachycardia

A

Vagal stimulating manoeuvres: carotid sinus massage
IV adenosine: breaks re-entry circuit
If fails: cardiovert
Maintenance therapy: flecainide, sotalol, propranolol
Treatment stopped at 1 yr if no further attacks

29
Q

Wolf Parkinson White

A

Atrioventricular reciprocating tachycardia
Due to abnormal accessory pathway: bundle of Kent
Palpitations, dizziness, syncope
Delta wave on ECG
Percutaneous radio frequency ablation of accessory pathway

30
Q

What is congenital complete heart block

A

Maternal antiRo / antiLa antibodies prevent normal dev of cardiac conduction system
Can cause: hydrops, death in utero, HF, syncope
Req endocardial pacemaker

31
Q

What is long QT syndrome

A

Sudden loss of consciousness in late childhood
Assoc with exertion, stress or emotion
Can -> sudden death from ventricular tachycardia
AD
Assoc w. Erythromycin therapy, electrolyte disorders, head injury

32
Q

What is rheumatic fever

A

Abnormal immune response to Beta- haemolytic strep pharyngitis -> 2-6 wk latent period
Polyarthritis, mild fever, malaise
With active myocarditis limitation if exercise essential
High dose aspirin +- corticosteroids
Symptomatic HF:diuretics ACEi
Prevent recurrence: monthly Ben pen until 18 yrs

33
Q

Manifestations of rheumatic fever

A 
Pericarditis
Myocarditis
Polyarthritis
Sydenham chorea
Erythema marginatum
Raised: ESR, CRP, leucocytes
Prolonged PR interval
34
Q

Infective endocarditis risk in children with congenital heart disease

A

Risk highest with turbulence: VSD, coarctation, PDA, prosthesis
Suspect with:
Fever, malaise, raised ESR, unexplained anaemia/ haematuria
6wks IV penicillin + aminoglycoside : strep viridans
Prophylaxis: good dental hygiene

35
Q

What is dilated cardiomyopathy

A 
Due to: inheritance, metabolic disease, viral myocarditis
Suspect with enlarge heart + HF
Diuretics, ACEi, carvedilol
Usually improves spontaneously
Some may need heart transplants
36
Q

Kawasaki and cardiac disease

A 
Echo at diagnosis
Pericardial effusion
Myocardial disease
Endocardial disease
Coronary disease with aneurysm formation may req angio or MRI
37
Q

Pulmonary hypertension

A

VSD, AVSD, PDA
Left untreated -> pulmonary vascular disease
Req heart/lung transplant eventually
inhaled NO, IV magnesium sulphate, oral phosphodiesterase inhibitors e.g. Sildafenil, IV prostacyclin, inhaled iloprost

38
Q

What is Transposition of the great Arteries

A

Congenital malformation
Aorta arises from R ventricle and the pulmonary artery from the L
Duct dependent due to two parallel circulations
Presents with cyanosis

39
Q

Diastolic murmur

Heard loudest at the apex

A

Mitral stenosis

Almost always caused by rheumatic fever

Toni's Paeds (16 decks)

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