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Paediatrics > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What is Kawasaki disease?

A

A type of vasculitis
Mainly affecting the coronary arteries
Also affects large/medium vessels
Typically 6m-4yrs

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2
Q

What causes Kawasaki disease?

A

Unknown
Genetics
Infection: Strep/Staph
Autoimmune

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3
Q

What is the pathophysiology of Kawasaki disease?

A

Immune mediated breakdown of endothelial tissue in arteries

Exposes Tunica Media

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4
Q

What are the complications of Kawasaki disease?

A 
Most common cause of acquired heart disease in the UK
Coronary aneurysm
MI
Sudden cardiac death
Ischaemia
Arrhythmia
HF
Myocarditis
Renal: Urethritis & sterile pyuria
CNS: Aseptic meningitis
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5
Q

How is Kawasaki disease treated?

A

Self-limiting: 25% chance of heart complications
High dose IV immunoglobulin 2g/kg
Aspirin 80-100mg/kg/day

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6
Q

What is the issue with giving a child Aspirin?

A

Can cause Reye’s syndrome

Benefits of Aspirin outweigh risk of Reye’s syndrome

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7
Q

What are the signs & symptoms of Kawasaki disease?

A

CRASH & BURN
C-Conjunctivitis: Limbus sparing
R-Rash: All over body, polymorphous leading to desquamation (flakes off)
A-Arthritis/adenopathy: Enlarged cervical lymph nodes
S-Strawberry Tongue: Red mouth & throat
H-Hands & feet: Swollen & red palms & soles
Burn= Fever: Doesn’t resolve with antipyretics >38.5 for 5d

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8
Q

How is Kawasaki disease investigated?

A 
No specific investigation
Bloods: Inc ESR, CRP, Clotting, FBC (anaemia & leucocytosis)
Urine culture: Can get proteinuria
ECG: Normal w/strain infarcts
ECHO: Look for aneurysm!
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9
Q

How is a diagnosis of Kawasaki disease made?

A

Child with an unexplained fever
AND
CRASH Symptoms: MUST have 4/5 symptoms

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10
Q

What is an innocent murmur?

A

Due to normal flow
Can be pronounced in minor illness
Can move when sitting/standing/breathing

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11
Q

How is an innocent murmur characterised?

A 
Soft
Systolic
Short
Symptomless
Sternal edge (Left)
No thrills
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12
Q

How can a murmur be split into?

A 
Cyanotic: RIGHT to LEFT shunt- Poor!
Tetralogy of fallout
Transposition of the great vessels
Non-cyanotic: LEFT to RIGHT shunt
Coarc
ASD/VSD/AVSD
Patent ductus arteriosus
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13
Q

What is ToF?
What are the symptoms?
What is the management?

A 
4 characteristics:
1) VSD
2) Overiding aorta
3) Pulmonary stenosis
4) RV hypertrophy
Murmur: Loud, long ejection systolic in 3rd intercostal space
Boot shaped heart
Symptoms: Blue baby, tet spells (baby crying loads then turn blue), FTT, squatting baby, SOBOE
Mx: Surgically in 1st year of life
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14
Q

What is transposition?
What are the symptoms?
What is the management?

A

Pulmonary artery & aorta swap
Symptoms: day 2-3 of life blue, duct dependant!
CXR: Narrow mediastinum, w/egg-on-side appearance
Mx: Keep ductus arteriosus open (prostaglandin infusion) & stabilising surgery

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15
Q

What is coarctation of the aorta?
What are the symptoms?
Is it associated with anything?
What is the management?

A

Narrowing of the aorta usually just distal to subclavian
Symptoms: Dependent on location, acute HF w/weak femoral pulses (BP higher in arms than legs)
Associated: Turner’s & berry aneurysm
CXR: Rib notching (development of large collaterals posterior to ribs)
Mx: Surgical ligation, balloon dilatation

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16
Q

What is ASD?
What are the symptoms?
What is the management?
Is it associated with anything?

A

Defect in atrial wall
Types: Ostium Secundum, Ostium Primum
symptoms: L > R shunt, Children usually well
Murmur: Widely split S2, ejection systolic best heard in 3rd L intercostal space, rumbling
Mx: Conservatively or percutanious surgery
Associated: Trisomy 21

17
Q

What is VSD?
What are the symptoms?
What is the management?
Is it associated with anything?

A

Hole in ventricular septal wall
L>R shunt, FTT, SOBOE, asymptomatic,
Large: SOB, difficulty feeding, excess sweating, Rx resp infections, FTT)
Murmur: Ejection systolic (small), pan systolic (large)
Mx: Diuretics, ACEi, Surgery
Associated: Trisomy 21, eisenmengers (baby HF)

18
Q

What is Patent ductus arteriosus?
What are the symptoms?
What is the management?
Is it associated with anything?

A

L >R shunt, usually asymptomatic, FTT, resp infections
Murmur: Machinery murmur inferior to left clavicle
Mx: Surgical ligation, Indometacin (prostaglandin inhibitor), Ibuprofen

19
Q

What is Eisenmenger’s syndrome?

A

Irreversible pulmonary HTN w/reversal of shunting (R>L)

Paediatrics (26 decks)

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