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Paediatrics > Cardiac > Flashcards

Cardiac Flashcards

1
Q

dDx breathless child

A

Left to right shunt
ASD
VSD
PDA

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2
Q

Features ASD

A

Secundum (most common, central defect) and partial AVSD- present similarly with different anatomy
Common asymptomatic

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3
Q

ASD secundum presentation

A

May present as recurrent chest infection/wheeze, arrythmias in 4th decade

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4
Q

Ix ASD secundum

A

Ejection systolic murmur best heard at upper left sternal edge
Fixed and widely split second heart sound
Xray showed cardiomegaly, enlarged pulmonary arteries, increased pulmonary vascular markings
ECG shows partial right BBB and right axis deviation

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5
Q

Mx ASD secundum

A

Treatment required if large enough to cause right ventricle dilation
Cardiac catheterization and insertion of an occlusion device

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6
Q

Ix partial AVSD

A

Asymptomatic pansystolic murmur from AV valve regurgitation

ECG shows QRS negative in AvF

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7
Q

Mx partial AVSD

A

Surgical correction between 3-5y

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8
Q

Features small VSD

A

<3mm and asymptomatic
Normal X Ray and ECG
Loud pansystolic murmur at left lower sternal edge
Usually self resolve
Require good dental hygiene prevent endocarditis

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9
Q

Features large VSD

A 
More prominent presentation 
Heart failure with breathlessness and faltering growth after 1 week old
Recurrent chest infection
Soft pansystolic murmur
Atypical mid-diastolic murmur
Loud pulmonary second sound
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10
Q

Ix large VSD

A

Chest Xray shows cardiomegaly, enlarged pulmonary artery, increased pulmonary vascular markings and pulmonary edema
ECG shows ventricular hypertrophy by 2 months of age

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11
Q

Mx large VSD

A

Drug therapy for heart failure with diuretics combine with captopril
Additional calorie input required
Surgery performed at 3-6 months to prevent permanent lung damage from pulmonary hypertension and high blood flow

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12
Q

Cx VSD uncorrected

A

Eisenmenger syndrome

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13
Q

Features Eisenmenger syndrome

A

Long term complications of untreated left right shunting
Pulmonary arteries become thick walled with high resistance
Features develop after 1 year of uncorrected shunt defect
Progressive presentation and death by right sided failure
Palliation or full heart lung transplantation (rare)

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14
Q

Features PDA

A

PDA failure to close within first months due to a defect in the contractile mechanism
Resorts with continuous machinery murmur under the left clavicle continuing into diastole
Pulse pressure decreases with a collapsing bounding pulse
Large ducts exhibit heart failure and pulmonary hypotension

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15
Q

Ix PDA

A

Normal chest Xray and ECG uless duct is large

In large duct ECG and X Ray exhibit signs of VSD

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16
Q

Mx PDA

A

Closure to prevent endocarditis and pulmonary vascular disease
Closure with coil or occlusion device via a cardiac catheter 1 year of age
Prostaglandin inhibitors may be effective in term infants .e.g. Indomethacin
Preterm infants less responsive to prostaglandin inhibitors

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17
Q

dDx blue baby

A

Right to left shunt
Tetralogy of fallot
Transposition of the great arteries
Eisenmenger syndrome

18
Q

Four features of tetralogy of fallot

A

Large VSD
Overriding of aorta with respect to ventricular septum
Subpulmonary stenosis causing right ventricular outflow obstruction
Right ventricular hypertrophy

19
Q

Exam and Ix in tetralogy of fallot

A

Loud ejection systolic murmur
Clubbing of fingers and toes develops in older childhood
Chest Xray features: relatively small heart, uptilted apex, pulmonary artery bay, concavity of the left heart border, decreased pulmonary vascular markings
ECG develops signs of right ventricular hypertrophy

20
Q

Mx tetralogy

A

Definitive correction at 6 months of age: closure of VSD, relieve RV outflow tract obstruction
Shunt via artificial tube between the subclavian and pulmonary OR balloon dilation of RV outflow obstruction
Hypercapnic episodes lasting >15 minutes related with analgesia, V propranolol, IV fluids, bicarbonate, artificial ventilation

21
Q

Features transposition of great arteries

A

Aorta connect to the RV and pulmonary artery connected to the LV
Without mixing, this is fatal
Cyanosis is predominant feature; profound and life threatening
Presentation typically follows ductal closure
Second heartland is often loud and single- no murmur

22
Q

Xray features transposition

A

egg on side appearance

increased vascular markings

23
Q

Mx transposition

A

Maintain patency of ductus arteriosus with prostaglandin infusion
Balloon atrial septostomy via the atrial septum
All patients require surgery in the neonatal period to switch vessels

24
Q

dDx blue and breathless

A

Common mixing
Complete AVSD
Tricuspid atresia

25
Q

Features complete AVSD

A

Associated with down’s syndrome
Defect in the middle of the heart producing a small fine leaflet valve stretch across whole AV junction
Diagnosis by antenatal US
Cyanosis or heart failure at 2 weeks to 3 months
No associated murmur

26
Q

Mx complete AVSD

A

Routine echo in all patients with down syndrome

Initially medical treatment with full repair at 3-6 months

27
Q

Features tricuspid atresia

A

Only Left ventricle is effective: right ventricle is small and non-functional
Cyanosis in newborn which is duct dependant

28
Q

Mx tricuspid atresia

A

Early palliation to maintain pulmonary blood supply low pressure: Blalock-Taussig shunt (subclavian to pulmonary artery)
Corrective surgery rarely possible due to single ventricle
Further palliative surgery: SVC to pulmonary at 6 months; IVC to pulmonary at 3-5 years

29
Q

Features coarctation of the aorta

A

Collapsed child with shock
Outflow obstruction
Atrial duct tissue overrides the aorta at the point of insertion of duct
Present with collapse on day 2 when duct closes
Very sick baby with heart failure
Cardiomegaly
Severe metabolic acidosis

30
Q

Features hypoplastic left heart

A

Underdevelopment of the entire left side of the heart: Mitral valve small and atretic
LV diminished
Small descending aorta
Antenatally detected
No flow in L side causing profound acidosis and cardiovascular collapse
Weakness or absence of peripheral pulses

31
Q

Mx hypoplastic left heart syndrome

A

Norwood procedure

32
Q

Features aortic stenosis

A

Aortic valve leaflets are partially fused giving restrictive outflow
Associated with mitral valve stenosis and coarctation of the aorta
Must have asymptomatic murmur: ejection systolic maximal in upper right sternal edge radiating to the neck
Reduced exercise tolerance, chest pain on exertion and syncope
Small volume, slow rising pulse, carotid thrill, apical ejection click, delayed soft aortic second sound

33
Q

Ix Aortic stenosis

A

Prominent LV with post stenotic dilation of ascending aorta visible on chest X Ray
LV hypertrophy on ECG

34
Q

Mx aortic stenosis

A

Regular clinic and echo assessment

Balloon valvotomy with symptoms on exercise, pressure gradient >64mmHg

35
Q

Features pulmonary stenosis

A

Pulmonary valve leaflets are partially fused
Mostly asymptomatic
Ejection systolic murmur on left sternal edge
Ejection click on upper left sternal edge
Thrill and heave present in severe disease

36
Q

Ix pulmonary stenosis

A

Post-stenotic dilation of pulmonary artery

ECG shows evidence of RV hypertrophy

37
Q

Mx pulmonary stenosis

A

Transcatheter dilation once pressure gradient exceeds 64mmHg

38
Q

Features supraventricular tachycardia

A

Rapid heart rate above 250-300 beats/min
Poor cardiac output
Pulmonary edema and heart failure
Hydrops fetalis and IUD if in utero
ECG shows narrow complex tachycardia with P wave following QRS
Wolff-Parkinson white accessory pathway associated with a delta wave

39
Q

Mx supraventricular tachycardia

A

Restore sinus rhythm with PPV, vagal maneuvers, adenosine, electrical cardioversion

40
Q

Features congenital complete heart block

A

Rare condition with anti-Rho and anti-La antibodies in maternal serum
Mother with connective tissue disorders: including latent and active
Antibody prevents normal electrical conduction development
Heart develops with atrophy and fibrosis of AVN
Can cause death in utero and neonatal heart failure
May be asymptomatic with some episodes of syncope or presyncope

41
Q

Mx congenital complete heart block

A

Endocardial pacemaker in symptomatic children

Paediatrics (22 decks)

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