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Cardiac Flashcards

1
Q

Signs of acute decompensation of heart disease

A
  • Difficulty feeding
  • Brady (imminenet arrest)
  • Hepatomegaly
  • Acidosis
  • Cyanosis
  • Dyspnoea
  • Tachycardia
  • Cool peripheries
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2
Q

What is the management of heart failure in a child

A
  • Sit up right
  • O2
  • NGT
  • Furesomide
  • +/- spironalactonr
  • ACEi
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3
Q

Examples of cyanotic heart disease

A
  • AV septal defect
  • Tetralogy of Fallot
  • Pulmonary/tricuspid atresia
  • transposition of the great vessels
  • total anomalous pulmonary venous return
  • truncus arteriosus
  • hypoplastic left heart
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4
Q

What are the key features of tetralogy of Fallot

A
  • Large VSD
  • Overriding aorta
  • Pulmonary stenosis
  • Right ventricular hypertrophy
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5
Q

Signs and symptoms of tetralogy of Fallot

A
  • Early systolic murmur left lower sternal edge
  • hypoxia: distress and pallor
  • Hypercyanotic episodes
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6
Q

Management of tetralogy of fallot

A
  • Corrective surgery at 6 months old
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7
Q

Examples of acyanotic heart disease

A
  • Patent ductus arteriosis
  • VSD
  • ASD
  • Coarctation
  • Aortic/Pulmonary stenosis
  • Mitral/tricuspid stenosis
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8
Q

What is the most common presentation of HF in children

A

poor weight gain
tachypnoea/wheeze
clear lung fields

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9
Q

What is the most common heart defect assoc with trisomy 21

A

atrio-ventricular septal defect

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10
Q

What is the most common benign murmur heard in infants

A

Short, systolic murmur over lower left sternal border and child is otherwise well

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11
Q

What is the most common type of heart defect assoc with William’s Syndrome

A

Supravalvular aortic stenosis

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12
Q

What is the most common type of heart defect assoc with Noonan’s syndrome

A

dysplastic pulmonary valve

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13
Q

What is the most common type of heart defect assoc with 22 q deletion

A

truncus arteriosis and tetralogy of fallot

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14
Q

What is the most common type of heart defect assoc with Holt Oram syndrome

A

atrial septal defects

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15
Q

Systolic murmur heard best at the cardiac apex

A

mitral regurgitation

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16
Q

Diastolic murmur heard best at the cardiac apex

A

mitral stenosis

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17
Q

Systolic murmur heard best at the lower left sternal border

A

Ventricular septa defect
tricuspid regurgitation
Common atrioventricular valve with regurgitation

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18
Q

Systolic murmur heard best at the upper left sternal border

A

pulmonary stenosis
patent ductus arteriosus
aortic stenosis
atrial septal defect

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19
Q

diastolic murmur heard best at the upper left sternal border

A

pulmonary regurgitation

aortic regurgitation

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20
Q

continuous murmur heard best at the upper left sternal border

A

Patent ductus arteriosus

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21
Q

Systolic murmur heard best at the neck/aortic area

A

aortic stenosis

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22
Q

Systolic murmur heard best at the back

A

coarctation of the aorta

pulmonary stenosis

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23
Q

Which congenital heart defects manifest symptoms of HF

A

Large VSD
AVSD
patent ductus arteriosus

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24
Q

Which congenital heart defects tend to be asymptomatic unless severe

A

Pulmonary stenosis
ASD
Aortic stenosis

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25
Q

What do you have to worry about in children with congenital heart defects

A

Prone to bacterial growths - look for signs of endocarditis - splinter haemorrhages

  • persistent fever
  • Oslo’s nodes
  • splenomegaly
  • microscopic haematuria
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26
Q

What advice should be given to individuals at risk of endocarditis

A
  • avoid tattoos and piercings
  • regular dental hygiene
  • prompt attention to dental issues
  • prophylactic antibiotics are no longer recommended following dental procedures.
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27
Q

Mitral regurgitation

A

systolic murmur cardiac apex

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28
Q

Mitral stenosis

A

diastolic murmur cardiac apex

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29
Q

VSD

A

systolic murmur lower left sternal border

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30
Q

tricuspid regurgitation

A

systolic murmur lower left sternal border

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31
Q

common atrioventricuoar valve with regurgitation

A

systolic murmur lower left sternal border

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32
Q

Pulmonary stenosis

A

systolic murmur upper left sternal border

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33
Q

patent ductus arteriosus

A

systolic/continuous murmur upper left sternal border

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34
Q

ASD

A

systolic murmur upper left sternal border

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35
Q

aortic stenosis

A

systolic murmur upper left sternal border
Into the carotid/aortic area
often assoc with a thrill

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36
Q

pulmonary regurgitation

A

diastolic murmur upper left sternal border

37
Q

aortic regurgitation

A

diastolic murmur upper left sternal border

38
Q

Coarctation of the aorta

A

systolic/continuous murmur heard best at the back
Systolic pressure higher in upper extremities
Absent/weak femoral pulses

39
Q

What may causes central cyanosis

A

congenital heard disease
pulmonary disease
abnormal haemoglobins (methemoglobins/sulhaemoglobin)

40
Q

What are the clinical features of central cyanosis

A

affects whole body
skin and mucosa blue
pulse oximetry abnormal

41
Q

What may cause peripheral cyanosis

A 
sluggish circulation
HF
Shock
exposure to cold temperatures
Arterial obstruction - Raynaud
venous obstruction (DVT)
42
Q

What are the clinical features of peripheral cyanosis

A

localised to peripheries
skin blue but mucosa pink
pulse ox generally normal.

43
Q

What is the most common site for coarctation of the aorta

A

segment of aorta adjacent to ductus arteriosus

44
Q

What is the management of coarctation of the aorta

A
  • surgical interventino to prevent LV dysfunction
  • angioplasty (re-coarctation can occur)
  • Rx of HTN
45
Q

what are the x ray findings in coarctation of the aorta

A

rib notching - doesn’t really occur in infancy

46
Q

what is the outcome of persistent L to r shunting

A

increase pulmonary resistance & severe pulmonary htn resulting in a R to L shunting causing cyanosis anf sometimes clubbing

47
Q

what is the pathophysiology of asd

A

oxygenated bloods passes from left to right atrium mixing with deoxygenated blood
most common CHD to be missed until adulthood

48
Q

what is the most common asd

A

ostium secundum- centre of the septum

49
Q

What is a patent ductus arteriosus

A
  • persistence of fetal vessel which connects aorta with pulmonary artery
  • Normailly closes in 1st week of life
  • 10% of all CHD
  • FEMALE>MALE
  • often assoc with coarctation and VSD
50
Q

What is thr pathophysiology of a patent ductus arteriosus

A

higher aortic pressure causes blood to shunt through to the pulmonary artery.

51
Q

What other clinical features other than a murmur may a patient have with a PDA

A
  • if severe, symptoms of HF
  • widened pulse pressure
  • bounding arterial pulse
  • enlarged heart with prominent apical pulse
52
Q

What is the treatment of PDA

A

usually done by ligation and division or intravascular coil in catheterisation lab.
Needed to prevent HF and pulmonary disease

53
Q

What is truncus arteriosus

A
  • failure of septum formation in truncus arteriosus to form pulmonary artery and aortic artery - controlled only with 1 valve
  • Most patients have a VSD
54
Q

What is a transposition of the great vessels

A

aortic artery and pulmonary artery are swapped.

Requires at least 1 shunt - ASD or VSD or PDA

55
Q

What is tricuspid atresia

A

Tricuspid valve never formed which means a patient requires both a VSD and an ASD to allow blood to go to the lungs to become oxygenated

56
Q

What is an over-riding aorta

A

the aorta takes blood from both the right and left ventricles

57
Q

What is total anomalous pulmonary venous connection

A 
Both pulmonary veins and SVC + IVC all terminate in the right atria causing mix of oxygenated and deoxygenated blood.
Needs ASD ( Or PDA) to move blood from right atria to left atria to ensure it goes into the peripheral circulation.
58
Q

What is the role prostaglandin E

A

Keep PDA open in conditions such as transposition of the great arteries or total anomalous pulmonary venous connetion

59
Q

What are the risk factors associated with transposition of the great arteries

A

mother is:

  • diabetic
  • > 40
  • alcohol use
  • poor nutrition
  • having rubella
60
Q

What is the most common cyanotic hear disease

A

tetralogy of fallot

61
Q

what may you classically see on cxr in a pt with tetralogy of fallot

A

boot shaped heart

62
Q

What heart defect MUST you have to survive truncus arteriosus

63
Q

What cxr findings may you seen in a patient with transposition of the great arteries?

A

egg on a string

64
Q

How long before symptoms of tricuspid atresia occur

A

immediately - surgery is required at birth

65
Q

How do you manage tricuspid atresia

A

3 stage operation

  1. Blalock–Thomas–Taussig shunt
  2. hemi-fontan procedure
  3. IVC then drains into pulmonary artery
66
Q

What is the Blalock–Thomas–Taussig shunt

A

like a PDA which allows mixing to happen

67
Q

What is a hemi-fontan procedure

A

some of the blood drains into pulmonary artery from SVC

68
Q

Where is the most common location for pulmonary veins to drain in total anomolous venous return

A

Most are supracardiac - into SVC (50%)
IVC 20%
right atrium 20%
mixed 10%

69
Q

What arrhythmia are children with WPW prone to

70
Q

What is the management of WPW

A

radiofrequency ablation of the accessory pathway

71
Q

What are the ECG findings of WPW

A
  • Shortened PR
  • Prolonged QRS
  • slurring of upstroke of QRS
72
Q

What drug is used to maintain patency of ductus arteriosus

A

prostaglandin infusion

73
Q

Duct dependent lesions associated with pulmonary flow

A 
pulmonary atresia
critical pulmonary htn
tetralogy of fallot
tricuspid atresia
Severe TR
Severe Epsteins anomalie
74
Q

Duct dependent lesions associated with systemic blood flow

A

critical aortic stenosis
coarctation of the aorta
Interruption of the aortic arch
left hypoplastic heart syndrome

75
Q

What is coarctation of the aorta

A

Narrowing of descending aorta adjacent to the point where the ductus arteriosus joins

76
Q

What us hypoplastic left heart syndrome

A

characterised by

  • hypoplasia of left ventricle
  • atresia/critical stenosis of aortic valve +/or mitral valve
  • hypoplasia of the ascending aorta and aortic arch
  • Coarctation of aorta often associated
77
Q

What is the management of hypoplastic left heart

A
  • IV prostglandin to keep duct open
  • univentricular circulation where one ventricle supports both pulmonary and systemic circulation - needs a staged surgical approach
78
Q

Physiological causes of palpitations

A

exercise
excitement
fever

79
Q

Psychogenic causes of palpitations

A

stress
anxiety
panic attacks

80
Q

Cardiac causes of palpitations

A 
arrythmias
congenital heart disease
post surgical
cardiomyopathies
cardiac tumours or infiltrative conditions
81
Q

Other medical causes of palpitations

A

anaemia
thyrotoxicosis
hypoglycaemia

82
Q

What is the most common abnormal cardiac ryhtm disturbance in children which requires treatment

83
Q

What is the recomended management of SVT

A
  • vagal manouveres: ice cold water on the fact, carotid sinus massage, valsalva
  • adenosine bolus
84
Q

What is the udnerlying mechanism of SVT in children

A

accessory pathway

85
Q

What are the ECG features of wolf parkinson white

A

short PR interval
delta wave
prolongation of QRS (secondary to early take off)

86
Q

What can be used to prevent SVT in children

A

beta blockers

- children who can’t verbalise their symptoms and have less cardiac reserve

87
Q

What is the difinitive treatment of accessory pathways

A

radio-frequency ablation

88
Q

what type of cardiomyopathy are you at risk of with maternal diabetes?

A

hypertrophic obstructive

89
Q

Who can’t have indomethacin for closure of PDA

A
  • renal impairment
  • NEC
  • intraventricular haemorrhage

Paediatrics (21 decks)

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