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Y5 Paediatrics > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What kind of shunts cause breathlessness?

A

left to right shunts

They drive oxygenated blood into lungs > less oxygenated blood to body > dyspnoea to attempt to compensatw

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2
Q

What are the left to right shunts?

A

VSD
ASD
PDA
AVSD

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3
Q

What kind of shunts cause cyanosis

A

right to left shunts

they drive deoxygenated blood from the R side of heart into the L side of circulation > into body

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4
Q

What are the right to left shunts?

A

Tetralogy of fallot

Transposition of great arteries

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5
Q

What is the function of the foramen ovale

A

allow blood to flow from R atrium to L A > systemic circulation

This is useful in a foetus because blood in R atrium comes from umbilical vein: it is oxygenated

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6
Q

Why does the foramen ovale shut

A

Due to changes in pressure
After birth
When resistance to pulmonary blood flow falls (due to breathing)
And volume of blood returning to right atrium falls (due to placenta being excluded)

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7
Q

What does the ductus arteriosus connect?

A

Pulmonary artery to aorta

Allows pulmonary blood to bypass the lungs

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8
Q

What are features of an innocent ejection murmur

A

InnoSSSSent

aSymptomatic
Soft blowing
Systolic only (not diastolic)
left Sternal ege

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9
Q

How do you manage heart failure

A

Reduce preload - DIURETICS e.g furosemide
Enhance contractility e.g. dopamine, digoxin
Reduce afterload e.g. ACe inhibitors, hydralazine

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10
Q

WHat does central cyanosis present as

A

Tongue is slate blue

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11
Q

What does peripheral cyanosis present as

A

Child is cold / unwell or with polycythaemia

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12
Q

What investigations must you get for chanosis

A

CXR, ECG
Echo with doppler
Specialist opinion

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13
Q

What are complications of heart disease in children?

A

Heart failure, SOB
Faltering growth
Recurrent chest infections
Infective endocaridtis

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14
Q

What are the two types of atrial septal defect

A

Secundum ASD

Partial AVSD

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15
Q

What is secundum ASD

A

Large defect in ASD, involves foramen ovale

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16
Q

How does ASD present

A

No symptoms
Reccurent chest infections / wheeze
Arrythmia (from 40yo)

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17
Q

What are ASD murmur

A

Ejection systolic murmur

Split second heart sound

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18
Q

What physical effect does ASD have on the heart

A

right ventricular dilatation

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19
Q

How do you manage ASD

A

OBSERVATION: as defect may close / shrink over time

Measure ratio of pulmonary:systemic blood flow

  • <1.5 no closure
  • > 1.5 or ASD large enough to cause RV dilatation: closure

Secundum:; cardiac catheterisation, insert occlusive device
Partial: surgical correction

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20
Q

What age is ASD treated at

A

3-5 years old

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21
Q

What is a ventricular septal defect categorised as

A 
Small = smaller than aortic valve 
Large = larger than aortic valve
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22
Q

What is the murmur occurring with large VSD

A

pansystolic

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23
Q

When should the ductus arteriosus close

A

1 month after expected delivery date

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24
Q

How do you manage patent ductus arteriosus

A

Close using coil / occlusive device through cardiac catheter

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25
Q

What test shows RtL shunt?

A

Hyperoxia (Nitrogen Washout) test

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26
Q

How does Hyperoxia (Nitrogen Washout) test work

A

place infant in 100% oxygen for 10 minutes

if PaO2 stays low (<15kPA)&raquo_space; CYANOTIC HEART DISEASE

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27
Q

How do you manage a cyanosed neonate

A

ABC > artificial ventilation if necessary
Start prostaglandin infusion immediately to maintain duct patency (key for survival)

Surgery at 6 months

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28
Q

What kind of blood movement occurs in cyanotic heart disease (RtL shunt)

A

deoxygenated blood into systemic circulation

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29
Q

What are the abnormalities in tetralogy of fallot

A

Ruksana Validates Orkid’s Patheticness

RV hypertrophy
VSD
Overriding aorta
Pulmonary artery stenosis

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30
Q

What is the outcome of the tetralogy of fallot

A

Excessive strain on RV

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31
Q

What is the key presentation in TOF

A

Severe cyanosis
Hypercyanotic spells
Squyatting on exercise

32
Q

When does TOF present

A

Cyanosis within months / yeara

Worse when crying / feeding

33
Q

What murmur occurs in TOF

A

LOUD ejection systolic

34
Q

What is CXR presentation in TOF

A

boot shaped heart

35
Q

What is the TGA

A

aorta and pulmonary arteries swap places
So two completely independent systems form
Incompatible with life, but foetus survives in utero due to patent ductus arteriosus

36
Q

When does TGA present in neonate

A

within DAYS !!!!

as soon as ductus arteriosus closes

37
Q

What is CXR appearance of TGA

A

Egg on stick

38
Q

What surgery is done in TGA

A

Balloon atrial septostomy - break flap valve of foramen ovale and encourage mixing of blood

then Arterial Switch procedure

39
Q

What is Eisenmenger syndrome aetiology

A

Large Left to right shunt not treated early
Causes pulmonary arteries to become hypertrophied, resistance to flow increases > increased pulmonary vascular resistance > RIGHT TO LEFT SHUNT FORMED

40
Q

How does Eisenmenger syndrome present

A 
20-40 year olds 
Triad CHE 
- Cyanosis 
- HF 
- Erythrocytosis
41
Q

What is the treatment for Eisenmenger syndrome

A

heart-lung transplant

42
Q

Who is ASVD common in

A

Down syndrome

43
Q

What is ASVD

A

large valve stretching across entire atrio ventricular junction

44
Q

What are outflow obstructions that occur in a well child

A

Aortic stenosis
Pulmonary stenosis
Aortic coarctation

45
Q

Explain aortic stenosis

A

Aortic valve leaflets fuse together

this restricts exit from left vntricle

46
Q

How do you treat aortic stenosis

A

balloon valvulotomy / aortic valve replacement

47
Q

What are aortic stenosis feratures

A

reduced exercise tolerance
chest pain
syncope

48
Q

what is aortic coarctation

A

narrowing of the aorta

49
Q

what are features of adult aortic coarctation

A 
gets progressively more severe 
asymptomatic 
systemic HTN in right arm 
Ejection systolic murmur 
Radio femoral delay
50
Q

What signs present on CXR in aortic coarctation

A 
Rib notching (due to delevlopmentof large collatewral intercostal arteries() 
3 sign (visible notch(
51
Q

How do you manage aortic coarctation

A

stent

52
Q

what are features of child aortic coarctation

A

acute circulatory collapse on day two when ductus closes

53
Q

What is rheumatic fever

A

Multisystem immune response to preceding infection with group A beta haemolytic strep

54
Q

How many people does RF progress to RHD

A

up to 80%

55
Q

What are sx of Rheumatic fever

A

2-6 weeks after pharyngeal / skin infection

Polyarthritis, fever, malaise

56
Q

How do you treat RHD

A

Aspirin (suppress inflammatory response of joint and heart)

Anti-strep antibiotics (PenV, benzylpenicillin, amoxicillin)
Corticosteroids

57
Q

Who do you give prophylaxis to prevemnt RHD

A

Until age of 21 / 10 years after RF

58
Q

What is prophylaxis for RHD

A

benzathine penicillin MONTHLY for 10 years since last episode or until age of 21

59
Q

What criteria are used for RF diagnosis

A

Jones criteria

60
Q

What investigations do you do for IE

A

Blood cultures

Echo (vegetations on valve leaflet)

61
Q

What is the most coommon pathogen to cause IE

A

Strep Viridans

62
Q

What is treatment for Strep viridans on native / prosthetic valves

A

beta lactam + gentamycin, 6 weeks

63
Q

what are presenting signs of PDA

A 
left subclavian thrill 
continuous machinery murmur 
large volume, bounding, collapsing pulse
wide pulse pressure 
heaving apex beat
64
Q

How do you manage aortic coarctation in neonates (usually presenting at 48h old, when DA closes)

A

Prostaglandin infusion to maintain patency

Surgical repaair

65
Q

How do you manage SVT

A

if haemodynamically stable: vagal maneuvres, adenosine

If unstable: cardioversion

66
Q

How do you manage tetralogy of fallot

A

prostaglandin infusion
Blalock Taussig shunt

Definitive surgery to repair defect from 4m onward

67
Q

What is Blalock Taussig shunt

A

artificial tube between subclavian artery and pulmonary artery

68
Q

What dwefects are repaired by surgery in TOF

A

Close VSD

Relieve right ventricle outflow obstruction

69
Q

How do you manage hypercyanotic spells in TOF

A
  1. place patient in knees to chest position
  2. aadminister oxygen
  3. IV line > phenylpeprhine, morphine suplhate, propanolol
  4. sodium bicarb if prolonged attacks
  5. refer. to cardiac centree
70
Q

describe a hypercyanotic spell in TOF

A

attack of paroxysmal hyperpnoea and increased cyanosis

occur spontaneously OR after feeding/prolonged crying/defcation

71
Q

How do you manage tricuspid atresia

A

Medical: prostaglandin infusion + cardioresp support (oxygen, mechanical vent, inotropes, IV fluid)

Blalock Taussig shunt insertion > corrective surgery

72
Q

What sound do you hear in VSD

A

loud pansystolic murmur at lower left sternal edge

Quiet pulmonary second heart sound

73
Q

How do youm manage VSD

A

Observation (small shunts close spontaneously)
Prophylactic amox if high risk of developing endocarditis
large VSD: open heart surgerty

74
Q

what are side effects of prostaglandins

A

apnoea
jittering
seizures

flushing
vasodilation
hypotensions

75
Q

what are the top causes of a grey baby who is cyanotic at 3-5 days

A

sepsis
TGA
inborn errors of metabolism
NAI

Y5 Paediatrics (30 decks)

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