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Cardiac disease Flashcards

(43 cards)

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1
Q

What is the most common congenital heart disease?

A

VSD

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2
Q

What are the R-L shunts?

A

Tetralogy of Fallot (TOF)

Transposition of the Great Arteries (TGA)

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3
Q

What colour would you expect an infant with a R-L shunt to be?

A

Cyanosed - blue

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4
Q

What are the L-R shunts?

A

VSD
ASD
Patent/persistent ductus arteriosus (PDA)

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5
Q

How does heart failure tend to come about in neonates?

A

Obstructed systemic circulation

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6
Q

What are the causes of neonatal heart failure?

A
  1. Hypoplastic L heart syndrome
  2. Critical aortic valve stenosis
  3. Severe aortic coarctation
  4. Interruption of the aortic arch
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7
Q

How does heart failure tend to come about in infants?

A

High pulmonary blood flow

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8
Q

What are the causes of infant heart failure?

A
  1. VSD
  2. ASD
  3. Large PDA
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9
Q

How does heart failure tend to come about in older children/adolescence?

A

R or L sided heart failure

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10
Q

What are the causes of older children/adolescent heart failure?

A
  1. Eisenmenger
  2. Cardiomyopathy
  3. Rheumatic
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11
Q

When is a VSD considered small?

A

Smaller than the aortic valve (i.e.

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12
Q

When is a VSD considered large?

A

Larger than the aortic valve (i.e. >~3mm)

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13
Q

How does a small VSD present?

A

Asymptomatic

HS - PANSYSTOLIC, loud murmur at lower L sternal edge

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14
Q

What are the heart sounds (HS) for a small VSD?

A

PANSYSTOLIC, LOUD, at the lower L sternal edge

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15
Q

A loud murmur implies what?

A

A smaller defect (greater turbulance)

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16
Q

What is the management for a small VSD?

A

Advise will close spontaneously

F/U with paediatrician + discharge with normal ECG and Echo

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17
Q

How does a large VSD present?

A

After 1 week of age, the child’s growth begin to falter and becomes SOB + tachycardic. If a more subtle change in these signs, may present with recurrent chest infections. Child is in heart failure, hepatomegaly present as result of HF
HS - PANSYSTOLIC, soft murmur at lower L sternal edge, may be no murmur

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18
Q

What are the HS in a large VSD

Study These Flashcards
A

PANSYSTOLIC, SOFT murmur at lower L sternal edge BIT may be NO MURMUR

19
Q

In a child with a large VSD, what would you see on their CXR?

Study These Flashcards
A
  1. Cardiomegaly
  2. Enlarged pulmonary arteries
  3. Increased pulmonary vascular markings
  4. Pulmonary oedema
20
Q

By what age, in a child with a large VSD, would you see ECG changes, and what are those changes?

Study These Flashcards
A

By 2 months you would expect to see biventricular hypertrophy

21
Q

How is a child with a large VSD managed?

Study These Flashcards
A

Management by paediatric MDT
Sx of heart failure treated with diuretic + captopril
Additional calorie intake - dietician input
Advise parents child will require surgery, usually at 3-6 months

22
Q

What are the two types of ASD?

Study These Flashcards
A
  1. Secundum ASD - 80%

2. Partial atrioventricular septal defect

23
Q

What is a secundum ASD?

Study These Flashcards
A

Involves centre of atrial septum, involving foramen ovale

24
Q

What is different about the mitral (L AV) valve in partial atrioventricular septal defects?

Study These Flashcards
A

It is tricuspid, where it is usually bicuspid

25
How do ASD's present?
Usually asymptomatic May have recurrent wheeze/chest infections HS - ESM at UPPER L sternal edge
26
What are the HS in ASD?
ESM at UPPER L sternal edge (due to increased flow across the pulmonary valve from the L to R shunt)
27
How is an ASD managed?
If the ASD is large enough such that it is causing R ventricle dilatation intervention is required. This will usually take place between 3 and 5 y/o. A secundum ASD = insertion of an occlusion device in cath lab, a partial AVSD = surgical correction
28
Which children are at greater risk of TGA?
Those born to mothers with poorly controlled/uncontrolled diabetes during pregnancy
29
When does cyanosis become most pronounced in TGA + why?
2nd day of life - if these is no concurrent septal defect, closure of the DA on the 2nd day results in a loss of mixing, hence cyanosis. It is less pronounced if there is a concurrent VSD etc.
30
What are the HS in TGA?
II HS is LOUD and SINGLE There isn't necessarily a murmur, but if there is, it will be systolic + due to increased outflow into the L (in this case pulmonary) outflow tract
31
What is the classical appearance of TGA on CXR?
1. Narrow upper mediastinum 2. Egg-on-side appearance 3. Increased pulmonary vascular markings
32
What is the management of TGA?
MUST FACILITATE MIXING 1. Prostaglandin-infusion - maintain DA patency 2. Atrial septostomy - essentially, tearing of the atrial septum via balloon catheter (The above are 'buying time' procedures) 3. Definitively = arterial switch procedure
33
What are the features of TOF?
1. Large VSD 2. Overriding of the aorta 3. Sub-pulmonary stenosis 4. RV hypertrophy
34
What is the 'classic' presentation of TOF?
Severe cyanosis + Hypercyanotic (Tett) spells + Squatting on exercise + Clubbing
35
How does TOF usually present now, in developed countries?
Dx from USS antenatally or cyanosis + murmur in first 2/12
36
What is the HS in TOF
LOUD, HARSH, ESM from first day of life at pulmonary listening point
37
What are the classical findings of TOF on CXR?
1. 'Boot-shaped' heart 2. Decreased pulmonary markings (due to decreased pulmonary flow) 3. Pulmonary artery bay
38
When is definitive surgery performed for TOF, and what is done?
At 6 months | The VSD is closed and RV outflow tract obstruction is relieved
39
When is a hypercyanotic spell considered 'prolonged' and what is done about it?
Prolonged = beyond 15 mins Sedation + pain relief; IV propranolol; IV fluids; bicarbonate for acidosis; muscle paralysis and ventilation to reduce O2 requirement
40
What does absent femoral pulses mean in the context of congenital heart disease?
Coarctation of the aorta
41
When does the DA usually close by?
Within 2 days of birth
42
What is the definition of PDA?
If the DA has remained patent for >1 month after the EDD
43
What are the signs in PDA?
1. Continuous murmur, below the L clavicle, that continues into diastole 2. Collapsing/bounding pulse

Paediatrics (27 decks)

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