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Paeds > Cardiac disease > Flashcards

Cardiac disease Flashcards

1
Q

Paediatric Heart failure aims

A 
Reduce preload:
- diuretics (furosemide) or rarely venous dilators (nitroglycerin)
Enhance contractility
-  IV dopamine (alt. digoxin, dobutamine, adrenaline)
Reduce afterload 
- PO ACEi, IV hydralazine, nitroprusside
Improving O2 delivery:
-beta blockers (carvedilol)
Enhance nutrition
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2
Q

If HF thought to be bc of cardiac malformation

A

If cyanotic: prostaglandin infusion (maintains PDA in duct dependent)
Echo to work out defect

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3
Q

Atrial septal defect

A

Murmur: ejection systolic heard best and LSE and fixed wide-split second HS
Significant ASD (enough to cause RV dilatation) req. treatment
Secundum ASDs managed by cardiac catheterisation w/ insertion of occlusive device (percutaneous closure)
Partial AVSD managed surgically
Treatment usually undertaken at 3-5y of age

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4
Q

Ventricular septal defect

A

Murmur: loud pansystolic murmur loudest LSE quiet pulmonary HS II
These will close spontaneously
Demonstrated by disappearance of murmur and normal echo
When present avoid bacterial endocarditis by dental hygiene
Large VSD:
- HF = diuretics +/- captopril
- Additional calories
- surgery at 3-6m:
- prevent permanent damage from pHTN and high blood flow (Eisenmenger)
- manage HF and faltering growth

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5
Q

PDA

A

Closure to remove lifelong risk of bacterial endocarditis and pulmonary dx
Closed medically using indomethacin or other NSAIDs
Can be closed using coil at 1yr age

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6
Q

Cyanotic dx dependent on PDA (e.g. TGA)

A

Keep PDA open until corrective surgery performed

start prostaglandin infusion to keep open PDA

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7
Q

Congenital cyanotic heart disease

A

Ix: O2 sats, ABG, echo, CXR, hyperoxia test
ABCDE
Start prostaglandin infusion (5ng/kg/min) , most infants w/cyanotic dx presenting in first week are duct dependent
Maintaining patency key to survival
Prostaglandin maintain patency
SE: apnoea, jitteriness, seizures, flushing, vasodilation, hypotension
IV broad spec ABx

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8
Q

Tetralogy of Fallot

A

Initially medical Mx w/surgery at 6mo
Surgery: closing VSD and relieving RV outflow obstruction
Very cyanosed: shunt
Hypercyanotic spells are usually self limiting and followed by period of sleep

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9
Q

Shunt in TOF

A

Connect tube between subclavian art and pulmonary art or by balloon dilatation of RV outflow tract

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10
Q

Mx of prolonged hypercyanotic spells in TOF

A

Sedation and pain relief - morphine
IV propranolol (peripheral vasocontrictor, relieving sub-pulmonary muscle obstruction)
IV volume administration
Bicarb to correct acidosis
Muscle paralysis and Artificial ventilation to reduce O2 demand

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11
Q

Transposition of the great arteries

A

In sick cyanosed neonate improve mixing
Prostaglandin infusion
Balloon atrial septostomy may save life
ALL pts require surgery (arterial switch in neonatal period including coronary attachment)

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12
Q

Balloon atrial septostomy

A

breaks valve of foramen ovale to causing mixing of blood

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13
Q

Tricuspid atresia

A

Early palliation to maintain blood to lungs and low pressure
- blalock-taussig shunt (subclav.+pulm. arteries)
- pulmonary banding if breathless
Complete corrective surgeryn not possible in most cases bc only one functioning ventricle
Operations can be performed to connect I/SVC to pulmonary artery

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14
Q

Aortic stenosis in children

A

regular echo monitoring
balloon valvulotomy if high resting pressure gradient or Sx on exercise
most will need replacement if significant stenosis

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15
Q

Pulmonary stenosis in children

A

If gradient across pulmonary valve >64mmHg then interene

transcatheter balloon dilatation

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16
Q

Coarctation of the aorta

A

surgical repair

17
Q

Hypoplastic LH syndrome

A

surgery (norwood procedure)

18
Q

Supraventricular tachycardia

A

Prompt resortation of sinus rhythm key to improvement
Circ+Resp support:
- correct tissue acidosis
- positive pressure ventilation needed
Vagal stimulation manoeuvres
IV adenosine
If fails: synchronised DC shock
Once sinus restored give maintenance therapy (fleicainide or sotalol)
90% of children will have no further attacks
Children who do relapse treated w/percutaneous radiofrequency ablation of cryoablation of accessory pathway

19
Q

Rheumatic fever

A

Acute rheumatic fever treated w/bed rest and anti-inflammatory agents
- aspirin effective at suppressing inflammation in heart and joints HIGH dose
Anti-streptococcal Abx (penicillin V, benzathine benzylpenicilin, amoxicillin)
consider corticosteroids
Sx relief of HF w/diuretics and ACEi
Prevent recurrence

20
Q

Preventing recurrence in rheumatic fever

A

proph. monthly benzathine penicillin
Alternative: PO penicillin OD
Most recommend prophylacis either 10y after the last episode of acute RF or until age of 21
Lifelong proph. recommended for sev. vascular disease
Surgical Mx w/valve repair or replacement may be req.

21
Q

Infective endocarditis in children

A

Approach: MDT (cardio, surgeons, ID, neuro, micro)
50% will req. surgery
Empirical Abx - consult ID

22
Q

IE of native valves

A

Penicillin sensitive strep viridans = beta-lactam (benzylpenicillin, ampicillin, ceftriaxone, amox) +/- gentamicin or vancomycin
Methicillin-sensitive Staph. aureus = beta-lactam or vanc or daptomycin or cotrimox AND clindamycin

23
Q

Prosthetic valves IE

A

Penicillin sensitive Strep viridans = betalactam +/- gentamicin
Methicillin sensitive S aureus = nafcillin OR oxacillin OR cefazolin OR vanc AND rifampicin AND gentamicin
?surgery

24
Q

Rx course in IE

A

6 weeks

25
Q

Prophylaxis against IE

A

Good dental hygiene
avoid piercings tattoos
Abx proph. no longer recommended

26
Q

Innocent murmurs

A

Ejection murmur: turbulent outflow
Venous hum: turbulent flow in great veins (countinuous blowing below clavicles)
Still murmur: low pitched sound at LSE

27
Q

ejection murmur common features

A 
Soft blowing in pulmonary area or short buzzing in aortic
some vary w/posture
localised no radiation
No diastolic component
No thrill
No added sounds
asymptomatic

Paeds (23 decks)

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