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paediatrics > cardiac disorders > Flashcards

cardiac disorders Flashcards

1
Q

causes of a left-to-right shunt?

A
  • VSD
  • ASD
  • PDA
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2
Q

presentation of left-to-right shunt?

A

breathless

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3
Q

causes of a right-to-left shunt?

A
  • ToF

- TGA

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4
Q

presentation of a right-to-left shunt?

A

blue

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5
Q

a) how does AVSD present?

b) why?

A

a) blue and breathless

b) blood from both ventricles is mixing

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6
Q

causes of outflow obstruction in a WELL child?

A
  • PS

- AS

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7
Q

cause of outflow obstruction in a sick neonate?

A

CoA

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8
Q

which cardiac conditions can a maternal rubella infection cause?

A
  • peripheral pulmonary stenosis

- PDA

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9
Q

cardiac presentation in child where there is maternal SLE?

A
  • complete heart block
  • anti-Ro
  • anti-La
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10
Q

which cardiac conditions can maternal warfarin therapy cause?

A
  • pulmonary valve stenosis

- PDA

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11
Q

which cardiac conditions can foetal alcohol syndrome cause?

A
  • ASD
  • VSD
  • ToF
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12
Q

congenital heart diseases seen in Down syndrome?

A
  • AVSD

- VSD

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13
Q

immediate management in duct-dependent cyanosis?

A

prostaglandin!!!

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14
Q

causes of ejection systolic murmur?

A
  • AS
  • ASD
  • PS
  • HOCM
  • ToF
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15
Q

causes of pansystolic murmur?

A
  • MR
  • TR
  • VSD (‘harsh’)
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16
Q

causes of a late systolic murmur?

A
  • MV prolapse

- CoA

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17
Q

causes of an early diastolic murmur?

A
  • AR

- PR

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18
Q

cause of continuous murmur?

A

PDA

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19
Q

which conditions could bring on an innocent murmur?

A
  • febrile illness

- anaemia

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20
Q

4 Ss of an innocent murmur?

A
  • soft blowing
  • systolic only
  • sternal edge (left)
  • symptomless (pt is asymptomatic)
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21
Q

presentation of heart failure?

A
  • breathlessness
  • sweating
  • poor feeding (and FTT)
  • recurrent chest infections
  • tachypnoea
  • tachycardia
  • hepatomegaly
  • cool peripheries
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22
Q

character of murmur heard in heart failure?

A

galloping rhythm

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23
Q

causes of right-sided heart failure?

A
  • pulmonary hypertension
  • long-standing rheumatic fever
  • tricuspid regurgitation
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24
Q

signs of right heart failure?

A
  • ankle oedema
  • sacral oedema
  • ascites
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25
Q

commonest cause of heart failure in neonate?

A
  • coarctation of the aorta
  • severe aortic stenosis
  • any other left ventricular outflow obstruction
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26
Q

causes of heart failure in infants?

A
  • high pulmonary blood flow
  • VSD
  • ASD
  • large PDA
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27
Q

causes of heart failure in older children?

A
  • eisenmenger syndrome (right sided only)
  • rheumatic heart disease
  • cardiomyopathy
28
Q

normal O2 sats for an infant?

A

> 93%

29
Q

infectious cause of cyanosis with respiratory distress in neonate?

A

septicaemia following GBS infection

30
Q

presentation of congenital heart disease?

A
  • antenatal ultrasound finds increasing proportion
  • murmur
  • cyanosis
  • heart failure
  • left-to-right shunt usually
  • shock
31
Q

character of murmur in a small VSD?

A
  • loud, pansystolic murmur at lower left sternal edge

- louder = smaller defect!

32
Q

management of a small VSD?

A
  • none
  • they close spontaneously
  • follow up shows that murmur has disappeared
33
Q

main complication of a small VSD?

A
  • bacterial endocarditis

- keep good dental hygiene

34
Q

age at presentation of large VSD?

A

> 1 week old

35
Q

features of large VSD?

A
  • heart failure with breathlessness
  • FTT
  • recurrent chest infections
  • hepatomegaly
  • tachypnoea
  • tachycardia
  • active precordium
36
Q

character of murmur in large VSD

A
  • soft pansystolic murmur

- no murmur = very big VSD!

37
Q

commonest type of ASD?

A

secundum ASD

38
Q

features of ASD?

A
  • asymptomatic
  • recurrent chest infections / wheeze
  • arrhythmia (in 40s)
  • murmur
39
Q

what is heard in auscultation in ASD?

A
  • ejection systolic mumur
  • loudest at upper left sternal edge
  • fixed, split S2 sound
40
Q

character of murmur in a partial AVSD?

A

apical pansystolic

41
Q

signs on CXR of ASD?

A
  • cardiomegaly
  • enlarged pulmonary arteries
  • increased pulmonary vascular markings
42
Q

signs on ECG in secundum ASD?

A
  • partial right bundle branch block

- right axis deviation

43
Q

gold standard investigation for ASD?

A

echocardiography

44
Q

management of

a) secundum ASD?
b) partial AVSD?

A

a) cardiac catheterisation

b) surgery at 3-5 years (to prevent RSHF)

45
Q

purpose of nitrogen washout test?

A

to determine if cyanosed neonate has congenital heart disease

46
Q

describe the nitrogen washout test

A
  • neonate placed in 100% O2 for 10 mins
  • if right radial arterial PaO2 <15kPa, then cyanotic heart disease (ToF, TGA)
  • BUT must exclude pulmonary hypertension first
47
Q

management of right-to-left shunt?

A
  • ABCs

- prostaglandin infusion 5ng/kg/min

48
Q

commonest cyanotic congenital heart disease?

A

tetralogy of Fallot

49
Q

4 cardinal features of ToF?

A
  • large VSD
  • overriding aorta
  • RVOTO
  • RV hypertrophy (last sign)
50
Q

symptoms of ToF?

A
  • murmur in first 2m of life
  • severe cyanosis
  • clubbing of fingers and toes (older children)
51
Q

character of murmur heard in ToF?

A
  • loud, harsh ejection systolic
  • left sternal edge
  • from day 1 of life
52
Q

signs on CXR of ToF?

A
  • boot-shaped heart
  • right-sided aortic arch
  • pulmonary artery “bay”
  • decreased pulmonary vascular markings
53
Q

ECG changes in ToF?

A
  • normal at birth

- RVH when older

54
Q

management of ToF?

A
  • surgery at 6 months
  • closes VSD
  • artificial patch can be put across pulmonary valve
55
Q

management of hypercyanotic spells in ToF?

A
  • most are self-limiting
  • if lasts >15 mins, give morphine
  • then IV propanolol
  • bicarbonate (corrects the acidosis)
56
Q

what is the artery set up in TGA?

A
  • aorta comes out of RV
  • PA comes out of LV
  • O2 blood going to lungs, de-O2 blood going to body
  • no mixing, two parallel circuits
57
Q

symptoms of TGA?

A
  • cyanosis
  • loud, single S2
  • may be a systolic murmur
58
Q

X-ray signs in TGA?

A
  • cardiac shadow looks like “egg on side”

- increased pulmonary vascular markings

59
Q

ECG in TGA?

A

normal

60
Q

management of TGA infant?

A
  • maintain the ductus arteriosus with prostaglandins

- balloon atrial septostomy

61
Q

explain eisenmenger syndrome

A
  • happens following a L-to-R shunt
  • pulmonary arteries eventually get stenosed
  • they get more resistant to flow
  • leads to pulmonary HTN
  • shunt reverses (R-to-L)
  • 10-15 years of age
  • before shunt reverses, their symptoms get eased
62
Q

a) conditions with common mixing?

b) presentation?

A

a) complete AVSD, tricuspid atresia

b) blue and breathless

63
Q

which condition is complete AVSD most associated with?

A

Down syndrome

64
Q

ECG finding in complete AVSD?

A

superior axis

65
Q

presentation of complete AVSD in neonate?

A
  • cyanosis

- heart failure at 2/3 weeks of age

66
Q

management of complete AVSD?

A
  • treat the heart failure

- surgical repair at 3-6 months

paediatrics (10 decks)

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