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Child Health > Cardiac Problems > Flashcards

Cardiac Problems Flashcards

1
Q

What are the symptoms of cardiac disease in an infant?

A 
Breathlessness
Difficulty feeding
Poor weight gain
Sweating with feeding
Cyanosis
Collapse
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2
Q

What are the features of an innocent heart murmur?

A

Systolic (diastolic is never innocent)
Low intensity
Asymptomatic
Often loudest at left sternal edge but may be elsewhere (e.g. venous hum)

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3
Q

Which type of cardiac defects are more likely to present with neonatal collapse?

A

Duct-dependent lesions

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4
Q

What is the difference between systemic and cyanotic duct dependent lesions?

A

Systemic:

  • severe obstruction of blood flow out of left side of heart
  • systemic circulation dependent on PDA

Cyanotic:
- obstruction to pulmonary blood flow OR lack of oxygenation of systemic blood

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5
Q

Which conditions are systemic duct dependent lesions?

A

Hypoplastic left heart syndrome
Critical aortic stenosis
Interrupted aortic arch (or severe coarctation)

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6
Q

Which conditions are cyanotic duct dependent lesions?

A

Transposition of the great arteries

Pulmonary atresia with intact septum

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7
Q

What are the features of an atrial septal defect (ASD)?

A 
SOB, cyanosis, haemoptysis
Chest pain
Ejection systolic murmur in pulmonary area
Split S1, wide fixed split S2
Pulmonary hypertension
Raised JVP
AF
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8
Q

How is ASD diagnosed?

A

Echo

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9
Q

What would be seen on ECG and CXR in ASD?

A

ECG: right axis deviation, RBBB
CXR: cardiomegaly, prominent pulmonary artery

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10
Q

How is ASD managed?

A

Surgical closure - open or trans catheter

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11
Q

What are the features of a VSD?

A

Harsh pan systolic murmur at left sternal edge
CHF: tachycardia, SOB, hepatomegaly
Systolic thrill
Parasternal heave

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12
Q

How is a VSD diagnosed?

A

Echo

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13
Q

What would be seen on ECG and CXR in VSD?

A

ECG: LVH signs
CXR: cardiomegaly, large pulmonary arteries

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14
Q

How is a VSD managed?

A

Initially medical as may close spontaneously:
- diuretics for HF
- ACE inhibitors to reduce afterload
Surgical closure if unsuccessful/complications

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15
Q

What are the complications of VSD?

A

Aortic regurgitation
Infective endocarditis
Eisenmenger’s –> shunt reversal + cyanosis

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16
Q

What is coarctation of the aorta?

A

Narrowing of the descending aorta –> LV pressure overload, CHF, HTN and hypo perfusion of lower body

17
Q

What are the clinical features of coarctation of the aorta?

A

Raised BP
Radio-femoral delay +/- weak femoral pulse
Systolic murmur in left intraclavicular area + below left scapula
Early heart failure if severe

18
Q

What might be seen on CXR in coarctation of the aorta?

A

CHF

Rib notching

19
Q

How is coarctation of the aorta diagnosed?

A

Echo

If unclear –> CT or MRI

20
Q

How is coarctation of the aorta managed?

A

Surgery:

  • indications: CHF or severe HTN
  • -> open angioplasty or balloon angioplasty with stenting
21
Q

What are the features of a PDA?

A 
Asymptomatic or SOB + poor feeding in infancy
Continuous machine like murmur
Left subclavicular systolic thrill
Displaced, heavy apex beat
Collapsing pulse and wide pulse pressure
22
Q

How is PDA diagnosed?

A

Echo

23
Q

How is PDA managed in a preterm infant?

A

Treat if symptomatic:

  • IV NSAIDs (first line)
  • surgical ligation (second line)
24
Q

What is the most common congenital heart defect?

A

VSD

25
Q

What are the risk factors for VSD?

A 
Maternal diabetes
Maternal rubella
Foetal alcohol syndrome
Uncontrolled maternal PKU
Family history of VSD
Trisomy 21, 13 and 18
26
Q

What are the complications of VSD?

A

Endocarditis

27
Q

What are the four features of Tetralogy of Fallot?

A

VSD
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta

28
Q

What are the risk factors for TOF?

A 
Males
Family history of CHD
Teratogens:
- alcohol
- warfarin
- trimethadione (anti epileptic)
Genetics:
- CHARGE syndrome
- Di George syndrome
- VACTERL association
29
Q

What are the features of CHARGE syndrome?

A 
Coloboma
Heart defects
Atresia choanae
Retardation of growth/development
Genitourinary anomalies
Ear anomalies
30
Q

What are the features of VACTERL?

A 
Vertebral anomalies
Anorectal malformation
Cardiac defects
Tracheo-oesophageal fistula
Renal anomalies
Limb malformations
31
Q

What are the clinical features of TOF?

A 
Poor growth
SOB including acute hypoxic episodes
Cyanosis + clubbing
Ejection systolic murmur
Toddlers may squat to increase peripheral resistance and hence reduce right --> left shunt
32
Q

How is TOF diagnosed?

A

Echo

33
Q

What might be seen on CXR in TOF?

A

Boot shaped heart

34
Q

How is TOF managed?

A 
Surgery by 1 year (earlier if severe)
Medical therapy until then if symptomatic:
- oxygen
- morphine
- beta blockers
- prostaglandins to keep ducts open
35
Q

What is transposition of the great arteries?

A

Aorta + pulmonary artery the wrong way round

36
Q

What are the features of transposition of the great arteries?

A

Cyanosis in first 24 hours of life
Prominent right ventricular heave
Systolic murmur if VSD present
No signs of respiratory distress

37
Q

How is transposition of the great arteries diagnosed?

A

Echo

38
Q

What does transposition of the great arteries look like on CXR?

A

‘Egg on a string’

39
Q

How is transposition of the great arteries managed?

A

Initial:
- emergency prostaglandin to keep ductus arteriosus open
- correct metabolic acidosis
- atrial balloon septostomy to allow mixing
Definitive:
- surgical correction, usually before 4 weeks

Child Health (16 decks)

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