Cardiac scenarios

Question 1

Case 1

The Blue Baby

Call from ED to assess a 2-day-old baby who presented looking dusky.

Baby alert, active, dusky all over, HR 160,RR 70,sats 82% in air, no grunting, minimal recession, no heart murmur, no heaves/thrills and abdo soft

Answer 1

Normal HR - 110 to 160
Normal RR -30 to 40
Normal sats - 95-100%

DDx - structure defects
Transposition of the great arteries

could be inhaled foregin body ( but will have breathing struggle so no resp causes)

Question 2

Differential diagnosis ?

Answer 2

Pulmonary cause - Pneumothorax
Diaphragmatic hernia
Pneumonia

Congenital Heart disease

Persistent Pulmonary Hypertension

Hypoventilation
Sepsis
Hypoglycaemia

Question 3

What is the next step management?

Answer 3

Assess ABC

Facial oxygen - no improvement in saturation

IV access

Monitoring

Check blood glucose

ECG

ECHO

Question 4

What test is required for hypoxic pt?

Answer 4

ABG or blood gas in neonates

Blood culture
Hyperoxia test

Question 5

What medications would you offer?

Answer 5

abx such as benzylpenicillin and gentamycin

Prostin if we want to keep the ductus arteriosus patent open and start if concerned about cardiac lesion

Question 6

What are the SD of Prostin?

Answer 6

Apnoea
Hypotension
Tachycardia

Question 7

What is the Diagnosis ?

Answer 7

TGA
Balloon atrial
Septostomy
Arterial Switch

Question 8

Case 2

The breathless baby

Question 9

What is Acquired Heart Disease ?

Answer 9

Kawasaki Disease is a common cause of acquired heart disease. The cause is still unknown and affects children < 5 years of age.

Common in East Asian Descent

Question 10

What is the diagnostic criteria for Kawasaki disease?

Answer 10

Fever for 5 days or more

Polymorphous rash

Bilateral conjunctival (dry)injection

Mucous Membrane changes -strawberry tongue

Peripheral extremity changes - skin starts peeling

Cervical Lymphadenopathy

Question 11

Pneumonic for Kawasaki ?

Answer 11

Warm CREAM

Question 12

What is the management of Kawasaki?

Answer 12

IV immunoglobulin single infusion 2g/kg given over 12 hours

Aspirin higher doses initially (QDS for 2 weeks) and

Children are treated with immunoglobulins should have immunisations with live vaccines e.g MMR
delayed for 3-11 months after treatment

Question 13

What is the complication of Kswaksi ?

Answer 13

They could get coronary artery aneurysms

Question 14

What is Rheumatic Fever?

Answer 14

Caused by Group A streptococcal infection

affects the joints, skin, heart and nervous system

recurrent occurs mostly often in the first 5 years after the initial episode

Question 15

What are the symptoms of Rhematic fever?

Answer 15

Appear between 1 and 5 weeks after the onset of a sore throat, onset faster in recurrent cases

Question 16

Which criteria do you follow for rheumatic fever?

Answer 16

JONES

Evidence of recent streptococcal infection – hx of scarlet fever, a positive throat swab or a raised ASOT tire >200 U/ml or Dnase B titre
Plus 2 major criteria or
1 major AND 2 minor criteria

Question 17

What is the investigation of Rheumatic fever ?

Answer 17

Check for antistreptococcal antibody levels 2 weeks apart for a rise
Generally, the antibodies rise during the first month after infection and then plateau for 3-6 before returning to normal levels at 6-12 months
Throat swabs usually negative by the time symptoms of RF appear
ECG and Doppler Echo

Question 18

What is the management of Rheumatic fever ?

Answer 18

Bed rest!
IM benzathine penicillin (or Azithromycin) to eradicate streptococcal infection
Aspirin to relieve the arthritis (consider other NSAIDs)
Treat the heart failure and mitral valve repair if required
Chorea is usually self-limiting but diazepam can be used