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Paediatrics > Cardio > Flashcards

Cardio Flashcards

1
Q

How common are congenital cardiac abnormalities?

A

1-2% of the population. 8:1000 are significant

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2
Q

What are the different ways congenital cardiac disease can present? What are some cardiac?

A
  • Cyanotic (right to left shunt): Tetralogy of Fallot, TGA
  • Acyanotic/breathless (left to right): VSD, PDA, ASD
  • Outflow obstruction (asymp/collapse): PS, AS, coarctation
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3
Q

What are some causes of congenital cardiac disease? Which CHD they classically associated with?

A

Chromosomal abnormality:

  • Down’s (30%): VSD, AVSD
  • Edwards + Patau: complex
  • Turner’s (15%): bicuspid aortic valve (AS), coarctation
  • DiGeorge (80%): aortic arch anomaly, ToF
  • Noonan: HOCM, ASD

Maternal factors:

  • Rubella: PS, PDA
  • SLE: complete heart block
  • Warfarin, alcohol, DM
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4
Q

What is the common cardiac defect in Down’s?

A

VSD, AVSD

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5
Q

What is the common cardiac defect in Turners?

A

Bicuspid aortic valve causing AS, coarctation

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6
Q

Describe the changes that occur in the fetal circulation at birth

A

At birth, liquid out of lungs -> decreased intrathoracic pressure -> decreased resistance in pulmonary vessels -> increased blood flow
Decrease R sided pressures and increased left sided (due to return from pulmonary) -> closure of foramen ovale
After several days: PDA closes

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7
Q

What are some features of innocent murmurs?

A
  • Soft, blowing
  • Left sternal edge
  • Systolic
  • No systemic features (breathlessness, cyanosis)
  • Normal pre and post-ductal sats
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8
Q

What are some causes of innocent murmurs?

A
  • Anaemia

- Infection/illness

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9
Q

How does heart failure present in children?

A

SOB (worse on feeding/exertion), poor feeding, sweating

Poor weight gain, ^HR and RR, murmur, enlarged heart, hepatomegaly

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10
Q

What are some causes of heart failure in children?

A

Neonates- obstruction eg coarctation. Also AVSD
Infants- left-to-right shunt eg VSD, large PDA
Children- Eisenmenger, RHD, cardiomyopathy

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11
Q

Why can coarctation cause collapse in the first few days of life? What is the term that is used for this type of condition? What is the treatment?

A

Severe obstruction means arterial perfusion is supplied by the DA. Closure occurs in the first few days of life -> rapid worsening + decreased flow
This is called duct-dependent circulation, and treatment is to maintain the DA with prostaglandins

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12
Q

What is Eisenmenger syndrome? What causes it?

A

A complication of untreated left-to-right shunt, where high flow through the pulmonary vessels causes pulmonary hypertension -> eventual reversal of the shunt -> cyanosis.
Caused by VSD, ASD, PDA

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13
Q

A newborn boy becomes cyanotic after several hours. Saturations are 88%. What is the initial management?

A

ECG and CXR

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14
Q

What are the signs of ASD on examination and CXR?

A

Examination:
Ejection systolic murmur at upper left sternal edge (due to high flow across pulmonary valve)
Fixed and widely split S2

CXR:
Cardiomegaly
Pulmonary oedema, enlarged arteries

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15
Q

What is the best investigation for diagnosing CHD?

A

Echo

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16
Q

What are the types of ASD? How are they managed?

A
  • Secundum (most): hole in middle of the septum. Cardiac catheterisation later in childhood
  • Primum, part of partial AVSD: assoc with Down’s. Surgical correction later in childhood.
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17
Q

What is a small VSD?

A

<3mm

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18
Q

How does a VSD present?

A

Small: asymptomatic

  • Pansystolic murmur, lower left sternal edge
  • Quiet P2

Large: cause heart failure, recurrent chest infection

  • Soft pansystolic murmur, apical mid-diastolic murmur
  • Loud P2
  • CXR shows cardiomegaly, pulm oedema, enlarged arteries
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19
Q

How is VSD managed?

A

Small: allow spontaneous closure
Large: surgical correction at 3-6 months. Treat heart failure with diuretics.

20
Q

Define PDA. What is the main risk factor?

A

Failure of the DA to close after 1 month from the expected delivery date. Prematurity

21
Q

What are the signs of PDA?

A

Bounding pulse
Continuous machine-like murmur
Possible heart failure in very severe cases

22
Q

What is the management of PDA?

A

PG inhibitors eg. indomethacin

Cardiac catheterisation + occlusion at 1 year

23
Q

How is cyanotic heart disease investigated?

A
  • Hyperoxia test: place baby in chamber with 100% O2 for 15 mins. Cyanotic- still low saturation on ABG
  • CXR: exclude lung disease
  • ECG
  • Echo
24
Q

What is the acute management of cyanotic neonates?

A

A-E

Start prostaglandin infusion (keep DA open)

25
Q

What are the morphological features of Tetralogy of Fallot?

A
  • Large VSD
  • Overriding aorta
  • RV outflow tract obstruction eg. PS
  • Right ventricular hypertrophy
26
Q

How does Tetralogy of Fallot present?

A
  • Cyanosis with hypercyanotic/’Tet’ spells (blue, crying, irritable, SOB with feeding)
  • Squatting on exercise (to improve venous return)
27
Q

What are the signs of Tetralogy on exam + CXR?

A

Exam:

  • Loud ejection systolic murmur left sternal edge
  • Single S2

CXR:

  • ‘Boot’ shaped heart, small
  • Pulmonary artery ‘bay’
28
Q

Describe the management of Tetralogy

A

Surgery at 6 months to close VSD and open RVOT

  • May need balloon dilatation in early life to relieve cyanosis
  • Prolonged Tet spells may need propranolol
29
Q

Describe the pathophysiology of TGA

A

The aorta arises from the RV and the pulmonary artery from the LV -> two separate circulations
Often co-existing defect eg. ASD, VSD that allows mixing

30
Q

How does TGA present? What are the signs?

A

Early life with severe cyanosis (esp after DA closure)
Exam: Loud and single S2, no murmur
CXR: Egg on side heart, increased pulm vessels

31
Q

What is the management of TGA?

A
  • Improve mixing with prostaglandin infusion
  • Balloon atrial septostomy (Rashkind) to allow mixing
  • Surgery within several weeks of life
32
Q

What is the pathophysiology of tricuspid atresia?

A

Complete absence of the tricuspid valve -> non-functioning RV
Cyanosis/SOB

33
Q

What are some symptoms of aortic stenosis?

A

Reduced exercise tolerance
Syncope
Chest pain

34
Q

What are some signs of aortic stenosis?

A

Ejection systolic murmur upper L sternal edge
Slow-rising pulse
Carotid thrill
Soft A2

35
Q

What are some signs of pulmonary stenosis?

A

Widely split S2, soft P2

Systolic ejection click/murmur over upper L sternal edge

36
Q

What are some signs/symptoms of coarctation?

A

Neonatal collapse (preductal)
Absent/weak femoral pulses
Hypertension in the R arm, ejection systolic murmur, continuous murmur on back

37
Q

What is the most common type of arrhythmia in children?

A

SVT

38
Q

What is the management of SVT?

A

1st: vagal manouvres eg. carotid massage
2nd: IV adenosine
3rd: cardioversion eg. DC, flecainide

39
Q

In a child with syncope, what features from the history would make you worried about a cardiac cause?

A
  • Not caused by an emotional stressor
  • Exercise-induced
  • Hx of palpitations
  • FHx of sudden cardiac death
40
Q

What are the features of acute rheumatic fever?

A 
Major criteria:
Polyarthritis
Erythema marginatum 
Subcut nodules
Pancarditis: endo, myo, peri 
Sydenham chorea
Minor: 
Fever
Polyarthralgia
Raised acute phase proteins
Prolonged PR interval
41
Q

What is the management of rheumatic fever?

A

Rest + high dose aspirin
Prevent recurrence with monthly IM benzathine penicillin for 10 years
Surgical repair of valves

42
Q

Which CHD types predispose to infective endocarditis?

A

Tetralogy, TGA, VSD, PDA and bicuspid aortic valves. Also anything with prosthetic materials

43
Q

How does infective endocarditis present?

A 
High fever
New/changed murmur
Malaise
Splinter haemorrhages
Janeway lesions
Roth's spots
Neuro signs
Splenomegaly

Anaemia
Raised ESR/CRP
Haematuria

44
Q

What is the most common causative organism of infective endocarditis?

A

Most common: Strep viridans

45
Q

What is the management of infective endocarditis?

A

Blood cultures!!!
Involve MDT of cardio, ID, neuro, surgeons
Initiate sepsis 6
IV broad spectrum antibiotics eg. beta-lactam +/- gent/vanc for 6 weeks

46
Q

Describe BLS for children

A
  • Check for safety, call for help
  • Airway: head tilt chin lift
  • Breathing: check for 10s. Give 5 rescue breaths
  • Circulation: check for 10s. Start compressions 15:2

Paediatrics (13 decks)

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