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Paeds > Cardio > Flashcards

Cardio Flashcards

1
Q

What are patients with VSD most at risk of

A

Endocarditis

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2
Q

What is transposition of the great arteries

A

Transposition of the great arteries (TGA) is a form of cyanotic congenital heart disease. It is caused by the failure of the aorticopulmonary septum to spiral during septation. Pulmonary artery is supplied by the LV and vice versa. Incompatible with life except for with PDA

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3
Q

How does transposition of the great arteries present

A

Cyanosis
Tachypnoea

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4
Q

What are prominent right ventricular impulse and loud single S2 seen in

A

transposition of the great arteries

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5
Q

Management of transposition of the great arteries

A

Maintain patent ductus arteriosus with prostaglandins
Balloon atrial septoplasty
Arterial switch surgical correction is definitive

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6
Q

What are the 4 features of tetralogy of fallot

A

Pulmonary stenosis
Leads to RV hypertrophy and right sided outflow obstructions
VSD which leads to eisenmenger syndrome as RV hypertrophy increases pressure to greater than LV
Overriding aorta

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7
Q

How dos tetralogy of fallot present

A

Typically around 2 months unlike other cyanotic heart conditions which present at birth
Tet spells where child is feeding/crying causes spasms of infundibular septum causing cyanosis and tachypnoea may even LOC
Squatting improves symptoms

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8
Q

What are the 3 cyanotic heart disease

A

Tetralogy of fallot
Tricuspid atresia
Transposition of great arteries

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9
Q

Pathophysiology of tricuspid atresia

A

Valve malformed or does not form at all
Incompatible with life unless ASD and VSD

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10
Q

What has egg on side X ray appearance

A

transposition of the great arteries

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11
Q

What determines the severity of tetralogy of fallot

A

Extent of pulmonary stenosis

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12
Q

Murmur in tetralogy of fallot

A

ESM louder on inspiration heard at left sternal edge- VSD tends to not present with murmur

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13
Q

CXR finding of tetralogy of fallot
ECG finding

A

CXR- boot shape
ECG- RVH

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14
Q

Management of tetralogy of fallot

A

Acutely prostaglandins to maintain PDA
If severe cyanotic episodes (over 15mins) where lose consciousness
- sutgical intervention where blood goes to lungs- BT shunt or RV balloon dilatation
- can use propanolol
Corrective surgery from 4 months onwards

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15
Q

Management of tricuspid atresia

A

Balock taussig shunt
Corrective surgery but is very difficult as only one functioning ventricle
Glenn operation then fontan
GF

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16
Q

Murmur in tricuspid atresia

A

ESM heard loudest at lower left sternal edge

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17
Q

What cardiac anomaly is downs associated with

A

ASVD

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18
Q

How is ASVD normally picked up

A

Routine echo for downs
Week 2-3 get cyanosis if not

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19
Q

Managment of ASVD

A

Treat heart failure and then corrective surgery at 3 months

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20
Q

What is point of balock taussig shunt

A

In cyanotic heart conditions like TOF and tricuspid atresia is lack of blood flow to lungs so this provides them with supply to oxygenate the blood

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21
Q

Murmur in ASD

A

Ejection systolic left sternal edge
Fixed splitting of S2

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22
Q

What are 2 types of ASD

A

Most common -Secundum where foramen ovale does not close
Primum- defect in AV septum

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23
Q

Management of the 2 types of ASD

A

Observation as will close spontaneously often
Manage if
- ratio of pulmonary to systemic blood flow ratio over 1.5
- right ventricular dilation
- symptomatic
Secundum- catheterisation and insertion of occlusive devise
Primum- corrective surgery

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24
Q

Presentation of ASD

A

Typically asymptomatic but can get recurrent infection, SOB

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25
Q

How are VSDs classified

A

Small (<3mm)
Large (>3mm)

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26
Q

How do small versus large VSD present

A

Small- SOB with normal saturations, abnormal feeding, tired
Large- HF, recurrent infections, hepatomegaly

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27
Q

Management of small versus large VSD

A

Small
- will correct naturally but monitor with echos
Large- need to prevent eisenmenger syndrome
- CDC
- increase calories, diuretics(furosemide) and catopril
- corrective surgery at 3-6 mths

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28
Q

Which type of VSD is endocarditis more common

A

Small

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29
Q

If have cyanosed baby what test determines if cyanotic HD

A

Hyperoxia test- give 10L for 10mins
Measure oxygen in blood gas of right arm, if stays below 15pa then cyanotic HD if have excluded lung disease and persistent pulomanry hypertension of the newborn

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30
Q

Complications of VSD

A

aortic regurgitation
infective endocarditis
Eisenmenger’s complex
right heart failure

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31
Q

Syndromes associated with VSD

A

Downs
Edward’s syndrome
Patau syndrome
cri-du-chat syndrome

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32
Q

What causes closure of ductus arteriosus

A

High oxygen

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33
Q

Risk factors for patent ductus arteriosus

A

Pre-term
Low oxygen ( born at high altitude, lung problems etc)
Maternal rubella infection during 1st trimester

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34
Q

Management of patent ductus arteriosus

A

Should close by 1 month
- indomethacin post natally
- surgical ligation at 1 year if indomethacin fails to close it

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35
Q

Signs and symptoms of PDA

A

Symptoms
- Often asymptomatic as should shut by 1 month post partum
- SOB, bradycardia and needs O2
Signs
- machine like murmur over ULSE
- heaving apex beat
- wide pulse pressure
- bounding pulse

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36
Q

What is the name of PDA murmur

A

Gibsons

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37
Q

What is eisenmenger syndrome and what causes it

A

Eisenmenger occurs in initial L->R shunts where the increased blood flow to pulmonary circulation results in vascular remodelling in the lungs. As such this causes pulmonary hypertensions which causes hypertrophy of RV- this then increases afterload of pulmonary circulation and can become greater than that of left side which reverses shunt. Then get cyanotic heart disease

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38
Q

Management of eisenmenger syndrome

A

Heart and lung transplant

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39
Q

How to distinguish innocent murmurs from pathological

A

InnoSent- 5 s’s
Asmypomatic
Silent
Left sternal edge
Soft blowing
Systolic only
Often occur in illness like infections when younger so check for fever etc
Also varies with posture

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40
Q

Symptoms of HF in infants

A

Breathless
Sweating
Feeding
Recurrent chest infections

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41
Q

Signs of HF

A

Poor weight gain
Tachypnoea
Tachycardia
Heart murmur
Enlarged heart
Hepatomegaly
Cool peripheries

42
Q

Causes of HF in neonates

A

Typically from obstructed systemic circulation
- hypoplastic left heart syndrome
- critical aortic valve stenosis
- severe aortic coarctation

43
Q

Causes of HF in infants

A

VSD
AVSD
Large PDA

44
Q

Causes of HF in older children

A

Eisenmenger syndrome
Rheumatic fever
Cardiomyopathy

45
Q

What causes cyanosis in an infant

A

Cyanotic heart disease
Respiratory disorders- surfactant deficiency, meconium aspiration, pulmonary hypoplasia
Peristent pulmonary hypertension of the newborn
Infection

46
Q

Causes of outflow obstruction

A

Pulmonary stenosis
Aortic stenosis
Aortic coarctation- most common

47
Q

How does aortic stenosis present

A

Moderate- SAD (syncope, angina, dyspnoea)
Severe- severe heart failure with shock in neonates

48
Q

Signs of aortic stenosis

A

Carotid thrill
ESM radiating to the neck
Slow rising pulse

49
Q

Management of aortic stenosis

A

Balloon valvulotomy
If needed transcatheter aortic valve replacement

50
Q

What are the 2 types of aortic coarctation

A

Infantile- proximal to DA
Adult- distal to DA

51
Q

Presentation of aortic coarcation

A

Asymptomatic could be
Infants- collapse on second day of life onwards when DA closes

52
Q

Examination findings of aortic coarctation

A

High blood pressure in arms but low in legs
Systolic murmur heard loudest in the back

53
Q

Management of aortic coarctation in infants

A

ABC and prostaglandin to open DA
Balloon repair or surgery

54
Q

What is hypoplastic left syndrome

A

Underdevelopment of the whole left side of heart- present the sickedt of all congenital heart conditions

55
Q

Difference between hypoplastic left heart syndrome and coarctation of aorta

A

Absent pulses in all peripheries- HLHD
Absent pulses in legs- CA

56
Q

Management of PA

A

Prostaglandin ABC
Norword procedure OR BK shunt ASAP

57
Q

What are 2 innocent murmurs

A

Venous hum- Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles
Stills murmur- Low-pitched sound heard at the lower left sternal edge

58
Q

What is most common childhood arrythmia

A

SVT
Sinus arrythmia common in children as detectable cyclical increase by 30bpm with inspiration

59
Q

How does SVT present in utero

A

HF or hydrops fetalis
leads to reduced CO and pulmonary oedema

60
Q

How does SVT show on ECG

A

Narrow complex tachycardia

61
Q

Wolf parkinson white on ECG

A

Delta wave

62
Q

Management guidelines for SVT

A

Circulation and resp support
Vagal manoevers
IV adenosine
DC cardioversion

Once sinus rythm restored maintenance with sotalol and flecainide

63
Q

What is given for maintenance after SVT

A

Flecainide or sotalol

64
Q

What is done if children relapse with SVT

A

Percutaneous radiofrequency ablation or cryoablation

65
Q

Cause of rheumatic fever

A

Group A strep infection
Scarlet fever
Typically occurs 2-6 weeks after the pharyngitis

66
Q

Signs and symptoms of rheumatic fever

A

J- polyarthritis
O- carditis (any)
N- subcut nodules
E- erythema marginatum
S- syndenhams chorea

67
Q

What diagnoses rheumatic fever

A

Jones criteria- Strep throat and 2 majors or 1 major and 2 minors
Major
J- joints
O- carditis
N- subcut nodules
E- erythema marginatum
S- sydenhams chorea

Minor
F- fever
R- raised CRP or ESR
A- arthralgia
P- prolonged PR
P- previous RF

68
Q

How can history of strep throat be shown

A

Group A strep on throat culture
Antistreptolysin titre

69
Q

Acute management of rheumatic fever
Long term too

A

High dose aspirin as suppresses inflam in joints and heart
Amoxicillin if presence of current infection
Steroids if fever and inflammation does NOT respond rapidly
Valve replacement if needed

70
Q

Prophylaxis for rheumatic fever

A

Monthly injections of benzathine penicillin for 10 years after or until age of 21
Lifelong if severe valve damage

71
Q

Management of hyperyanotic attacks in tetralogy of fallot

A

Knee to chest position
Administer O2
IV morphine, adrenaline and propanolol
Potentially sodium bicarbonate

72
Q

What do if at GP examine child and are absent femoral pulses

A

Same day consultation with paeds

73
Q

What causes ebsteins anomaly

A

Lithium use during pregnancy

74
Q

Pathophysiology of ebsteins anomaly

A

Posterior leaflets of tricuspid valve are displaced anteriorly causing stenosis and regurgutation

75
Q

Murmur in ebsteins anomaly

A

Stenosis- mid-diastolic
Regurg- pansystolic
Presents as murmur during diastole and systole

76
Q

CXR finding of ebsteins anomaly

A

Right atrial enlargement

77
Q

CXR finding of ebsteins anomaly

A

Right atrial enlargement

78
Q

Resp infection and then cardiac issues with cardiac enlargement

A

Viral myocarditis-> dilated cardiomyopathy

79
Q

What typically presents with feeling faint and chest pain when exercising

A

Aortic stenosis

80
Q

What syndrome is aortic stenosis associated with

A

Williams

81
Q

How are hypercyanotic episodes managed in cyanotic babies with TOF

A

IV propanolol
Pain relief
Fluids
IV bicarbonate

82
Q

Systolic murmur which radiates over the praecordium

A

VSD

83
Q

Best way to assess venous congestion from RHF in a child

A

Hepatosplenmegaly as neck is short to assess neck veins

84
Q

With congenital heart defects how do children appear during feeds

A

Breathless and sweaty

85
Q

Which heart diseases worsen on closing of ductus arteriosus

A

Pulmonary stenosis
Tricuspid atresia
TOF
Transposition of the great arteries

86
Q

On top of prostaglandins what else should be given to a child awaiting an echo

A

Abx to cover for sepsis

87
Q

What is most common presentation of rheumatic fever

A

Polyarthritis

88
Q

Murmur in VSD

A

Holosystolic (pansystolic) murmur heard over LLSE

89
Q

Murmurs if ULSE

A

Pulmonary stenosis
PDA
ASD

90
Q

Murmur in pulmonary stenosis

A

Starts at beginning of systole
Radiates to back
Thrill
Loudest at ULSE

91
Q

If patient presents unwell with VSD what is first management

A

NG tube to promote calory intake

92
Q

Cyanosis with left axis deviation and apical impulse

A

Tricuspid atresia

93
Q

Which cyanotic condition at birth can present with no murmur

A

Transposition of great vessels as valves intact

94
Q

What is eisenmenger most associated with

A

VSD

95
Q

Cardiac anomaly associated with DiGeorge

A

Interruption of aortic arch

96
Q

What can exacerbate innocent murmurs

A

Febrile illness

97
Q

Complications of aortic coarctation affecting brain vessels

A

Cerebral aneurysms due to increased pressure pre coarctation due to activation of RAAS

98
Q

What can cause delayed presentation of transposition of the great arteries

A

If VSD present

99
Q

Systolic murmur heard loudest in the back

A

Aortic coarctation

100
Q

Maternal risk factor for transposition of the great arteries

A

Uncontrolled DM

101
Q

What is target sign

A

concentric alternating echogenic and hypoechoic bands

Paeds (17 decks)

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