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Paeds > Cardio > Flashcards

Cardio Flashcards

1
Q

What is an atrial septal defect?

A

Birth defect in which there is a hole in the atrial septum.

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2
Q

Clinical features of an atrial septal defect, what murmurs are seen?

A

Often asymptomatic

Recurrent chest infections

Arrhythmias in later life

Ejection systolic murmur, loudest at the left upper sternal edge

Fixed and widely split second heart sound

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3
Q

Investigations of an atrial septal defect

A

Bedside

ECG

Imaging

CXR (may show evidence of heart failure and cardiomegaly)

Echocardiogram

May be done using bubble contrast to better visualise the defect

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4
Q

Management of an atrial septal defect

A

Often do not require treatment if the defect is small

Percutaneous closure of defect

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5
Q

What is an AVSD? Who is it commonly seen in?

A

Congenital heart defect in which there is an abnormal connection between the atria and the ventricles.
Commonly associated with Down syndrome

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6
Q

What does an AVSD present with?

A

Often asymptomatic
Symptoms of heart failure

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7
Q

Investigations of an AVSD

A

Bedside
ECG
Imaging
Echocardiogram

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8
Q

Management of an AVSD

A

Medical management of heart failure
Surgical closure

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9
Q

What is coarctation of the aorta? Who is it commonly associated with?

A

Congenital defect characterised by narrowing of the aorta.
Commonly associated with Turner syndrome

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10
Q

Cardiac defect in Down’s

A

AVSD

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10
Q

Cardiac defect in Turner’s

A

Coaractation of aorta

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11
Q

Clinical features of coarctation of aorta

A

Asymptomatic
Secondary cause of hypertension (should be considered in any young patient presenting with hypertension)
Radio-femoral delay
If severe, can cause heart failure and circulatory collapse

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12
Q

What diagnosis should be considered in any young patient with hypertension?

A

Aortic coarctationIn

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13
Q

Investigations of aortic coarctation

A

Bedside
ECG (features of left ventricular hypertrophy)
Imaging
CXR (rib notching)

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14
Q

ECG sign of aortic coarctation

A

LVH

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15
Q

CXR findings of aortic coarctation

A

Rib notchingM

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16
Q

Management of aortic coarctation

A

Often conservative if asymptomatic
May require surgical resection or stenting if severe

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17
Q

What is congenital complete heart block? what is it often assocaited with?

A

A congenital condition in which the electrical impulses from the atria does not transmit to the ventricles.
Often associated with maternal autoimmune disorders (e.g. SLE) and, in particular, the presence of anti-Ro and anti-La antibodies

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18
Q

Clinical features of congenital complete heart block

A

Bradycardia
Pale
Features of heart failure (e.g. shortness of breath)
Reduced exercise tolerance

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19
Q

Investigations of congenital complete heart block

A

Bedside
ECG
Imaging
Echocardiogram

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20
Q

Management of congenital complete heart block

A

Endocardial pacemaker insertion if symptomatic

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21
Q

What is Eisenmenger syndrome? Give examples of which conditions this can occur in

A

Serious complication of congenital heart disease characterised by reversal of a pre-existing left-to-right shunt. It has a very poor prognosis.

Causes of left to right shunt are PDA, ASD, VSD

THINK: 3 letters

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22
Q

Pathophysiology of Eisenmenger syndrome

A

In patients with a VSD or ASD, the left side of their heart will initially be stronger than the right, so blood from the left side will be shunted in to the right side.
This does not cause any major acute complications, however, it does lead to increased right heart pressures.
This, over time, will lead to right ventricular hypertrophy.
Eventually, the pressures generated by the right heart will exceed the pressures generated by the left heart resulting in reversal of the shunt. This will lead to cyanotic heart disease over time.

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23
Q

Clinical features of Eisenmenger syndrome

A

Cyanosis
Features of heart failure
Arrhythmia

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24
Q

Investigations of Eisenmenger syndrome

A

Bedside
ECG
Evidence of right ventricular hypertrophy
Imaging
Echocardiogram
Cardiac catheterisation

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25
Q

What may ECG and echo show in eisenemnger syndrome?

A

RVH

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26
Q

Management of eisenmenger syndrome

A

Difficult to treat once it is established
The only curative option is a heart-lung transplant

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27
Q

What is hypoplastic left heart syndrome?

A

Congenital heart defect characterised by underdevelopment of the left side of the heart resulting in features of left heart failure soon after birth.

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28
Q

Clinical features of hypoplastic left heart syndrome, why do these occur?

A

Cardiovascular collapse when the duct closes
This is because there is little output coming from the left ventricle, therefore, the right ventricle and the ductus arteriosus are responsible for maintaining the systemic circulation.

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29
Q

Management of hypoplastic left heart syndrome

A

Surgical correction (Norwood procedure)

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30
Q

Norwood procedure

A

Surgical correction of hypoplastic left heart syndrome

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31
Q

What is an interrupted aortic arch? What is it associated with?

A

Rare congenital heart defect in which there is no connection between the section of the aorta on either side of the ductus arteriosus
Associated with 22q11.2 deletion syndrome (DiGeorge Syndrome)

32
Q

Clinical features of interrupted aortic arch

A

Features of heart failure and cardiogenic shock in the neonatal period
Features of DiGeorge syndrome (hypocalcaemia, palatal defects)

33
Q

Cardiac defect in DiGeorgre syndrome

A

Interrupted aortic arch

34
Q

Management of interrupted aortic arch

A

Prostaglandin infusion to maintain the ductus arteriosus
Surgical correction

35
Q

What is patent ductus arteriosus?

A

Persistence of the ductus arteriosus (connecting the pulmonary artery to the aorta) after birth. It normally closes within 4 hours of birth.

36
Q

RFs for patent ductus arteriosus

A

Prematurity
Maternal rubella

37
Q

Clinical features of patent ductus arterious

A

Often asymptomatic and incidentally noted during routine neonatal examination
Can lead to features of heart failure (shortness of breath resulting from pulmonary oedema)

38
Q

Management of PDA

A

Pharmacological Closure –> NSAIDs (e.g. IV Indomethacin, ibuprofen)
Surgical ligation or percutaneous catheter-guided closure

39
Q

What is pulmonary stenosis? How does it usually present?

A

Narrowing of the pulmonary valve

Usually asymptomatic
Ejection systolic murmur
Evidence of right ventricular hypertrophy

40
Q

Whaat mrumur is heard in PDA?

A

Gibson murmur –> continous, machine like

41
Q

What murmur is heard in ASD?

A

ESM + fixed S2 splitting

42
Q

Investigations for pulmonary stenosis

A

Bedside
ECG (right ventricular hypertrophy)
Imaging
CXR
Echocardiogram

43
Q

Management of pulmonary stenosis

A

Transcatheter balloon dilatation

44
Q

Criteria for Rheumatic Fever

A

Jones

45
Q

What is in the criteria for Rheumatic fever?

A
46
Q

What organism causes rheumatic fever?

A

Step pyogenes (group A strep)

47
Q

Investigations for rheumatic fever

A

Bedside
ECG

Bloods
CRP
ESR
ASO Titre

Imaging
Echocardiogram

48
Q

Management of rheumatic fever

A

Antibiotics
1stLine: Benzathine Benzylpenicillin
Alternative: Phenoxymethylpenicillin, Erythromycin

Arthritis
NSAIDs and Aspirin

Cardiac Complications
Anti-arrhythmics
ACE inhibitors
Diuretics

Chorea
Anticonvulsants

49
Q

What antibiotics are used in rheumatic fever?

A

1stLine: Benzathine Benzylpenicillin
Alternative: Phenoxymethylpenicillin, Erythromycin

50
Q

How is arthritis in rheumatic fever treated?

A

NSAIDs and Aspirin

51
Q

How are cardiac complications in rheumatic fever treated?

A

Anti-arrhythmics
ACE inhibitors
Diuretics

52
Q

How is chorea in rheumatic fever treated?

A

Anticonvulsants

53
Q

What are the 3 types of cyanotic heart disease?

A

ToF
TGA
TA

54
Q

What are the 3 types of left to right shunt? What type of heart disease do they cause?

A

PDA, ASD, VSD

They cause non-cyanotic heart disease

55
Q

What are the two types of outflow obstruction? what do they cause?

A

Valve stenosis, aortic coarctation

non-cyanotic heart disease

56
Q

What is the most common form of congenital cyanotic heart disease? What is it characterised by?

A

Tetralogy of Fallot

Large VSD
Overriding Aorta (caused by VSD)
Pulmonary Stenosis
Right Ventricular Hypertrophy (caused by pulmonary stenosis)

57
Q

Clinical features of ToF

A

Infants develop cyanotic episodes often precipitated by exertion (e.g. feeding) - tet spells
May take up to 1 month for symptoms to be noted

58
Q

When does cyanosis present in ToF? How does this compare to TGA and TA?

A

within days to months

TGA - hours

TA - minutes

59
Q

Tet spells

A

ToF

60
Q

What murmur heard in ToF

A

ejection systolic murmur at left sternal edge

61
Q

Investigations in ToF

A

Bedside
ECG (often normal)
Imaging
CXR (boot-shaped heart)
Echocardiogram

62
Q

CXR finding in ToF

A

boot shaped heart

63
Q

Management of ToF

A

If the patient is profoundly cyanotic, they should be urgently started on a prostaglandin infusion (this keeps the ductus arteriosus open, thereby allowing blood from the systemic and pulmonary circulation to mix
Surgical correction

64
Q

What is TGA?

A

Congenital cyanotic heart disease in which the main arteries leaving the heart are connected the wrong way around.
This means that blood is pumped from the right side of the heart directly into the systemic circulation, and blood from the left side of the heart is pumps back into the pulmonary circulation.
In essence, the two circuits are independent, and life is only sustained in utero due to mixing of blood via other connects (e.g. ductus arteriosus, septal defects)

65
Q

Clinical features of TGA

A

Cyanosis soon after birth (usually within 2 days, as the ductus arteriosus closes)
NO murmur heard on auscultation

66
Q

cyanotic heart disease with no murmur

A

TGA

67
Q

Investigations for TGA

A

Bedside
ECG (often normal)
Hyperoxia Test
High-flow oxygen is applied to the patient but it fails to improve the saturation measured by the peripheral saturation probe as there is no connection between the pulmonary and systemic circulations.

Imaging
CXR (egg-on-a-string appearance)
Echocardiogram

68
Q

How to assess whether cause is respiratory or cardiac in neonatal cyanosis?

A

Hyperoxia test

Do ABG on heel of baby, check initial pO2 and then give 100% o2 for 10 mins, then another ABG

If o2 increases  respiratory  not enough o2 to go into blood, then when supplemented issue resolves

If o2 remains low  cardiac issue as even with supplemental o2, can’t get it to peripheries

69
Q

CXR finding in TGA

A

egg-on-a-string appearance

70
Q

Management of TGA

A

Acute Management of Cyanosed Infant
Promptly start prostaglandin infusion to keep the ductus arteriosus open
Balloon atrial sepstostomy may be considered to maintain connection between atria
Surgical correction (arterial switch)

71
Q

What is tricuspid atresia? What does it result in?

A

Congenital heart defect in which the tricuspid valve fails to develop resulting in atrialisation of the right ventricle.

NOTE: As there is no connection between the right atrium and the right ventricle, there has to be a ventricular septal defect to allow blood to mix.

72
Q

Clinical features of TA

A

Cyanosis
Shortness of breath

73
Q

Management of TA

A

Prostaglandin infusion to maintain a patent ductus arteriosus

Surgical Intervention
Blalock-Taussig shunt (creates connection between subclavian artery and pulmonary artery)
Cavopulmonary anastomosis
Fontan procedure (redirect IVC and hepatic vein blood flow into the pulmonary circulation)

74
Q

Blalock Taussing shunt

A

creates connection between subclavian artery and pulmonary artery –> used in surgical management of TA

75
Q

What is VSD? How does it present?

A

Congenital heart defect in which there is a hole in the ventricular septum.

Often asymptomatic
Features of heart failure (e.g. shortness of breath)
Pansystolic murmur at the lower left sternal edge

76
Q

What murmur in VSD?

A

Pansystolic murmur at the lower left sternal edge

77
Q

Investigations in VSD

A

Bedside
ECG
Often normal
May show evidence of left or right ventricular hypertrophy

Imaging
CXR
Often normal but may show cardiomegaly and other changes associated with heart failure
Echocardiogram

78
Q

Management of VSD

A

Defects often close spontaneously
Surgical closure of defect

Paeds (14 decks)

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