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Phase 3a Paeds > cardio > Flashcards

cardio Flashcards

1
Q

Foetal anatomy:
what are the 3 shunts and what are their functions?

A

-Foramen ovale (R + L Atria)
-Ductus arteriosus (pul artery + aorta)
(Both bypass lungs)

-Ductus venosus (umbilical vein into IVC)

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2
Q

What blood vessels run through the umbilical cord? what do they carry?

A

1 umbilical vein (oxygenated blood to baby)
2 umbilical arteries (deoxygenated away from baby)

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3
Q

Name some cyanotic cardiac disease?

A

-Tetrology of fallot
-transposition of great arteries
-tricuspid atresia
-total anomalous pulmonary venous return

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4
Q

cyanosis is when Hb is?

A

deoxygenated Hb >5g/dL

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5
Q

Acyanotic can become cyanotic due to?

A

Eisenmenger syndrome

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6
Q

what is eisenmenger syndrome?

A

ASD or VSD allows L to R shunting causing pulmonary htn
Pulmonary pressure > systemic, then R to L shunting
Blood bypasses lung = cyanosis

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7
Q

what do benign murmurs occur?

A

Turbulent flow through naturally smaller valves

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8
Q

Is a thrill normal or pathological?
when is a thrill common?

A

Thrill = pathological
Common during febrile illness and anemia (high CO)

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9
Q

How do benign murmurs sound?

A

Soft blowing murmur
aSx
Systolic only
left Sternal edge
no added Sounds
varies with poSture

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10
Q

what are the main RFs for congenital heart disease (CHD)?

A

Maternal rubella
diabetes
downs

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11
Q

what does CHD increase the risk of?

A

IE + arrhythmia risk

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12
Q

Sx of CHD?

A

Poor feed
Failure to thrive

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13
Q

Dx of CHD?

A

echo

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14
Q

Tx of CHD?

A

Surgery
Indomethacin / NSAIDS (<1y)
Alprostadil (prostaglandin E1) >1y

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15
Q

what is the MC CHD in babies?

A

ventricular septal defect

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16
Q

what is an atrial septal defect?

A

Failure of atrial septum to close
(acyanotic)

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17
Q

what are the types of atrial septal defects?

A

Ostium secundum (80%)
MC = Centre of atrial septum

osmium primum
(lower part of atria)

formen ovale

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18
Q

RF for atrial septal defect?

A

Downs!!
foetal alcohol syndrome

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19
Q

Sx of atrial septal defect?
what is heard on auscultation?

A

Mid systolic crescendo decrescendo at upper L sternal border
Fixed S2 splitting
(high O2 sats in RA, RV, PA = extra blood volume = delayed pul valve closure = S2 split)

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20
Q

Dx of atrial septal defect?

A

antenatal scan
newborn examination

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21
Q

Tx of Atrial septal defect?

A

Monitor child - small openings may close
Surgery - via catheter or open heart, patch/plug in place
Anticoagulants

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22
Q

Complications of atrial septal defect?

A

Paradoxical embolism (RA -> LA -> Systemic circulation)
Stroke
AF / Aflutter
Pulmonary htn
RHF
eisenmengers

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23
Q

what is a ventricular septal defect?

A

Septum between ventricles has opening

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24
Q

RF for ventricular septal defect?

A

Downs

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25
Q

what is heard in ventricular septal defect?
quieter = ?

A

Harsh pan systolic murmur at L lower sternal border

quieter = bigger

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26
Q

Dx of ventricular septal defect?

A

Antenatal scan
newborn examination

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27
Q

Tx of ventricular septal defect?

A

Small + no pulmonary htn or HF = watched over time

Bigger = surgical - tranvenous catheter / open

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28
Q

RF for atrioventricular septal defect?

A

Downs!

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29
Q

Sx and what is heard in atrioventricular septal defect?

A

No murmur
severe distress

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30
Q

Tx of atrioventricular septal defect?

A

ECHO
HF Tx

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31
Q

What is patent ductus arteriosus?

A

failure of ductus ateriosus to close leading to blood moving from aorta to pulmonary artery
High pul htn + right heart strain

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32
Q

when does the ductus arteriosus normally stop functioning and closes?

A

Stops functioning = 1-3 days

closes at 2-3 weeks

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33
Q

RF for patent ductus arteriosus

A

Rubella (1/3)
prematurity

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34
Q

Sx and what is heard in patent ductus arteriosus?

A

Poor growth, infections, dyspnoea, lower body cyanosis

-Continuous machinery murmur at L subclavian border
-Wide pulse pressure (bounding collapsing pulse)
-Heaving apex

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35
Q

Tx of patent ductus arteriosus?

A

ECHO monitoring
<1y = NSAIDs / Indomethacin
>1y = surgery

36
Q

Dx of patent ductus arteriosus?

A

ECHO - ventricular hypertrophy

37
Q

why do we give NSAIDS for patent ductus arteriosus?

A

Prostaglandins keep Ductus arteriosus open
NSAIDS inhibit prostaglandin activity

38
Q

what is the MC cause of cyanotic CHD in 50-70% children?

A

tetralogy of fallot

39
Q

what is tetralogy of fallot?

A

4 heart abnormalities

40
Q

what are the 4 abnormalities in tetralogy of fallot?

A
  1. pulmonary stenosis
  2. R ventricular hypertrophy
  3. large ventricular septal defect
  4. Overriding aorta
41
Q

RF for tetralogy of fallot?

A

Di Georges
Downs
Rubella
Maternal DM
M>40Y
Foetal alcohol

42
Q

Sx of tetralogy of fallot?
what is heard?

A

Cyanosis of lips and fingers at birth
clubbing after months
feeding difficulties
fail to develop

Ejection systolic murmur at pulmonary valve

43
Q

what are ‘tet spells’ in tetralogy of fallot?

A

High O2 = heart pumps more blood =
Sudden low O2 Sats (worsened L to R) = cyanotic episode = improved by squatting

44
Q

why is a ‘tet spell’ in tetralogy of fallot improved by squatting?

A

High vascular resistance in peripheral arteries
high systemic circulation pressure
High pressure L>R side
Shunt temporarily reverses

45
Q

Dx of tetralogy of fallot?

A

Antenatal
Chest x ray = boot shaped heart (RVH)
ECG = R axis deviation
ECHO = degree

46
Q

Tx of a tet spell in tetralogy of fallot?

A

O2
Morphine
IV fluids (+ bicarb if acidotic)
IV Propanolol (peripheral vasoconstrictor = relaxed RV)

47
Q

Tx of tetralogy of fallot?

A

Neonates = prostaglandin infusion
GS = total surgical repair - VSD closure, pul stenosis corrected (outflow tract enlarged) in 1st year life

48
Q

what is transposition of great arteries?

A

Pulmonary arteries + aorta swap places

49
Q

RF for transposition of great arteries?
associated with?

A

Maternal DM

VSD, CoA, pul stenosis

50
Q

Sx of transposition of great arteries?

A

No Sx in utero as FO + DA
Cyanotic within 1h birth
tachypnoea
often another shunt present (ASD, VSD, PDA)
no murmur

51
Q

Dx of transposition of great arteries?

A

ECHO
Chest xray = sideways egg

52
Q

Tx of transposition of great arteries?

A

Neonates = prostaglandin E1 infusion (keeps DA open)
Surgical correction

53
Q

what is levo - transposition of great arteries?

A

R + L ventricle switch too
normal function
Acyanotic

54
Q

what is coarctation of the aorta?

A

narrowing of aorta, distal to branches, near ductus arteriosus

55
Q

RF for coarctation of the aorta?

A

turners

56
Q

Sx of coarctation of the aorta?

A

High BP in upper body + head, low BP in lower body
-Htn + bounding pulse in upper body
- weak/absent femoral pulse
- R-R / R-F delay
-Cold extremeties
- dizziness / epistaxis

57
Q

what is coarctation of the aorta associated with?

A

berry aneurysm + HTN

58
Q

Dx of coarctation of the aorta?
what is heard?

A

systolic murmur between 2 clavicles

Chest xray = intercostal artery tortousity, figure 3 sign, rib notching (Roester sign)

59
Q

Tx for coarctation of the aorta?

A

Balloon angioplasty

60
Q

what is triscupid atresia?
what is it associated with?

A

absence of tricuspid valve (no opening)
non functional RV

assoc with another shunt

61
Q

What is hypoplastic Left heart syndrome?

A

malformation of L heart, hypoplastic LV + mitral atresia

62
Q

What is ebstein anomaly?

A

Tricuspid valve (septal and posterior leaflets) is set lower in R side of heart towards apex = bigger RA and smaller RV

63
Q

what is ebstein anomaly associated with?
RF for it?

A

associated with ASD + WPW
RF = maternal lithium

64
Q

what murmurs are heard in ebstein anomaly?

A

gallop rhythm + sail sound

2x murmurs:
1. Pan systolic (tricuspid regurgitation)
2. Mid diastolic (tricuspid stenosis)

65
Q

Heart failure manifests as?

A

oedema (facial and sacral)

66
Q

Causes of Heart failure in:
neonates?
infants?
older?

A

severe co-arctation of aorta

L to R shunts eg. VSD, ASD, AVSD, PDA

Eisenmengers, RHD, cardiomyopathy

67
Q

Sx of Left heart failure?

A

backs up in lungs
SOB, gallop rhythm, cool peripheries, cardiomegaly

68
Q

Sx of right heart failure?

A

backs up In body
-peripheral oedema
-hepatomegaly

69
Q

Tx for Heart failure?

A

-Ionotropes (increases heart contraction)
-ABAL (ACE-I, BB, Aldosterone agonist eg. spironolactone, Loop diuretics eg. furesomide)
-High calorie diet

70
Q

What is infective endocarditis?
RF?

A

Infection into inflammation of heart valves
CHD

71
Q

Causes of infective endocarditis?

A

S.aureus MC
S.viridans
S.epidermidis
HACEK

72
Q

What would you typically see in a Px with infective endocarditis? How would it present?

What are all kids with IE + CHD having surgery given?

A

Fever and new murmur with increased risk in CHD

All kids with CHD having surgery given prophylactic Abx

73
Q

Sx of infective endocarditis?

A

DUKE criteria
2 major or 1 major 2 minor
New murmur, fever, septic signs, immunological signs

vegetations = brain emboli / stroke

74
Q

Dx of infective endocarditis?

A

Bloods (high WCC, ESR/CRP)
Blood cultures MC+S
ECHO (vegetations)

75
Q

Tx of infective endocarditis?

A

High dose IV Abx for 4-6 weeks
IV Gentamicin + flucloxacillin

76
Q

What Is rheumatic fever?
pathophysiology?
MC cause of?

A

Autoimmune condition which occurs 2-4 weeks post group A strep infection (sore throat)

T2 hypersensitivity vs M protein - molecular mimicry (strep antigens + Px tissues same) - cross react with smooth muscle

mitral stenosis

77
Q

rheumatic fever
cause?
ages it affects?
M or F?
RF involves heart what % of the time?

A

Strep pyogenes

ages 5-15

M

50%

78
Q

Sx of Rheumatic fever?

A

JONES FEAR
Major (Jones):
-Joints (migrating upwards polyarthritis)
-Organ inflammation (carditis)
-Nodules SC
-Erythema Marginatum (non itchy rash, red margin + clear centre - chest)
-Sydenham chorea (uncoordinated involuntary jerky movements)

Minor (Fear)
-Fever >38*c
-ECG changes (Prolonged PR)
-Arthralgia (without arthritis)
-Raised ESR/CRP

2 major or 1 major + 2 minor

79
Q

Dx of Rheumatic fever?

A

Jones criteria
Bloods
Antistreptolysin O titre (ASOT)
Anti DNAase B +ve
ECG
ECHO
Aschoff body (nodules in heart of RF Px due to inflammation)

80
Q

Tx of rheumatic fever?

A

stat IV Benzylpenicillin then PO phenoxymethylpenicillin

Pericarditis = NSAIDS
Chorea = haloperidol / diazepam
reduce reoccurrence = IM Benzathine benzylpenicillin

81
Q

Complications of rheumatic fever?

A

Reoccurance
valvular HD
HF
Scarring
Fibrosis = RHD = myocarditis, endocarditis, pericarditis

82
Q

what is brugada syndrome?
Dx?

A

Autosomal dominant
5CN5A mutation
Na+ channel

Dx = ECG

83
Q

What are the ECG findings in brugada syndrome?

A

pseudo RBBB
ST segment elevation V1-V3
Saddle back ST-T elevation

84
Q

What is the MC pads dysarrhythmia?

A

SVT
WPW

85
Q

What does WPW cause on ECG?

A

Slurred delta wave
PR <120ms
Wide QRS

86
Q

Tx of SVT?
Acute?
long term: medical + surgical ?

A

Acute = vasovagal, adenosine
medical = bisoprolol
surgical = catheter ablation (bundle of Kent)

Phase 3a Paeds (14 decks)

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