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Paeds > Cardio > Flashcards

Cardio Flashcards

1
Q

When during pregnancy are cardiac abnormalities detected?

A

during 20 week antenatal scan

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2
Q

What are the characteristics of a L to R shunt?

What are common conditions that would result in a L to R shunt?

A

breathless

VSD (30%)

Persistent arterial duct (12%)

ASD (7%)

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3
Q

What are the characteristics of a R to L shunt?

What are common condiitons that would result in a R to L shunt?

A

blue

tetralogy of Fallot (5%)

transposition of great arteries (5%)

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4
Q

What are the characteristics of a mixing shunt?

What are common condiitons that would result in a Mixed shunt?

A

breathless and blue

atrioventricular septal defect

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5
Q

What are the characteristics of an outflow obstruction in a well child?

What are common conditions?

A

Asymptomatic + murmur

Pulmonary Stenosis

Aortic Stenosis

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6
Q

What are the characteristics of an outflow obstruction in a sick neonate?

What are common conditions?

A

Collapsed w/shock

Coarctation of aorta

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7
Q

What can cause congenital heart disorders ?

How can they be grouped?

A

Maternal syndrome - rubella, SLE

Maternal Drugs - warfarin, fetal alcohol syndrome

Chromosomal - down’s, edward’s, Patau’s, william’s

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8
Q

Describe circulation in the fetus?

A

Pressure in RA > LA

Foramen ovale held open, blood flows across atrial septum –> left atrium —–> left ventricle —–> body

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9
Q

What happens to the fetal circulation at birth/first breath?

A

Resistance to pulmonary blood flow decreases

Volume of blood flowing through the lungs increases 6x and this causes an increase in LA pressure

Placenta becomes excluded, so volume of blood to right atrium decreases

Change in pressure causes foramen ovale to close

ductus arteriosus also closes

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10
Q

IF a congenital heart condition is picked up antenatally what is the next step? What options are then available?

A

Fetal echo

allows for - counselling, termination, management plan antenatally, offer delivery close to cardiac centre

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11
Q

What is an innocent murmur?

A

4S - aSymptomatic patient, Soft blowing murmur, Systolic murmur, not diastolic, left Sternal edge

normal heart sounds
no parasternal thrill
no radiation

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12
Q

When do innocent or flow murmurs occur? Why?

A

Febrile illness

Anaemia

caused by increased cardiac output

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13
Q

What are the symptoms heart failure?

A

Breathlessness
Sweating
Poor Feeding
Recurrent Chest Infections

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14
Q

What are the signs of heart failure?

A

Poor weight gain

tachypnoea

tachycardia

heart murmur

cardiomegaly

cool peripheries

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15
Q

What are the causes of heart failure in neonates?

A

hypoplastic left heart syndrome

critical aortic valve stenosis

severe coarctation of the aorta

interruption of aortic arch

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16
Q

What are the causes of heart failure in infants?

A

VSD

AVSD

Large persistent ductus arteriosus

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17
Q

What are the causes of heart failure older kids and adolescents?

A

Eisenmenger syndrome

Rheumatic heart disease

Cardiomyopathy

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18
Q

In the first week of life, what is a usual cause of heart failure?

A

left heart obstruction

If significant, arterial perfusion via arterial duct = duct dependent system of circulation

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19
Q

After first week of life what is a usual cause of heart failure? What are the short and long term consequences of this?

A

most likely left-to-right shunt

short term : pulmonary oedema and breathlessness and pulmonary vascular resistance decreases and increases flow from L -> R

long term : symptoms will increase up to 3 months, then improve as pulmonary vascular resistance increases in response to the L -> R shunt

this then leads to Eisenmonger syndrome

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20
Q

What is Eisenmonger syndrome? What is treatment?

A

irreversibly raised pulmonary vascular resistance

causes shunt to become R –> L and teenager to become blue

treatment is a heart-lung transplant

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21
Q

What can cyanosis and respiratory distress be an indication of?

A

i) cardiac disease
ii) respiratory disease
iii) persistent pulmonary hypertension
iv) infection
v) metabolic disease

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22
Q

What investigations would you carry out in suspected for congenital cardiac abnormality?

A

CXR + ECG - not diagnostic but gives baseline for future reference

Echo + Doppler USS - diagnostic

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23
Q

How does an Atrial Septal Defect present? What signs are normally present?

A

commonly none
recurrent chest infection
arrythmias

Ejection Systolic Murmur at the Left Upper Sternal Edge
Split second heart sound

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24
Q

What would imagin show in an atrial septum defect? How would you manage this?

A

cardiomegaly
enlarged pulm. arteries

cardiac catheterisation with an occlusive device

surgical correction

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25
Q

How does a SMALL Ventricular Septal Defect present? What signs are normally present?

A

Presents asymptomatically

Loud pansystolic murmur Lower Left Sternal Edge
Quiet Pulmonary Second Sound

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26
Q

What would you see on CXR and ECG or a SMALL VSD? How would you manage it?

A

CXR and ECG are normal

Will close spontaneously

However maintaining good dental hygiene to avoid bacterial endocarditis is important

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27
Q

How would a LARGE Ventricular Septal Defect present? What signs are present?

A

Heart failure with breathlessness

Failure to thrive after 1 weeks old

Recurrent chest infections

Signs ; tachypnoea, tachycardia, soft pansyst murmur or no murmur
active precordium
loud pulmonary second sound

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28
Q

What would you see on imaging of patient with a LARGE Ventricular Septal Defect?

A

cardiomegaly
enlarged pulmonary artery
pulmonary oedema

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29
Q

How would you manage a LARGE Ventricular Septal Defect?

A

Diuretics + captopril
additional calorie input

surgery

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30
Q

What is a PDA?

A

Patent Ductus Arteriosus

blood flow from aorta to pulmonary artery

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31
Q

How would a PDA present?

A

continuous murmur beneath the left clavicle
increased pulse pressure

if the duct is large -> heart failure and pulmonary hypertension

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32
Q

What investigation would you diagnostic for PDA?

A

Echo

CXR and ECG would you be normal

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33
Q

How would you manage a PDA?

A

coil or occlusive device to decrease risk of bacterial endocarditis and pulmonary vascular disease

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34
Q

What are the components that make up the tetralogy of fallot?

A

Large VSD

Overriding Aorta with respect to ventricular septum

Subpulmonary stenosis causing right ventricle outflow tract obstruction

Right Ventricular hypertrophy as a result

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35
Q

How would tetralogy present? How is it normally diagnosed?

A

Severe cyanosis, hypercyanotic spells, squatting on exercise, developing in late infancy

Diagnosed normally antenatally or around 2 months when murmur is heard

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36
Q

What signs are seen with tetralogy of fallot?

A

clubbing of fingers and toes in older children

loud harsh ejection systolic murmur at the Left Sternal Edge

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37
Q

What would you see on CXR of tetralogy of fallot?

A

small heart, RV hypertrophy

concavity on left heart border

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38
Q

How would you manage a tetralogy of fallot?

A

Surgery at 6 months of age

close VSD and relieving RV outflow tract obstruction

Blalock-Taussig shunt

39
Q

Acutely, how would you treat a hypercyanotic spell in a child with tetralogy of Fallot?

A

sedation and pain relief

IV propanolol

IV volumre administration

Bicarb to correct acidosis

reduce metabolic demand

40
Q

What is happening to the blood vessels in transposition of great arteries?

A

RV -> Aorta -> blue blood to body

LV -> Pulm. Artery -> pink blood to lungs

41
Q

What is the prognosis for transposition of great arteries?

A

incompatible with life unless there is mixing of blood

that’s why often co-exists with VSD, ASD, PDA

42
Q

How does TGA present ?

A

cyanosis normally by day 2

43
Q

What signs seen in TGA?

A

cyanosis

second heart sound loud and single

usually no murmur

44
Q

What is seen on CXR of TGA?

A

narrow upper mediastinum ‘egg on side’ appearance of the cardiac shadow

45
Q

How would you manage TGA?

A

maintain ductus arteriosus with prostaglandin infusion

ballon atrial septostomy

surgery to swicth arteries

46
Q

In what population is AVSD commonly seen?

A

children with Down’s Syndrome

47
Q

When is AVSD diagnosed? How does it present?

A

Presents on antenatal USS

Cyanosis at birth

HF @ 2-3weeks

no murmur

48
Q

How would you manage AVSD?

A

manage HF medically

surgical repair 3-6 months of age

49
Q

What are examples of complex congenital heart diseases that cause common mixing of blood?

A

Tricuspid atresia

Mitral atresia

double inlet left ventricle

common arterial trunk

50
Q

How would tricuspid atresia present?

A

common mixing of systemic and pulmonary venous return in LA causes

i) cyanosis in the newborn period
ii) child well @ birth and becomes cyanoses or breathless

51
Q

How would you manage tricuspid atresia?

A

Blalock - Taussig shunt insertion

Pulmonary artery banding

52
Q

What is aortic stenosis commonly associated with?

A

mitral valve stenosis and coarctation of aorta

53
Q

How would aortic stenosis present?

A

asymp murmur

reduced exercise tolerance, chest pain on exertion or syncope

In neonates - critical stenosis can lead to HF then shock

54
Q

What signs would you see in aortic stenosis?

A

small volume, slow rising pulses
carotid thrill

ejection syst. murmur at RUSE radiating to neck

55
Q

What would you see on CXR of patient with Aortic Stenosis?

A

prominent left ventricle and dilation of ascending aorta

56
Q

How would you manage aortic stenosis?

A

balloon valvotomy

aortic valve replacement

57
Q

How would pulmonary stenosis present?

A

neonates with critical stenosis will become cyanosed

58
Q

What signs would you see in pulmonary stenosis?

A

Ejection systolic murmur at LUSE

59
Q

What would you see on CXR of pulmonary stenosis?

A

Pulmonary Artery dilation

60
Q

How would you manage pulmonary stenosis?

A

Transcatheter balloon dilation

61
Q

How would adult-type coarctation of aorta present? what signs?

A

asymptomatically

systemic hypertension in right arm

signs = ejection systolic murmur upper sternal edge
radio femoral delay

62
Q

What would you see on CXR of patient with Adult-type CoA?

A

rib notching

3 sign

63
Q

How would you manage adult-type CoA?

A

stent

64
Q

How would outflow obstruction in a sick infant present? what would be the immediate management?

A

Present with heart failure leading to shock

Resus with ABC

Prostaglandin commenced at earliest opportunity

65
Q

What is the difference between adult-type coarc and paediatric coarct?

A

ductus is closed in the adult form while remains open in the paediatric one

66
Q

How would coarct present?

A

normal during first day of life

collapse during 2nd or following days, as the duct closes

67
Q

What signs would you seen in a infant with coarctation?

A

sick infant with severe HF
absent femoral pulses
severe metabolic acidosis

68
Q

What would you see on CXR of coarct and how would you manage it?

A

cardiomegaly from HF and shock

surgical repair

69
Q

What is hypoplastic left heart syndrome?

A

underdeveloped entire left side of the heart
mitral valve is small or atretic
left ventricle small
aortic valve atresia

70
Q

How would hypoplastic left heart syndrome present?

A

detected antenatally by USS

becomes very ill after birth, duct dependant circulation
absence of peripheral pulses

71
Q

How would you treat HLHS? At what points in time?

A

Norwood procedure (first 2 weeks)

Glenn/ Hemi-Fontan (6 months)

Fontan (3 years)

72
Q

What is sinus arrhythmia?

A

It is a normal arrythmia in children, it is detectable as a cyclical change in HR with respiration

Acceleration during inspiration

Deceleration during expiration

73
Q

What is the most common childhood arrhythmia?

A

Supraventricular tachycardia

74
Q

How would you manage a child with SVT?

A

circulatory and respiratory support

Vagal stimulating manoevres (carotid sinus massage, cold ice pack)

IV adenosine

Electrical cardioversion

75
Q

In SVT, once sinus rhythm is restored, what can be used for maintenance?

A

Flecainide or sotalol which can be stopped after one year

if relapse or are at risk - percutaneous radiofrequency ablation can be used

76
Q

What associations are seen with congenital heart block?

A

related to anti-Ro/anti-La antibodies in maternal serum

mothers usually latent connective tissue disorders

77
Q

What are causes of syncope?

A

Neurocardiogenic - prolonged standing

Situational - defecation, urination, cough

Orthostatic - BP fall >20mmHg after 3 mins

Ischaemic

Arrythmic - heart block, SVT

78
Q

What organisms are commonly responsible for rheumatic fever?

A

group A beta-hemolytic streptococcus

79
Q

When do you normally see contraction of rheumatic fever?

A

following 2-6 week latent phase

after pharyngeal infection
polyarthritis
mild fever

80
Q

What is the long-term consequence of Rheumatic fever?

A

mitral stenosis

81
Q

How would you manage rheumatic fever?

A

best rest and anti-inflamm

aspirin

if fever and inflamm doesn’t resolve –> corticosteroids

HF treated with dieretics and ACE-I

Anti-strep abx if persisting infection

82
Q

What can be given prophylactically for rheumatic fever?

A

benzathine penicillin

83
Q

Who are at risk of infective endocarditis?

A

All children with congenital heart disease

84
Q

When should infective endocarditis be suspected ?

A

Should be suspected in any child or adult with sustained fever, malaise, raised ESR, unexplained anaemia or haematuria

85
Q

What organism is most commonly responsible for Infective Endocarditis?

A

alpha hemolytic strep

86
Q

What investigations would you carry out for infective endocarditis?

A

multiple blood cultures

echo - vegetations

87
Q

How would you treat infective endocarditis?

A

high-dose penicillin and aminoglycoside for 6 weeks through IV

88
Q

What would you suspect in any child with an enlarged heart and heart failure?

A

dilated cardiomyopathy

89
Q

How would you treat dilated cardiomyopathy?

A

diuretics

ACE-I

Carvedilol

some might need a heart transplant

90
Q

How would define pulmonary hypertension?

A

> 25mmHg

have a large post-tricuspid shunt w. high pulmonary blood flow and low resistance

91
Q

How would you treat pulmonary hypertension?

A

Inhaled nitric oxide

IV MgSo4

Endothelin receptor antagonists

92
Q

What is Ebstein’s Anomaly? What are conditions are associated with it?

A

Ebstein’s anomaly is a congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle. It is sometimes referred to as ‘atrialisation’ of the right ventricle.

tricuspid incompetence (pan-systolic murmur, giant V waves in JVP)
Wolff-Parkinson White syndrome
93
Q

What medication usage in-utero is associated with Ebstein’s Anomaly?

A

Lithium

Paeds (13 decks)

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