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Paediatrics > Cardio > Flashcards

Cardio Flashcards

1
Q

Basic circulatory changes at birth

A

Before birth: little return to left atrium from lungs so blood in right atrium pressed across to left via foramen ovale.
At birth lung venous return increases and as not placenta in circulation return to right atrium decreases, new pressure difference = close foramen ovale.

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2
Q

5 ways a congenital heart defect could broadly present

A 
On antenatal ultrasound
With heart failure
Cyanosis
With a heart murmur
Shock
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3
Q

Innocent murmur features

A 
Asymptomatic
Soft blowing sound murmur
Systolic not diastolic
Heard at the left sternal edge
No radiation
No thrill
No added heart sounds
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4
Q

Left to right shunts examples

A

Atrial septal defect
Ventricular septal defect
Persistent ductus arteriosus

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5
Q

Right to left shunts examples

A

Tetralogy of Fallot

Transposition of the great arteries

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6
Q

Common mixing examples

A

Atrioventricular septal defect

Tricuspid atresia and other complex congenital heart disease

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7
Q

Outflow obstruction heart disease

A

pulmonary stenosis and aortic stenosis

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8
Q

Vital treatment for survival in a cyanotic neonate

A

Prostaglandin, maintain duct patency.

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9
Q

Clinical features of an atrial septal defect

A

Asymptomatic.
Recurrent chest infections and wheeze.
Fixed and widely split second heart sound.
Systolic murmur at upper left sternal edge from pulmonary blood flow.

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10
Q

Investigations and results from atrial septal defect

A 
CXR = cardiomegaly, enlarged pulmonary artery.
ECG = right axis deviation due to right side hyperplasia and right bundle branch block
Echocardiogram = diagnostic to decipher partial or secundum ASD.
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11
Q

Management of atrial septal defect

A

Secundum ASD = cardiac catheterisation plus occlusion device.
Partial ASD = cardiac corrective surgery at 3-5yrs

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12
Q

Ventricular septal defect clinical features

A

Dependent on size. Small are asymptomatic, large cause heart failure (breathlessness, failure to thrive, recurrent infections)
Signs: Loud pan-systolic murmur at left sternal edge - the louder the murmur the smaller the defect.

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13
Q

Investigations and results from ventricular septal defect

A 
CXR = cardiomegaly and pulmonary engorgement and cane have pulmonary oedema if large.
ECG = ventricular hypertrophy
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14
Q

Management of ventricular septal defect

A

Small are self-resolving, large need surgery.

Treat with HF meds e.g. diuretic

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15
Q

Anatomy of ductus arteriosus

A

Connects the pulmonary artery to descending aorta.

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16
Q

Definition of patent ductus arteriosus and persistent

A 
Persistent  = term babies, not closed by 1month after birth.
Patent = preterm babies failure to close 1 month after due date
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17
Q

Flow of blood in a patent ductus arteriosus

A

From aorta to pulmonary artery.

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18
Q

Clinical features of patent ductus arteriosus

A

Asymptomatic unless large defect = HF and hypertension. Failure to thrive, breathless, recurrent infections, hepatomegaly. Increased risk of infective endocarditis.
Signs = continuous machine murmur below left clavicle, thrill, collapsing, gallop pulse (increase pulse pressure), loud S2.

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19
Q

Investigations for patent ductus arteriosus

A

CXR and ECG = normal.

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20
Q

Management of patent ductus arteriosus

A

Patent in preterms = Ibuprofen/NSAID to close

Persistent in term = endovascular surgery to reduce risk of bacterial endocarditis. Coil or occlusion device fitted.

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21
Q

Machine murmur under left clavicle

A

Patent ductus arteriosus

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22
Q

Loud pan-systolic murmur at left sternal edge

A

Ventricular septal defect

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23
Q

Systolic murmur at upper left sternal edge

A

Atrial septal defect +split and wide 2nd heart sounds.

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24
Q

General symptoms of a left to right shunt

A

Breathless or asymptomatic

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25
Q

General symptoms of a right to left shunt

A

Cyanosis!

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26
Q

Four cardinal features of tetralogy of fallot

A

Large ventricular septal defect.
Overriding aorta
Subpulmonary stenosis
Right ventricular hypertrophy.

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27
Q

Clinical features in tetralogy of fallot

A

Cyanotic, Toddler squat, Clubbing.
Loud, harsh ejection systolic murmur at the left sternal edge due to pulmonary stenosis.
Antenatal diagnosis

28
Q

Investigations for tetralogy of fallot

A

CXR - small heart, untitled apex and right ventricular hypertrophy = boot shaped, pulmonary artery bay,
ECG = right bundle branch block from RV hypertrophy.
Genetics for 22q deletion.

29
Q

Management of tetralogy of fallot

A

Surgery at 6months of age, may need beta-blocker.

30
Q

Complication of tetralogy of fallot

A

Sudden short severe exacerbations of cyanosis, hypoxia and hypercapnia. Can precipitate MI and stroke.

31
Q

Transposition of the great arteries anatomy

A

Aorta blood flows from right ventricle and the pulmonary artery flows from left ventricle. Usually occurs with a septal defect to allow blood mixing, otherwise it is incompatible for life.

32
Q

Clinical features of transposition of the great arteries

A

Cyanotic, weak pulse, tachycardia, tachypnoea.

Antenatal diagnosis.

33
Q

Investigations for transposition of the great arteries.

A

CXR - narrow upper mediastinum, egg-shaped heart.

Echocardiogram

34
Q

Management of transposition of the great arteries

A

Prostaglandin if septal defect present to keep missing or balloon septostomy.
Surgical correction

35
Q

Eisenmenger syndrome

A

Untreated left to right shunt causes pulmonary arteries to thicken and increase blood flow resistance. Shunt decreases and patient becomes less symptomatic.
In 10-15yrs the shunt reverses and patient becomes cyanotic = Eisenmenger syndrome. Eventually die of right side heart failure.

36
Q

Patients group who commonly have a complete atrioventricular septal defect

A

Down syndrome, trisomy 21

37
Q

Clinical features of complete atrioventricular septal defect

A

Antenatal screening.
Cyanosis and heart failure within first weeks of life.
No murmur
ECG = superior axis

38
Q

Aortic stenosis clinical features

A

Reduced exercise tolerance, chest pain on exertion and syncope.
Carotid thrill
Ejection systolic murmur heard at upper right sternal edge.
Delayed and soft S2
Apical ejection click.

39
Q

Investigations and management of aortic stenosis

A

ECG: left ventricular hypertrophy changes, downing T wave.

Balloon valvotomy.

40
Q

Clinical features of pulmonary stenosis

A

Ejection systolic murmur and click best heart at upper left sternal edge, radiates to back.
Heave if server on right ventricular area.

41
Q

Types of atrial septal defects

A

Secundum = no valve effect
Primum = 3 leaf mitral valve
Sinus venous ASD

42
Q

Coarctation of the aorta pathology

A

Tissue encircles and constricts the aorta usually at area of ductus arteriosus in the aortic arch.

43
Q

Clinical features of coarctation of the aorta

A

Weak femoral pulses, especially compared to brachial pulse. Discrepancy between upper limb and lower limb BP.
Older patients get murmur on back as co-laterals develop.
Severe metabolic acidosis and sick baby if duct has closed.

44
Q

Management of coarctation of the aorta

A

Surgical repair.

45
Q

Those at risk of bacterial endocarditis

A

Congenital heart disease (except sesundum ASD) - create turbulent blood flow in aorta or ductus arteriosus.
prosthetic valve replacement.
Valvular heart disease
Poor oral hygiene.

46
Q

Clinical features of infective endocarditis

A 
Sustained fever
Malaise
Raised ESR
Anaemia
Haematuria (microscopic)
Splinter haemorrhage + clubbing in fingers
Splenomegaly
Rash
47
Q

Main causative organism for infective endocarditis

A

Streptococcus viridians. alpha-haemolytic strep.

48
Q

Investigations for infective endocarditis

A

Raised inflammatory markers
Blood cultures - at least 3 at different times and sites.
Echocardiogram = vegetations made up of fibrin and platelets and infectious organism.

49
Q

Management of infective endocarditis

A

Benzylpenicillin + gentamicin.

50
Q

Prophylaxis of infective endocarditis

A

No routine use of antibiotics.

Educate on good oral hygiene.

51
Q

Diagnostic criteria for rheumatic fever

A

Jones criteria. Need 2 major or 1major+2minor+evidence of preceding infection.

52
Q

Evidence of a preceding group A strep infection

A

Raised ASO titre to show antibodies.
Scarlet fever
Throat swab msc with group A strep

53
Q

Main organism in rheumatic fever and pathophys

A

Rheumatic fever symptoms come on 2-3weeks after a Strep pharyngitis infection. Group A beta-haemolytic strep infections. Susceptible patients have a systemic inflammatory response to the organism.

54
Q

Common age for occurrence of rheumatic fever

A

5-15yrs

55
Q

Major signs for Jones Criteria of Rheumatic heart disease

A 
Carditis
Polyarthritis
Erythema marginatum
Subcut nodules 
Sydenham's chorea
56
Q

Carditis components in rheumatic heart disease

A 
changed murmur
CCF
cardiomegaly
Friction rub
Signs on echocardiogram
57
Q

Minor symptoms in Jones Criteria for rheumatic heart disease

A 
Fever
Arthralgia (pain no swelling)
Prolonged PR interval on ECG
Raised ESR and CRP
Previous rheumatic fever or rheumatic heart disease
58
Q

Histological feature of rheumatic fever on valves

A

MacCallum plaques of Aschoff bodies.

59
Q

Management of rheumatic fever

A

Bed rest.
Aspirin - anti-inflammatory for joints and heart.
Steroids e.g. prednisolone for persistent fever and inflammation.
Phenomoxymethylpenicillin then Benpen for persistent infection.

60
Q

Prophylaxis of rheumatic fever

A

Secondary - phenoxymethylpenicillin prevent reoccurrence.

61
Q

Cardiac pathology and Turner’s

A

Bicuspid aortic valve

Coarctation of aorta

62
Q

Causes of heart failure

A 
critical aortic valve stenosis (left heart obstruction)
hypoplastic left heart syndrome
VSD (left to right shunt)
AVSD
large patent ductus arteriosus
Esinmenger syndrome
Cardiomyopathy
63
Q

CFx of heart failure

A 
breathlessness (on feeding)
sweating
poor feeding
recurrent chest infections
Faltering growth
TP, TC.
Cardiomegaly
Hepatomegaly
Murmur
64
Q

Heave + ejection systolic murmur heard best at the right second interspace which does not radiate

A

Aortic stenosis

65
Q

Regular jerky pulse. The cardiac impulse is hyperdynamic & not displaced. There is a mid-systolic murmur, with no ejection click, loudest at the left sternal edge.

A

Hypertrophic cardiomyopathy

Paediatrics (16 decks)

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