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Y4: Paeds > Cardio > Flashcards

Cardio Flashcards

1
Q

How do left to right shunts present?

A

Breathless (left to right - think water on the lungs)

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2
Q

How do right to left shunts present?

A

Blue (right to left - think blood not being oxygenated)

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3
Q

How does common mixing present?

A

breathless and blue

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4
Q

How does outflow obstruction in a well child present?

A

asymptomatic with murmur

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5
Q

How does outflow obstruction in a sick neonate present?

A

collapsed with shock

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6
Q

Causes of left-to-right shunts

A
  • VSD
  • PDA
  • ASD
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7
Q

Causes of right-to-left shunts

A
  • TOF
  • TGA
  • Eisenmenger
  • other ‘Ts’
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8
Q

Causes of outflow obstruction in a well child

A
  • PS
  • AS
  • adult-type CoA
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9
Q

Causes of outflow obstruction in a sick neonate

A
  • CoA

- HLHS

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10
Q

Features of an innocent murmur

A

InnoSent

  • aSymptomatic
  • Soft blowing murmur
  • Systolic only (not diastolic)
  • left Sternal edge
  • no added sounds
  • no radiation
  • no thrill
  • normal exam inc. femoral pulses
  • normal sats
  • normal ECG
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11
Q

When to refer day 1 murmurs

A
  • symptomatic
  • loud (esp. day 2 of life)
  • abnormal exam (inc. syndromic)
  • sats <94%
  • abnormal ECG
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12
Q

What is heart failure in the first few weeks of life normally due to?

A

left heart obstruction

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13
Q

What is heart failure in infants normally due to?

A

left to right shunt

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14
Q

When can cyanosis be missed?

A

anaemia (central cyanosis will not be visible)

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15
Q

Ix for suspected congenital heart disease

A

Echo + Doppler US (+ ECG + CXR)

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16
Q

Presentation/examination of ASD

A
  • usually asymptomatic
  • soft ESM at ULSE (over pulmonary valve) due to increased flow through PV from left-to-right shunt
  • fixed and widely split S2

With primum ASD (partial AVSD): apical pansystolic murmur from AV regurg

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17
Q

What is a partial AVSD the same as?

A

primum ASD

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18
Q

Management of ASD

A

secundum: cardiac catherization + occlusion device

primum (partial AVSD): surgical correction at 3-5yrs

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19
Q

Presentation and exam of VSD

A

Small:

  • asymptomatic
  • loud pansystolic murmur
  • soft P2

Large:

  • heart failure (SOB, faltering growth) from 1 weeks
  • recurrent chest infections
  • soft pansystolic murmur
  • loud P2
  • thrill
  • apical mid-diastolic murmur
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20
Q

Management of VSD

A

Small: close spontaneously
Large: diuretics ± captopril (ACEi), additional calorie input, surgery at 3-6 months

21
Q

When is a ductus arteriosus ‘persistent’?

A

failure to close by 1 month of EDD

22
Q

Presentation and exam of PDA

A
  • usually asymptomatic
  • if large: pulmonary HTN, heart failure
  • most have continuous ‘machinery murmur’ below left clavicle at ULSE
  • increased pulse pressure, collapsing or bounding pulse
23
Q

Management of PDA

A
  • close with coil or occlusion device via cardiac catheter at 1yr
  • occasionally surgical ligation needed
24
Q

What test should be performed in cyanotic neonates?

A

hyperoxia (nitrogen washout test) - place infant in 100% O2 for 10mins
- if right radial artery PaO2 remains low - diagnose cyanotic congenital heart disease (if lung disease/persistent pulmonary HTN ruled out)

25
Q

Management of a cyanosed neonate

A
  1. ABCDE

2. prostaglandin infusion to keep DA patent

26
Q

4 features of Tetralogy of Fallot

A
  1. large VSD
  2. over-riding aorta (lies over VSD)
  3. (sub)pulmonary stenosis
  4. RV hypertrophy
27
Q

Presentation features (not really presentation) of TOF

A

usually detected antenatally, or following detection of murmur in first 2 months of life +/- cyanosis

  • ‘Tet’ spells (hypercyanotic spells)
  • loud, harsh ESM at left sternal edge from day 1 of life
  • boot-shaped heart on CXR
28
Q

Management of TOF

A
  • surgical repair around 6months

- treatment of prolonged (>15mins) tet spells

29
Q

Treatment of prolonged (>15mins) tet spells

A
  • hold knees up/let them squat
  • sedation, analgesia
  • IV propranolol
  • IV fluids
  • bicarbonate to correct acidosis
  • muscle paralysis + artificial ventilation to reduce metabolic demand
30
Q

Presentation of TOF

A
  • usually day 2 of life when DA closes
  • severe cyanosis (less severe if more mixing of blood from associated anomalies)
  • usually no murmur
31
Q

Management of TOF

A
  • prostaglandin infusion to keep DA parent
  • balloon atrial septostomy
  • surgery (arterial switch procedure) in neonatal period (first few days of life)
32
Q

What is Eisenmenger syndrome

A

right to left shunt secondary to high pulmonary blood flow and hypertension, cause by left to right shunt/common mixing (if not treated early enough)

33
Q

Presentation of Eisenmenger syndrome

A
  • 10-15yrs
  • LESS symptomatic of original problem (left-to-right/common mixing)
  • cyanosis
  • progressive, will die of right heart failure if untreated
34
Q

Management of Eisenmenger syndrome

A
  • palliative medication

- heart-lung transplant

35
Q

Presentation of complete AVSD

A
  • cyanosis at birth or heart failure at 2-3 weeks of life
  • no murmur
  • most commonly seen in Down’s syndrome
36
Q

Management of complete AVSD

A
  • treat heart failure medically

- surgical repair at 3-6 months

37
Q

Presentation of aortic stenosis

A
  • asymptomatic
  • ESM at URSE, radiating to the neck
  • always also a carotid thrill
  • if severe: reduced exercise tolerance, chest pain on exertion, syncope
  • if critical: heart failure and shock as neonate
38
Q

Management of aortic stenosis

A
  • regular assessment and echo to decide when to intervene (safer in older children)
  • balloon dilatation (valvotomy) when severe
  • may eventually need valve replacement
39
Q

Presentation of pulmonary stenosis

A
  • asymptomatic
  • ESM at ULSE
  • may have a thrill
40
Q

Management of pulmonary stenosis

A
  • regular assessment and echo to decide when to intervene (safer in older children)
  • balloon dilatation (valvotomy) when severe
  • may eventually need valve replacement
41
Q

What does a boot-shaped heart on CXR suggest?

A

Tetralogy of Fallot (TOF)

42
Q

What does an egg-on-string heart on CXR suggest?

A

Transposition of the great arteries (TGA)

43
Q

What is seen on ECG in WPW

A
  • short PR interval

- delta wave

44
Q

What should you advise patients with congenital heart disease/prostheses?

And which is the exception

A
  • risk of IE
  • good dental hygiene
  • avoidance of tattoos and piercings

Exception is secundum ASD

45
Q

What age does Kawasaki disease affect

A

any age, predominantly 6m-5y, peak onset 1st year of life

46
Q

Diagnosis of Kawasaki disease

A

Fever >5 days plus 4 of:

  • lymphadenopathy
  • rash
  • mucositis (strawberry tongue, cracked lips)
  • conjunctivitis (non-purulent)
  • extremity involvement (red, peeling finger tips)
47
Q

Management of Kawasaki disease

A
  • ECHO
  • 10mg/kg/6hr (high dose) aspirin until fever subsides
  • IV Ig 2g/kg
  • low dose aspirin when fever abates (around day 10)
  • echo at 6 weeks
  • if giant coronary aneurysm: may need long-term warfarin and close F/U
48
Q

What does a machinery murmur at the ULSE suggest?

A

PDA

Y4: Paeds (7 decks)

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