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Sarah Paeds > Cardio > Flashcards

Cardio Flashcards

1
Q

To which group of mothers are infants with congenital heart block most commonly born to?

A

Those with connective tissue disorders

With anti-Ro, anti-La antibodies

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2
Q

Sudden loss of consciousness during exercise, stress or emotion

A

Long QT syndrome

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3
Q

What is the most common cause of cardiac problem in children?

A

Congenital lesion

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4
Q

What are the pressures in the sides of the heart in a fetus?

A

L pressure low (low lung return)

R pressure high (receiving systemic venous return)

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5
Q

What happens at birth in the heart?

A

Foramen ovale closes because pressure builds in L atrium, reduces in R atrium. FO has one way flap

DA also closes as pulmonary artery pressure increases

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6
Q

What is the most common symptom of a L to R shunt?

A

Breathlessness (or asymptomatic) because lungs become congested. Particularly in neonates who are trying to feed

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7
Q

What are three types of L to R shunts?

A

ASD
VSD
PDA

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8
Q

What are two types of ASD?

A

Secundum (80%) - patent foramen ovale

Partial atrioventricular

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9
Q

What are the symptoms of ASD?

A

Largely asymptomatic
Breathlessness
Recurrent infections/wheeze
Later arrhythmias

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10
Q

What are the clinical features of ASD?

A

Breathlessness

ESM (loudest at LUSE)
Split second heart sounds

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11
Q

What are the heart sounds in ASD?

A

ESM loudest at LUSE

Split second heart sound

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12
Q

What are the CXR features of ASD?

A

Enlarged heart
Increased pulmonary vasculature markings
Visible pulmonary arteries

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13
Q

What are the ECG features of ASD?

A

(Increased R sided pressure, RV enlargement)=

  • RBBB
  • RAD
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14
Q

What is the management for ASD?

A

Observation

If there is significant RV dilatation with raised pulmonary pressures, use an occlusive device to “close” the FO

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15
Q

What percentage of congenital heart disease cases are VSD?

A

30%

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16
Q

What are two types of VSD?

A

Small (<3mm e.g. smaller than aortic valve)

Large (>3mm)

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17
Q

What may be heard on auscultation of a child with a small VSD?

A

PSM at LLSE

Quiet P2

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18
Q

What management should be considered in a small VSD?

A

Bacterial endocarditis prevention

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19
Q

How does a large VSD present?

A

HEART FAILURE
SOB, FTT, recurrent chest infections

Tachypnoea, tachycardia,
Hepatomegaly

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20
Q

Auscultation large VSD

A

Soft PSM

Apical MDM

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21
Q

What will be heard on auscultation of a child with a huge VSD?

A

Nothing - no turbulent flow because valve so big

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22
Q

CXR and ECG features of VSD

A

CXR: enlarged heart, increased pulmonary vasculature, pulmonary oedema
ECG: Bilateral ventricular hypertrophy

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23
Q

What is the management for child with large VSD?

A 
Management of heart failure:
- Diuretics (furosemide)
- Captopril 
- Digoxin 
Increased calories (if FTT)
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24
Q

What is a complication of a large VSD?

A

Eisenmenger’s syndrome

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25
Q

What is Eisenmenger’s syndrome?

A

L to R shunt causes pulmonary HTN. Eventually this pressure is raised above L side, and shunt switches to R to L = cyanosis

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26
Q

What are two (broad) causes of PDA?

A

Failure to close (congenital)

Prematurity

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27
Q

What is a persistent ductus arteriosus?

A

Failure of DA to close by 1 mo (generally a defect in constrictor mechanism)

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28
Q

Ausculation child with PDA

A

Continuous murmur loudest beneath L clavicle

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29
Q

What happens to the pulse pressure in PDA?

A

Increased

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30
Q

CXR/ECG features of PDA

A

CXR: often normal but with features of HF if large
ECG: often normal, but LVH, or RVH (if pHTN)

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31
Q

What are children with a PDA at increased risk of?

A

Bacterial endocarditis, pulmonary vascular disease (Eisenmenger’s)

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32
Q

How is a PDA managed?

A

MEDICAL (closure)

  • Prostacyclin synthetase inhibtor
  • IV Indomethacin
  • Ibuprofen
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33
Q

When should a PDA be kept open? How?

A

If there is a duct dependent circulation (e.g. a R to L shunt additionally). Kept open using prostaglandin infusion until that anomaly is sorted

34
Q

What is the commonest presentation of R to L shunts?

A

Cyanosis within the first week of life

35
Q

What is the mainstay of treatment to keep ducts open?

A

Prostaglandin infusion

36
Q

How is a cyanotic heart disease investigated?

A

Nitrogen washout test.
Measure R radial PaO2.
If <15 kPa, cyanotic heart disease

37
Q

What are two examples of R to L shunts?

A

Tetralogy of Fallot

Transposition of the Great Arteries

38
Q

What is the commonest cause of cyanotic heart disease?

A

Tetralogy of fallot

39
Q

What are the four anatomical features of tetralogy of fallot?

A

Large VSD
Pulmonary stenosis
Aorta lies over ventricular septum
Resulting RVH

40
Q

What are four physiological features of ToF?

A

Cyanosis
Hypercyanotic spells
Dyspnoea
Fainting

41
Q

Two clinical features of ToF?

A

Clubbing

Loud ESM at LSE

42
Q

CXR/ECG features of ToF

A

CXR: small heart, uplifted apex, pulmonary artery “bay”
ECG: RVH (no S wave)

43
Q

Medical management of ToF

A

Hypercyanotic spells lasting >15 mins

  • Knees to chest in parent’s arms
  • Sedation/pain relief
  • IV propranolol
  • IVI
  • HCO3- to correct acidosis
  • Artifical ventilation to reduce metabolic demand

(With view to surgery at 6 mos)

44
Q

Surgical management of ToF

A

Close VD, relieve obstruction

45
Q

What happens in transposition of great arteries?

A

Essentially two parallel circulations (R-R and L-L).

Incompatible with life WITHOUT an open duct

46
Q

Ausculation TOGA

A

Loud, single S2

47
Q

CXR/ECG TOGA

A

CXR: egg shaped heart on side
ECG: normal

48
Q

Management of TOGA

A

Improve mixing -
PROSTAGLANDIN INFUSION to keep ducts open

Ballon septostomy to keep ducts open

49
Q

In what syndrome is AVSD quite common?

A

Down’s

50
Q

What happens in tricuspid atresia?

A

Right ventricle is small and non function.

Mixing occurs through patient foramen ovale (in L ventricle) and patient VSD allows blood out pulmonary artery

51
Q

What is the management for triscupid atresia?

A

KEEP DUCTS OPEN - prostaglandin infusion

Blalock Taussig - shunt insertion from subclavian to pulmonary

52
Q

Clinical features of AS?

A

ESM radiating to carotid
Carotid thrills
Slow rising pulse

  • Dyspnoea
  • Syncope
  • Chest pain
    (All worse on exercise)
53
Q

CXR/ECG features of AS

A

CXR: enlarged heart (LV). Dilatation of ascending aorta
ECG: LVH

54
Q

Management for AS

A

Regular clinical/ECHO monitoring
Balloon valvulotomy (TAVR)
Antibiotic/anticoagulant prophylaxis

55
Q

Ausculation PS

A

ESM UPLSE

56
Q

Give three examples of outflow obstruction in sick infant

A
  • Coarctation of aorta
  • Interruption of aortic arch
  • Hypoplastic L heart
57
Q

What is the mainstay of treatment in outflow obstructions?

A

Prostaglandin infusions to keep ducts patent for mixing

58
Q

When does coarctation of aorta present?

A

2 days (when DA closes)

59
Q

Clinical features of coarctation of aorta?

A

Absent femoral pulse
Severe metabolic acidosis
Severe heart failure

60
Q

Whcih syndrome is interruption of aortic arch associated with?

A

Di George

61
Q

What is interruption of aortic arch codependent on?

A

PDA (R to L shunt)

62
Q

Clinical features of hypoplastic left heart syndrome

A

All peripheral pulses absent

63
Q

Commonest childhood arrhythmia

A

SVT

64
Q

SVT acute management

A

Circ and resp support
Vasovagal manoevres - carotid sinus massage, cold ice pack on face, bear down
ADENOSINE (IV/IO)
Synchronised DC

65
Q

SVT maintenance management

A

Fleicanide

Propranolol

66
Q

Clinical features SVT

A

Reduced CO = pulmonary oedema

Hydrops fetalis
IUD

67
Q

What symptoms are suggestive of a cardiac cause of syncope?

A

Arrythmias
Symptoms on exercise
FHx sudden unexplained death

68
Q

How can vasovagal syncope be managed?

A

Look out for warning signs
Avoid triggers
Physical counter pressure manoeuvres, tilt training

May need to increased salt (consider furosemide) to improve volume

69
Q

How long is the latent interval in RhF?

A

2-6 weeks

70
Q

Which infection does RhF follow?

A

GA haemolytic strep

71
Q

Age range of RhF?

A

5-15 years

72
Q

Major criteria RhF

A 
Carditis/murmur 
Arthritis 
S/c nodules 
Erythema marginatum (map-like)
Sydenham's chorea (2-6mos after)
73
Q

Minor criteria RhF

A 
Arthralgia 
Fever 
Hx RhF 
Raised APPs (ESR/CRP)
Prolonged PR interval
74
Q

Acute management of RhF

A

Bed rest and anti-inflammatories (ASPIRIN)

75
Q

How is RhF prevented from recurring?

A

Benzathine penicillin (monthly)

76
Q

What might congenital heart disease raise the risk of?

A

Bacterial endocarditis

77
Q

Features of bacterial endocarditis

A
  • Fever (prolonged)
  • Malaise
  • New murmur
  • Raised ESR
  • Unexplained anaemia/haematuria
  • Splinter haemorrhages, JWL, ON, clubbing
  • Roth spots
78
Q

Investigations fof suspected BE?

A

2 blood cultures BEFORE abx

Echo (vegetations)

79
Q

Commonest causative organisms in BE?

A

Strep viridans

80
Q

Management of BE?

A

Resuscitation

Abx (penicillin and gentamicin)

81
Q

Commonest congenital heart defect

A

VSD

82
Q

Second commonest congenital heart defect

A

PDA

Sarah Paeds (20 decks)

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