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paeds > cardio > Flashcards

cardio Flashcards

1
Q

What does left to right shunt present as?

give some causes

A

Breathlessness
ASD
VSD
Persistent duct

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2
Q

What does right to left shunt present as?

what are some causes?

A

BLUE
tetralogy of fallot
transposition of great arteries

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3
Q

What is the cause of a common mixing condition?

A

complete AVSD

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4
Q

What are the hallmarks of innocent ejetion murmur

A 
innoSent 
Asymtpomatic
Soft and blowing
Left sternal edge
systolic
AND -
No parasternal thrill
no radiation
no additional heart sounds
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5
Q

Symtpoms + signs of HF

A

symptoms: breathless, sweaty, recurrent chest infections, poor feding
signs: tachypnoea, gallop rhythm, murmur, enlarged heart

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6
Q

Causes of HF in neonates

A 
caused by duct dependent circulation
hypoplastic LH syndrome
aortic valve stenosis
coarctation of aorta
interruption of aortic arch
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7
Q

Causes of HF in infants

A

caused by high pulmonary blood flow
VSD
ASD
large persistent DA

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8
Q

cause of HF in older children

A

caused by right/left heart failure
Eisenmeger syndrome (RHF only)
cardiomyopathy
rheumatic heart disease

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9
Q

What is eisenmeger syndrome

A

L –> R shunt is left untreated
leads to increased pulmonary blood flow
pulmonary hypertension
reversal to R –> L shunt causing cyanosis

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10
Q

Mx of HF

A

Reduce preload - diuretics (furosemide), venous dilators (nitroglycerin)
enhance contractility - IV dopamine, digoxin, dobutamine
reduce afterload - ACEi, IV hydralazine/nitroprusside
improve o2 delivery - beta blockers
enhance nutrition

If it’s due to circulation through malformation do prostaglandin infusion to keep duct open

  1. no tx
  2. ACEi/ARB
  3. ACEi + mineralocrticoid antagonist (+ diuretic + beta blocker)
  4. IV inotropes and diuretics
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11
Q

Causes of cyanosis in children

A 
CARDIO:
persistent cyanosis in healthy kid - 
structural heart defet
persisten cyanosis + resp problems - 
congenital cardiac problem
RESP:
 RDS, pulmonary hypoplasia, meconium aspiration
persistent pulmonary hypertension
OTHER:
infection
inborn error of metabolism
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12
Q

What are the 2 types of ASD

A

Secundum - problem in the middle of the atrial septum, this involves foramen ovale
primum (partial AVSD) - defect in the atrioventricular septum

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13
Q

Signs of ASD

A

Fixed splitting of 2nd heart sound
ejection systolic murmur heard best at left sternal edge (due to L to R shunt)
AVSD gets a pansystolic murmur

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14
Q

CXR features of ASD

A

cardiomegaly and enlarged pulmonary arteries and markings

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15
Q

ECG features of ASD

A

secundum - RBBB + RAD

primum - superior QRS as av node is displaced so conducts superiorly

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16
Q

Mx of ASD

A 
measure pulmonary to systemic blood flow
<1.5 nothing
>1.5 it's big enough to damage RA so:
secundum - catheter and correction 
primum - surgical
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17
Q

symptoms + signs of VSD

A

Small are asymptomatic
Large:
HF, breathlessness etc.
tachypnoea, tachycardia, hepatomegaly due to HF, large precordium

pansystolic murmur heard best at left lower sternal edge
loud murmur implies smaller defect
loud pulmonary second sound

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18
Q

ECG and CXR changes in VSD

A

Large:
CXR - cardiomegaly, pulmonary oedema (HF)
ECG - biventricular hypertrophy

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19
Q

Mx of VSD

A

small:
close spontaneously - ensure good dental hygiene so don’t get bacterial endocarditis (can give prophylactic amoxicillin to those at high risk)

Large-
treat HF
prevent eisenmeger
tx surgically at 3-6 months

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20
Q

Definitio of PDA

A

failure to close at 1 month after expected due date

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21
Q

Signs of PDA

A

Continuous murmur under left clavicle
High pulse pressure
bounding pulse (caused by high pulse pressure)

Can get left to right shunt causing vent. hypertrophy, pulmonary HTN etc.

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22
Q

Mx of PDA

A

Close it

  1. IV indomethacin
  2. prostacycin synthetase inhibitor
  3. ibuprofem

SURGICAL LIGATION

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23
Q

Components of tetralogy of fallot (TOF)

A

large VSD
overriding aorta (with respect to septum)
right outflow tract obstruction
right ventricular hypertrophy

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24
Q

Signs of TOF

A

Cyanosis
HYPERCYANOTIC SPELLS
squatting on exercise

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25
Q

What conditions do you have to exclude when doing nitrogen washout test

A

Persistent pulmonary HTN

lung disease

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26
Q

Mx of cyanosed infant

A

ABC

Prostaglandin infusion to maintain duct patency

27
Q

Signs of TOF

A

harsh ejection systolic murmur on left sternal edge

CLUBBING

28
Q

CXR signs of TOF

A

axis tilted to R
Pulmonary bay where pulmonary arteries should be
decreased pulmonary vasc. markings

29
Q

Mx TOF

and mx of cyanotic spells

A

If bad cyanosis - PG infusion
surgery to repair

for hypercyanotic spells -
knee to chest position
administer o2
IV line and give morphine and a peripheral vasoconstrictor

30
Q

Signs of transposition

A

Cyanosis on day 2 when duct closes
loud single 2nd heart sound
rarely a murmur

31
Q

CXR signs of transposition

A

Increased pulmonary vasculature

32
Q

Mx of transposition

A

PG E1 infusion

balloon atrial septostomy

33
Q

What condition is complete AVSD associated with

A

Down’s syndrome

34
Q

features of AVSD

A

pulmonary HTN
cyanosis at birth or HF at 2-3 weeks
ALWAYS have superior ECG axis

35
Q

What happens in tricuspid atresia

A

RV doesn’t work, only left side of heart

36
Q

Features of tricuspid atresia

A

CYANOTIC

Risk high pulmonary pressure

37
Q

mx of tricuspid atresia

A

PG infusion
need to ensure blood flow to lungs at low pressure
3 stage surgical procedure at diff ages

38
Q

4 examples of complex congenital heart disease

A

tricuspid atresia (most common)
mitral atresia
double inlet LV
common arterial trunk

39
Q

What is aortic stenosis commonly associated with

A

mitral stenosis

coarctation of aorta

40
Q

Signs and symptoms of aortic stenosis

A

Reduced exercise tolerance
chest pain
syncope (if severe)

Slow rising pulse
carotid thrill (ALWAYS)
EJECTION SYSTOLIC MURMUR at R sternal edge

41
Q

Signs of pulmonary stenosis

A

Usually asymptomatic but can be a bit cyanotic

ejection systolic and CLICK murmur at L sternal edge
parasternal heave

42
Q

Signs of adult type coarctation of aorta

A 
Gets worse over time 
Hypertensio in right arm 
radio-femoral delay
ejection systolic murmur (outflow obstruction)
rib notching
43
Q

How to manage outflow obstructions

A

Prostglandin infusions til you can operate

44
Q

Signs of neonatal coarctation

A

Present with circulatory collapse at 2 days when ductus closes
absent femorals
severe metabolic acidosis

45
Q

What is interruption of aortic arch

A

no connection between proximal aorta and distal to ductus arteriosus
Circulation through ductus arteriosus
associated with VSD

46
Q

What is hypoplastic left heart associated with

A

Coarctation of aorta
get severe acidosis and complete circulatory collapse
no peripheral pulses

47
Q

Why are arrhythmias in childhood normal

A

HR changes with breathing
inspiration - acceleration
expiration - decceleration

48
Q

How does SVT present

A 
HR can spike to 250-300bpm 
narrow complex tachy
no P waves
delta waves if WPW
(can cause hydrops foetalis in utero)
49
Q

Mx of SVT

A

If haemodynamically stable:

  1. vagal manoeuvres
  2. adenosine (50-100mcg) then increment dose
  3. choice of: DC cardioversion, fleicanide, amiodarone

If haemodynamically unstable:
try vagal manoeuvres and adenosine but do DC CARDIOVERSION ASAP

Cardiac ablation if recurrent/accessory pathways

50
Q

How does long QT present

A

Syncope
often late childhood
mistaken for epilepsy

51
Q

What causes syncope in children

A

Neural - certain stressors, standing up too quickly
get dizziness, pallor, abnormal vision

cardiac -
electrical - arrhythmia
structural - HOCM etc.
symptoms worse on exercise, breathlessness etc.

52
Q

What is rheumatic fever

A

AI response to infection with group a b haemolysing strep

it is an acute disease but can progress to chronic in 80% of cases

53
Q

Symptoms of rheumatic fever

A

Polyarthritis, myalgia, malaise

chronic sequelae - mitral stenosis leading to heart failure

54
Q

How do you diagnose rheumatic fever

A

Jones criteria

55
Q

Mx rheumatic fever

A

Acute: aspirin
Symptomatic HF: diuretics, ACE i

Prophylaxis: monthly injections of benzylpenicillin

56
Q

Who should you suspect endocarditis in

A

Raised ESR, unexplained anaemia, sustained fever, haematuria

57
Q

Signs of bacterial endocarditis

A 
NEW MURMUR
fever
anemia 
splinter haemorrhages
clubbing
Pancarditis (valve problems, carditis, pericardial effusions)
58
Q

Diagnosis of bacterial endocarditis

A

2 major criteria or 1 major and 2 minor (w/ evidence of preceding group a strep infection)
Major -
pancarditis
polyarthritis (ankle and knees)
sydenham chorea (jerky movements 2-6 months after)
erythema marginatum (on trunk and limbs)
subcutaneous nodules (extensor surfaces)

Minor-
fever
polyarthralgia
Hx rheumatic fever
raised APP
prolonged PR on ECG
59
Q

Causes of bacterial endocarditis

A

Staph a.
strep viridans (biggest cause - alpha haemolytic strep)
enterococcus

60
Q

Ix bacterial endocarditis

A

Multiple blood cultures BEFORE ABx STARTED

detailed echo

61
Q

mx bacterial endocarditis

A

Give Ab prophylaxis if at high risk (pt with prosthetic valve, patients with hx of infective endocarditis, patients with congenital heart disease)

MDT approach
Tx depending on native or prosthetic valves
if strep viridans - beta-lactam +/- gent
if staph a - beta-lactam

Surgery to remove infected prosthetic material

62
Q

types of pulmonary HTN

A

arterial HTN - persistent shunt, persistent pulmonary infection of newborn
venous HTN - occlusion, LH failure
HTN w/ resp disease - chronic obstructive disease, bronchopulmonary dysplasia, interstitial lung disease

63
Q

How do outflow obstructions present (what are the two kinds?)
And what causes them?

A

Outflow obstruction in well child - asymtpomatic w/ murmur
e.g. pulmonary stenosis, aortic stenosis
outflow obstruction in sick child - collapsed + shock
e.g. coarctation of aorta

paeds (19 decks)

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