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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
What conditions do you have to exclude when doing nitrogen washout test
Persistent pulmonary HTN | lung disease
26
Mx of cyanosed infant
ABC | Prostaglandin infusion to maintain duct patency
27
Signs of TOF
harsh ejection systolic murmur on left sternal edge | CLUBBING
28
CXR signs of TOF
axis tilted to R Pulmonary bay where pulmonary arteries should be decreased pulmonary vasc. markings
29
Mx TOF and mx of cyanotic spells
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
Signs of transposition
Cyanosis on day 2 when duct closes loud single 2nd heart sound rarely a murmur
31
CXR signs of transposition
Increased pulmonary vasculature
32
Mx of transposition
PG E1 infusion | balloon atrial septostomy
33
What condition is complete AVSD associated with
Down's syndrome
34
features of AVSD
pulmonary HTN cyanosis at birth or HF at 2-3 weeks ALWAYS have superior ECG axis
35
What happens in tricuspid atresia
RV doesn't work, only left side of heart
36
Features of tricuspid atresia
CYANOTIC | Risk high pulmonary pressure
37
mx of tricuspid atresia
PG infusion need to ensure blood flow to lungs at low pressure 3 stage surgical procedure at diff ages
38
4 examples of complex congenital heart disease
tricuspid atresia (most common) mitral atresia double inlet LV common arterial trunk
39
What is aortic stenosis commonly associated with
mitral stenosis | coarctation of aorta
40
Signs and symptoms of aortic stenosis
Reduced exercise tolerance chest pain syncope (if severe) Slow rising pulse carotid thrill (ALWAYS) EJECTION SYSTOLIC MURMUR at R sternal edge
41
Signs of pulmonary stenosis
Usually asymptomatic but can be a bit cyanotic ejection systolic and CLICK murmur at L sternal edge parasternal heave
42
Signs of adult type coarctation of aorta
``` Gets worse over time Hypertensio in right arm radio-femoral delay ejection systolic murmur (outflow obstruction) rib notching ```
43
How to manage outflow obstructions
Prostglandin infusions til you can operate
44
Signs of neonatal coarctation
Present with circulatory collapse at 2 days when ductus closes absent femorals severe metabolic acidosis
45
What is interruption of aortic arch
no connection between proximal aorta and distal to ductus arteriosus Circulation through ductus arteriosus associated with VSD
46
What is hypoplastic left heart associated with
Coarctation of aorta get severe acidosis and complete circulatory collapse no peripheral pulses
47
Why are arrhythmias in childhood normal
HR changes with breathing inspiration - acceleration expiration - decceleration
48
How does SVT present
``` HR can spike to 250-300bpm narrow complex tachy no P waves delta waves if WPW (can cause hydrops foetalis in utero) ```
49
Mx of SVT
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
How does long QT present
Syncope often late childhood mistaken for epilepsy
51
What causes syncope in children
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
What is rheumatic fever
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
Symptoms of rheumatic fever
Polyarthritis, myalgia, malaise | chronic sequelae - mitral stenosis leading to heart failure
54
How do you diagnose rheumatic fever
Jones criteria
55
Mx rheumatic fever
Acute: aspirin Symptomatic HF: diuretics, ACE i Prophylaxis: monthly injections of benzylpenicillin
56
Who should you suspect endocarditis in
Raised ESR, unexplained anaemia, sustained fever, haematuria
57
Signs of bacterial endocarditis
``` NEW MURMUR fever anemia splinter haemorrhages clubbing Pancarditis (valve problems, carditis, pericardial effusions) ```
58
Diagnosis of bacterial endocarditis
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
Causes of bacterial endocarditis
Staph a. strep viridans (biggest cause - alpha haemolytic strep) enterococcus
60
Ix bacterial endocarditis
Multiple blood cultures BEFORE ABx STARTED | detailed echo
61
mx bacterial endocarditis
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
types of pulmonary HTN
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
How do outflow obstructions present (what are the two kinds?) And what causes them?
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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