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paediatrics > cardio > Flashcards

cardio Flashcards

1
Q

what type of murmur is Turner’s syndrome associated with?

A

ejection systolic murmur due to bicuspid aortic valve

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2
Q

The consultant asks you to examine a 3-week-old girl on the neonatal ward. She was born prematurely at 27 weeks gestation. She is pink in colour and warm to touch, developing well and gaining weight appropriately. She is currently saturating well on oxygen and her lungs sound clear. On auscultation of her heart, you detect a continuous machinery murmur over the upper left sternal edge. The murmur does not vary with position or radiate.

Which murmur is this most likely to reflect?

A

Patent ductus arteriosus: machinery murmur at the upper left sternal edge

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3
Q

what is the ductus arteriosus?

A

A connection between the pulmonary artery and the aorta to allow blood to bypass the lungs in utero. It usually closes by 2 days after birth.

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4
Q

ejection systolic murmur over the left upper sternal edge

A

Pulmonary stenosis

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5
Q

systolic murmur in the left infraclavicular area and under the left scapula

A

coarctation of the aorta

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6
Q

murmurs typical of pulmonary stenosis and sometimes VSD and usually presents with hypercyanotic episodes around 1 month after birth

A

Tetralogy of Fallot

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7
Q

what are the types of innocent murmurs heard in children?

A
  1. ejection murmurs
  2. venous hums
  3. Still’s murmur
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8
Q

what is an ejection murmur?

A

due to turbulent blood flow at the outflow tract of the heart

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9
Q

what are characteristics of an innocent ejection murmur?

A
  • soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
  • may vary with posture
  • localised with no radiation
  • no diastolic component
  • no thrill
  • no added sounds (e.g. clicks)
  • asymptomatic child
  • no other abnormality
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10
Q

what is a venous hum?

A

due to turbulent blood flow in the great veins returning to the heart.

heard as a continuous blowing noise just below the clavicles.

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11
Q

what is a Still’s murmur?

A

Low-pitched sound heard at the lower left sternal edge

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12
Q

Cyanotic congenital heart disease presenting within the first days of life is…?

A

TGA

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13
Q

Cyanotic congenital heart disease presenting at 1-2 months of age is…?

A

TOF

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14
Q

what are the components of TOF?

A
  1. VSD
  2. Right ventricular hypertrophy
  3. Right ventricular outflow obstruction (pulmonary stenosis) – responsible for the ESM heard
  4. Overriding aorta
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15
Q

what is the classical CXR and ECG finding of TOF?

A

CXR: “boot-shaped” heart
ECG: RVH

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16
Q

what is the definitive mx for TOF?

A

surgical repair (around 6-months of age)

cyanotic spells are managed with b-blockers (to reduce infundibular spasm and thus prevent worsening of RV outflow obstruction).

17
Q

what are the causes of cyanotic congenital heart disease?

A
  1. tetralogy of Fallot (TOF)
  2. transposition of the great arteries (TGA)
  3. tricuspid atresia
18
Q

what is used in patent ductus arteriosus (PDA) to promote duct closure?

A

indomethacin or ibuprofen

inhibits prostaglandin synthesis

closes the connection

19
Q

what is used to keep the ductus ateriosus present?

A

prostaglandin E2

indicated in complex congenital heart defects where a shunt is necessary to maintain life (e.g. TGA)

20
Q

what is Turner’s syndrome associated with?

A

aortic coarctation and bicuspid aortic valve

21
Q

what are the common causes of acyanotic heart disease?

A
  1. VSD
  2. ASD
  3. PDA
  4. coarctation of the aorta
  5. aortic valve stenosis
22
Q

what is transposition of the great arteries (TGA)?

A

a form of cyanotic congenital heart disease, caused by failure of aorticopulmonary septum to spiral during septation

23
Q

who are at an increased risk of TGA?

A

children of diabetic mothers

24
Q

what are the basic anatomical changes in TGA?

A
  • aorta leaves right ventricle

- pulmonary trunk leaves left ventricle

25
Q

what are the clinical features of TGA?

A
  • cyanosis
  • tachypnoea
  • loud single S2
  • prominent right ventricular impulse
  • ‘egg-on-side’ appearance on CXR
26
Q

what is the mx for TGA?

A
  • maintenance of the ductus arteriosus with prostaglandins

- definitive: surgical correction

27
Q

what is an Ebstein’s anomaly?

A

a congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle – “atrialisation” of the right ventricle

28
Q

what may Ebstein’s anomaly be caused by?

A

exposure to lithium in-utero

29
Q

what is Ebstein’s anomaly associated with?

A
  • patent foramen ovale (PFO) or ASD, resulting in a shunt between right and left atria
  • Wolff-Parkinson White syndrome
30
Q

what are the clinical features of Ebstein’s anomaly?

A
  • cyanosis
  • prominent ‘a’ wave in the distended jugular venous pulse
  • hepatomegaly
  • tricuspid regurgitation (PSM, worse on inspiration)
  • RBBB → widely split S1 and S2

paediatrics (23 decks)

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