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* Paediatrics > Cardio - congenital heart defects > Flashcards

Cardio - congenital heart defects Flashcards

1
Q

What does rubella increase the risk of - in terms of congenital heart defects?

A

PDA

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2
Q

What does SLE increase the risk of - in terms of congenital heart defects?

A

complete heart block

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3
Q

What does diabetes increase the risk of - in terms of congenital heart defects?

A

increased likelihood of any abnormality

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4
Q

What does mum taking warfarin during pregnancy increase the risk of - in terms of congenital heart defects?

A

pulmonary stenosis

PDA

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5
Q

What does mum drinking alcohol during pregnancy increase the risk of - in terms of congenital heart defects?

A

fetal alcohol syndrome:
ASD
VSD
tetralogy of Fallot

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6
Q

What does Down syndrome increase the risk of - in terms of congenital heart defects?

A

atrioventricular septal defect

VSD

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7
Q

What does Turner syndrome increase the risk of - in terms of congenital heart defects?

A

aortic valve stenosis

coarctation of the aorta

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8
Q

Name 5 cyanotic heart diseases

A

1-5 T’s!

1) Truncus arteriosus (aorta and pulmonary artery arise as one vessel)
2) transposition of the great arteries
3) tricuspid atresia
4) tetralogy of Fallot
5) total anomalous pulmonary venous return (pulmonary veins go into RIGHT atrium, not left)

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9
Q

name 3 non-cyanotic congenital heart defects (holes)

and 3 non-cyanotic congenital heart defects (obstructions)

A

ventricular septal defect
atrial septal defect
patent ductus arteriosus

pulmonary stenosis
aortic stenosis
coarctation of the aorta

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10
Q

ventricular septal defect

how and when does it present?

A

if big - breathless, failure to thrive, heart failure - enlarged liver - ^RR ^HR

pansystolic murmur - louder when VSD is SMALLER - small ones tend to close by themselves (and be asymptomatic)

presents, if big, breathless after 1 week, if not within a few weeks of birth

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11
Q

ventricular septal defect - management

A

ECG/ECHO
small - close spontaneously
big - treat heart failure (captopril and diuretics), extra calories
surgery at 3-6 months

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12
Q

what’s the risk of untreated right to left shunt with pulmonary hypertension - in VSD’s?

A

Eisenmenger syndrome - where the shunt reverses to right to left.
Will die in 40s-50s
patient turns blue - cyanotic

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13
Q

atrial septal defect - overview of the two types

A

secundum ASD where the septum secundum doestnt develop properly - this is 80% of ASDs and 10-15% all heart defects
primum ASD the septum primum doesnt go all the way down - common id Down syndrome

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14
Q

atrial septal defect - presentation

A

often asymptomatic, but recurrent chest infections
ejection systolic murmur heard best at upper left sternal edge (pulmonary stenosis murmur)

cardiomegaly
ECG changes - right ventricular enlargement (R axis dev) - [secundum ASD]

ECHO for diagnosis

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15
Q

when is ASD treated surgically

A

if large, cardiac catheterisation with occlusion device for hole
done between 3-5 years of age
(otherwise Right heart failure/arrhythmias later)

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16
Q

patent ductus arteriosus - presentation

A

normal in preterms because it hasnt closed yet
expected to close in first month

continuous murmur, collapsing pulse
asymptomatic (if v bad - HF/pul. HTN)

closed to prevent endocarditis with catheter or ibuprofen

ECHO to see it

17
Q

heart murmurs in newborn - what are characteristics of an innocent murmur?

A

asymptomatic
slow blowing murmur
left sternal edge
systolic only

normal hearts sounds, no thrills or radiation

often heard infebrile illness/anaemia - because of increased cardiac output

18
Q

clinical features of heart failure in kids

A

breathless - on feeding/exertion (poor feeding)
sweaty - unusual for kids otherwise
recurrent chest infections

poor weight gain
^RR ^HR
heart murmur - gallop rhythm
cardiomegaly, hepatomegaly
cool peripheries
19
Q

differentials for cyanosis and ^RR in newborn

A

cyanotic congenital heart disease
respiratory distress syndrome (surfactant deficiency)
meconium aspiration
infection - GBS sepsis
inborn error of metabolism (metabolic acidosis and shock)

to see if there is a heart disease - nitrogen washout - put in 100% O2 to see if blood gas is still low in O2 - cyanotic heart disease if so

20
Q

management of cyanosed neonate

A

ABC
Prostaglandin IV
SEs- apnoea, jittery, seizures, flushing, vasodilation, hyotension

21
Q

tetralogy of Fallot - 4 components

A

large VSD
overriding aorta (outflow obstruction)
pulmonary stenosis [which causes..)
right ventricular hypertrophy

22
Q

presentation of tetralogy of Fallot

A

cyanosis soon after birth
hypercyanotic spells - squatting on exercise when older - these can cause MI, stroke - they cry lots, irritable, breathless and pale

older get clubbing
harsh ejection systolic murmur at upper left sternal edge from day 1

ECHO

23
Q

management of tetralogy of fallot

A

surgery at 6 months (close VSD, relieve pulmonary stenosis)

if very cyanosed - shunt

hypercyanotic spells - morphine (pain and sedation)
propanolol IV
fluids IV
bicarbonate for acidosis

24
Q

transposition of the great arteries - overview, presentation

A

the aorta and pulmonary artery are switched
severe cyanosis on day 2 of life when the duct closes

ECHO

25
Q

management of transposition of the great arteries

A

IV prostaglandins
balloon atrial septstomy - open foramen ovale
surgery to correct

26
Q

atrioventricular septal defect - overview

A

mainly seen in Down syndrom
cyanosis at birth/heart failure at 2-3 weeks
ECHO
surgical repair at 3-6 months

27
Q

aortic stenosis in neonate

duct dependent?

A

when critical - duct dependent, heart failure and shock
pulses of small volume and slow rising
carotid thrill
ejection systolic murmur and upper right sternal edge radiating to neck

but if not critical asymptomatic and murmur

ECHO
balloon dilation if Rx required but will need aortic valve replacement later in life

28
Q

pulmonary stenosis - overview

A

mostly asymptomatic with murmur
if critical - pulmonary blood flow is duct dependent
ejection systolic murmur heard best upper left sternal edge +heave if severe
ECG
Rx transcatheter balloon dilation if severe

29
Q

coarctation of the aorta overview

is it duct dependent

A

outflow obstruction
can be duct dependent if severe

sick baby, heart failure
no femoral pulses
severe metabolic acidosis

Rx ABC, IV prostaglandins, surgery

30
Q

hypoplastic left heart syndrome

A

small left side of heart
very sick
duct dependent circulation
v weak pulses all over

lots of surgeries

* Paediatrics (22 decks)

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