Cardio-Everything else Flashcards
Why would a left to right shunt occur at the age of 6-8 weeks?
At the is age there is decreased pressure in the pulmonary artery and SVR
This leads to a louder left to right shunt like a VSD
What do Inotropes do?
They help with myocardial contractility
What does heart failure typically present like in children?
- Tachypneao
- Tachycardiac
- Poor feeding
- Cyanosis
- Hepatomegaly
- Peri-orbital oedema
- sweating
- Palpable spleen
- Gallop rhythm and S3
What are the causes of heart failure?
- Cyanotic congenital heart failure with increased pulmonary blood flow
- Acyanotic congenital heart failure with increased pulmonary blood flow OR severe obstruction to ventricular outflow
- Myocarditis
- Cardiomyopathy
- Tachyarrythmia
- Bradyarrythmia
What is the management of infants with heart failure?
- Monitor their temperature
- Prop the child at 60 degrees
- Give oxygen via nasal prongs
- Start medication
What medication would you give?
- Intotropes
- digoxin (5-10mcg/kg/day) orally or IM injection but oral works better in children with no vomiting - IV infusion of donut amine or dopamine if severe cardiac failure
- Diuretics
- furosemide (1-6mg/kg/day in 2 to 4 divided doses) give IV first and the maintenance orally
- spironolactone which is also a diuretic (potassium sparing) - Vasodilator
- ACE-I like captopril (0,5-6 mg/kg/day)
What do ACE-inhibitors do?
They reduce the left ventricular after load and used specifically in dilated cardiomyopathy
What is cyanosis?
It is defined as blue or purple discoloration that occurs in the skin and mucous membranes when deoxyhaemoglobin is >5g/dl in the baby’s blood
How do we classify cyanosis?
- Peripheral-caused by some obstruction or inadequate circulation
- Central-caused by respiratory, CNS or cardiac problems causing decreased oxygenated blood
What are the causes of central cyanosis?
- Neuro:
- intracranial haemorrhage
- drug overdose eg heroin - Resp
- pneumonia
- asthma
- bronchiolitis
- COPD
- pulmonary hypertension
What are the causes of peripheral cyanosis?
- all the causes from central
- venous obstruction
- arterial obstruction
- cold exposure
- reduced cardiac pressure
What are the signs of peripheral cyanosis?
- The tip of the nose
- The earlobes
- The outer linings of the lips, chin and cheek
- The fingertips and toes
- Palms and soles fo feet
What are the signs of central cyanosis?
- Blue tongue
- Blue inner lining of the mouth, check and soft palate
- Mucous membrane of the gum
What is cardiomyoapthy?
Non-inflammatory conditions causing myocardial dysfunction leading to cardiac failure There’s 3 main types: 1. Dilated cardiomyopathy 2. Restrictive cardiomyopathy 3. Hypertrophic cardiomyopathy
What are the signs of right heart failure?
- Oedema(usually in the legs)
- Increase in respiratory rate because no blood flow to lungs
- Shortness of breath
What are the signs of left heart failure?
- Pulmonary oedema
- Syncope (no blood going to the brain)
- Weakness and lethargy
- Angina if older
- Sometimes ystemic embolisation occurs
What would you find on examination of a patient with cardiomyopathy?
- Distended neck veins
- Peripheral oedema
- Hepatomegaly
- Displaced apex beat towards the axilla
- S3
- Murmur heard is usually mitral and tricuspid regurgitation (pansystolic murmur)
- They have a reduced pulse pressure because of the increased resistance increasing the diastolic pressure
What is the differential diagnosis for cardiomyopathy?
- Myocarditis
- Pericarditis
- Rheumatic fever
- Pericardial effusion
What are the other types of cardiomyopathy?
- HIV cardiomyopathy
- Berberi due to thiamine deficiency
- hypertrophic obstructive cardiomyopathy
- Asymmetrical septal hypertrophy
What is myocarditis?
Inflammation and infection of the cardiac muscle which can lead to cardiac failure
How is it spread in infants?
From the mothers
-coxsackie B virus
How does myocarditis present in infants?
- Tachypnea
- Tachycardia
- Loud S3 at the apex
- On X-ray we see generalised cardiomegaly and pulmonary congestion
How do we treat myocarditis?
- Digoxin and a diuretic (furosemide and spirinolactone)
What is pericarditis?
It is infection of the pericardium(the lining around the heart) There’s 3 types: -serous -haemorrhagic -purulent
How do these children present?
- Dyspnea
- Friction rub
- Muffled heart sounds
- Distended neck veins(increased JVP)
- Pleural effusions are common
- Rapid pulse and pulsus paradoxus
What is cardiac tamponade?
This is when the ventricles cannot fill up properly and causes a decrease in casrdiac output and blood pressure
What is constrictive pericarditis?
This is when the effusion is big enough to start preventing the heart from relaxing enough to allow blood to flow into the ventricles. This causes a decrease in stroke volume and cardiac output
What are the causes of pericarditis?
- Rheumatic fever
- TB
- Viral infections like coxsackie B virus
- Bacterial -staphylococcus, streptococcus, pneumococci, H.influenzae
- Malignant lymphomas in the mediastinum
What is the treatment for pericarditis?
- Treat rheumatic fever with prednisone
- Treat TB with TB drugs
- If bacterial-treat the purulence with antibiotics
- Aspirate the effusion if you know the diagnosis
What are the causes of pulmonary hypertension (not congenital cardiac causes)
- Cor pulmonale
- Chronic upper airway obstruction
- large tonsils and adenoids that need to be removed because they cause snoring and right ventricular failure - Persistent pulmonary hypertension do the newborn
- occurs to post dates or term babies with birth asphyxia or meconium aspiration - Bilharzia
