Cardio - other stuff in paeds

Question 1

Sinus arrhythmia - what is it, is it bad

Answer 1

it is normal

heart rate changes with respiration - speeds up on inspiration, slows on expiration (30bpm change possible)

Question 2

supraventricular tachycardia

Answer 2

HR 250-300
poor cardiac output/pulmonary oedema
causes heart failure symptoms
can cause hydrops fetalis (fluid in 2 compartments) and intrauterine death

ECG

Rx - carotid sinus massage/ice pack to face is effective
IV adenosine
electrical cardioversion

then flecainide or sotalol to maintain

Question 3

Long QT syndrome

Answer 3

sudden loss of consciousness during exercise, stress or emotion (late childhood usually)
can lead to venticular tachycardia and death
autosomal dominant inheritance

Question 4

rheumatic fever
causative organism
who does it affect
how many acute forms become chronic

Answer 4

response to group A b-haemolytic streptococcus
affects 5-15 y/o’s
80% become chronic

2-6 weeks after pharyngeal/skin infection
joint pain, mild fever and malaise

chronic disease from scarring/fibrosis of valves (especially mitral)

treat acute with rest and aspirin, steroids if fever doesnt settle
penicillin if active infection

Jones criteria
(carditis, arthritis, chorea etc)

Question 5

Infective endocarditis - who is at risk

Answer 5

anyone with congenital heart disease (not secundum ASD) - especially with turbulent jet of blood (VSD)
neonates
prosthetic material in heart

Question 6

infective endocarditis signs

Answer 6

fever/malaise
anaemia/pallor
splinter haemorrhages
clubbing
skin lesions
haematuria (micro)
retinal infarcts, cerebral infarct neuro signs

Question 7

diagnosis of infective endocarditis
most common organism?

treatment?

Answer 7

ECHO
Strep viridans

treat with penicillin and aminoglycoside IV

Question 8

What is a dilated cardiomyopathy

Answer 8

a large, poorly contracting heart

congenital
secondary to metabolic disease
secondary to viral illness

? if big heart and unwell

Question 9

Cardiomyopathy/myocarditis

treatment

Answer 9

diuretics
ACEi
carvedilol

Question 10

How do you treat pulmonary hypertension

Answer 10

(>25mmHg = Pul HTM)
Nitric oxide
MgSO4 IV
sildenafil