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Child Health > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Ductus venosus

A

Umbilical vein-> IVC

Bypass liver

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2
Q

Foramen ovale

A

Right atrium-> left atrium

Bypass right ventricle and pulmonary circulation

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3
Q

Ductus arteriosus

A

Pulmonary artery->aorta

Bypass pulmonary circulation

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4
Q

Features of innocent murmurs

5S

A 
Soft
Short
Systolic
Situation dependent
Symptomless
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5
Q

Pan-systolic murmurs DD

A

Mitral stenosis: 5th intercostal space, mid-clavicular line
Tricuspid regurgitation: 5th intercostal space, left sternal border
VSD: left lower sternal border

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6
Q

Ejection-systolic murmurs

DD

A

Aortic stenosis: 2nd intercostal space, right sternal border
Pulmonary stenosis: second intercostal space, left sternal border
Hypertrophy obstructive cardiomyopathy: 4th intercostal space, left sternal border

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7
Q

Conditions associated with infective endocarditis

A 
VSD
PDA
Aortic valve abnormalities 
Bicuspid aortic valve
Tetralogy of fallot
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8
Q

Infective endocarditis triad

Pathophysiology

A

Endothelial damage, sheer stress forces
Platelet adhesion
Microbial adherence

Bacteraemia
Bacteria protected in vegetation

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9
Q

Infective endocarditis causative organisms

A

Organisms have surface receptors to fibronectin
S. Aureus
Strep viridans, after dental procedures
Enterococci, after GU or GI surgery

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10
Q

Clinical features of infective endocarditis

A 
Persistent low grade fever
Heart murmur
Splenomegaly 
Petechiae
Oslers node
Jane way lesions
Splinter haemorrhages
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11
Q

Embolic phenomena in infective endocarditis

A 
Splinter haemorrhages
Glomerular nephritis: haematuria
Pulmonary emboli 
Cerebral emboli: seizures, hemiparesis
Roth spots: retinal haemorrhages
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12
Q

Infective endocarditis investigations

A

Blood cultures, 3 culture over 48-72hours
Echocardiography
Microscopic haematuria
Anaemia, leukocytosis, raised ESR

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13
Q

Modified Dukes criteria for infective endocarditis

Major criteria

A

Positive blood culture:
2 blood cultures >12hrs apart
3 positive cultures >1 hour apart

ECHO:
Mass on valve/ implanted material;
Abscess
Dehiscence of prosthetic valve 
New valvular regurgitation
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14
Q

Modified Dukes criteria for infective endocarditis

Minor criteria

A

Predisposing heart condition or IV drug use
Fever: temperature >38
Vascular phenomena
Immunological phenomena: glomerulonephritis, Roth spots, oslers nodes, rheumatoid factor
Microbiological pneumonia
ECHO

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15
Q

Diagnosis of infective endocarditis

A

Modified dukes criteria
Two major criteria
5 minor
One major three minor

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16
Q

Complications of infective endocarditis

A 
Systemic embolisation
Abscess formation
Pseudoaneurysm 
Valvular perforation
Heart failure
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17
Q

Infective endocarditis

A

IV penicillin or ceftriaxone 4 weeks

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18
Q

Acute rheumatic fever

A

2-4 weeks after pharyngitis

Strep pyogenes

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19
Q

Epidemiology acute rheumatic fever

A

Developing countries
Tropical countries
Females

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20
Q

Pathophysiology rheumatic fever

A

Streptococcus pyogenes
Gram-positive cocci
Cytolytic toxins: streptolysin O and S

M proteins are immunogenic to B cells
Anti-M antibodies affect heart (rheumatic heart disease), brain, joints and skin

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21
Q

Risk factors for rheumatic fever

A 
Children and young people
Poverty
Overcrowded and poor hygiene places
FH of Rh fever
D8/17 B cell antigen positivity
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22
Q

Diagnosis of acute rheumatic fever

A

Positive throat culture for Group A B-haemolytic streptococci
Or Elevated anti-streptolysin O
Or Anti-deoxyribonuclease B titre

And

2 major criteria
1 major and 2 minor

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23
Q

Major criteria (SPECS)

A 
Sydenham chorea
Polyarthritis 
Erythema marginatum 
Carditis 
Subcutaneous nodules
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24
Q

Minor criteria (CAPE)

A 
CRP/ ESP- raised acute phase reactant
Arthralgia
Pyrexia/ fever
ECG- prolonged PR interval 
Joint (arthritis or arthralgia) and cardiac (carditis or prolonged PR interval)
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25
Q

Acute rheumatic fever investigations

A 
Bloods: ESR, CRP, FBC
Bloods culture to exclude sepsis
Rapid antigen detection test
Throat culture
Anti-streptococcal serology
ECG
CXR
ECHO
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26
Q

Management of rheumatic fever

A

Benzathine benzylpenicillin, phenoxymethylpenicillin, amoxicillin
Aspirin or NSAIDs
Emergency valve replacement
In severe carditis: glucocorticoids and diuretics

Secondary prophylaxis with IM benzathine benzylpenicillin every 3-4weeks
Oral phenoxymethylpenicillin twice daily
Oral sulfadiazine daily
Oral azithromycin

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27
Q

ASD

A

Females more likely to have ostium secundum

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28
Q

Risk factors PDA

A 
Rubella in maternal 
Prematurity 
Maternal smoking in 1st trimester
Maternal diabetes
Maternal drug use
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29
Q

PDA features

A 
Sob
Difficulty feeding
Poor weight gain 
LRTI
L->r shunt, pulmonary HTN, right heart hypertrohpy, LVH
30
Q

PDA murmur

A

Crecendo- decrecendo
Machinery
Continues through second heart sound

31
Q

Management PDA

A

Monitor until 1 year
Trans-catheter
Surgical closure

32
Q

Types of ASD

A 
Patent foramen ovale
Ostium secundum defect
Ostium primum defect
Sinus venosus defect
Coronary sinus defect
33
Q

Syndromes associated with ostium secundum ASD

A

Treacher-Collins syndrome

Thrombocytopenia- absent radii syndrome

34
Q

Complications PDA

A

Stroke, VTE can pass from right heart-> left heart-> brain
Pulmonary HTN, RSHF
AF, atrial flutter
Eisenmenger syndrome

35
Q

ASD presentation

A 
SOB
Difficulty feeding
Poor weight gain
LRTI
Dyspnoea, weight gain, stroke
36
Q

ASD murmur

A

Mid-systolic ejection murmur
Crecendo-decrecendo murmur
At upper left sternal border
Fixed split second heart sound: pulmonary valve closes after aortic valve
Diastolic rumble in lower left sternal edge

37
Q

Management ASD

A

<5mm spontaneous closure within 12months
Transvenous catheter closure
Open heart surgery via femoral vein
Anticoagulants: aspirin, warfarin, NOACs

38
Q

VSD genetic association

A

Down’s syndrome

Turner’s syndrome

39
Q

Risk factors VSD

A 
Maternal DM
Maternal Rubella infection
Alcohol maternal
Uncontrolled maternal phenylketonuria
FH
Down’s syndrome
Trisomy 18
Trisomy 13 
Holt-oram syndrome 
Teratogens
40
Q

Presentation VSD

A 
Poor feeding
Tachypnoea
Failure to thrive
Dyspnoea 
Eisenmenger s cyanosis
41
Q

Examination VSD

A 
Undernourished 
Sweat on forehead, LOW CO so increases SNS
Increased WoB 
Cyanosis, blue complexion 
Clubbing
42
Q

Murmur VSD

A 
Pan-systolic murmur
Left lower sternal border
3rd/4th intercostal space
Systolic thrill on palpation 
S1–>S2
43
Q

VSD management

A

Transvenous catheter closure via femoral vein
Open heart surgery
Infective endocarditis prophylaxis

44
Q

Medical management VSD

A

Adequate weight gain, NG tube feedings
Diuretics, reduce pulmonary congestion
ACEi
Digoxin

45
Q

Complications VSD

A 
CHF
Growth failure
Aortic valve regurgitation 
Pulmonary vascular disease, Eisenmengers 
Frequent chest infections
Infective endocarditis
Arrhythmias
Sudden death
46
Q

Lesions that result in Eisenmenger

A

ASD
VSD
PDA

47
Q

Examination findings Eisenmenger syndrome

A

Right ventricular heave
Loud P2
Raised JVP
Peripheral oedema

48
Q

Features of Eiesenmenger syndrome

A 
Polycythaemia
Plethoric complexion
Cyanosis
Clubbing
Dyspnoea
49
Q

Csues of death in Eisenmenger syndrome

A

Heart failure
Infection
Thromboembolism
Haemorrhage

50
Q

Management

A 
Heart-lung transplant
Oxygen
Sildenafil for pulmonary HTN
Treat arrhythmias
Treat polycythaemia with venesection
Treat thrombosis with anticoagulants
Prevention of infective endocarditis with prophylactic antibiotics
51
Q

What genetic condition is associated with coarctation of the aorta?

A

Turners syndrome

52
Q

Presentation of coarctation of aorta

A 
Weak femoral pulses 
Tachypnoea 
Poor feeding
Grey and floppy baby
Left ventricular heave: LVH
Underdeveloped left arm 
Underdevelopment of legs
53
Q

Coarctation of aorta

A

Systolic murmur Left infraclavicular area

Below left scapula

54
Q

Management of coarctation of aorta

A

Prostaglandins to keep ductus arteriosus open

Surgery then ligates ductus arteriosus, correct coarctation

55
Q

Aortic valve stenosis

A 
Fatigue
SOB
Dizziness
Fainting
Symptoms worse on exertion
56
Q

Aortic valve stenosis auscultation

A 
Ejection systolic murmur
Second intercostal space, right sternal border
Crecendo-decrecendo murmur
Radiates to carotid
Ejection click before murmur
Palpable thrill during systole
Slow rising pulse, narrow pulse pressure
57
Q

Management of aortic valve stenosis

A

Percutaneous balloon aortic valvoplasty
Surgical aortic valvotomy
Valve replacement

58
Q

Complications of aortic valve stenosis

A 
Left ventricular outflow tract obstruction
Heart failure
Ventricular arrhythmia
Bacterial endocarditis
Sudden death, often on exertion
59
Q

Conditions associated with pulmonary valve stenosis

A

Tetralogy of fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome

60
Q

Presentation of pulmonary valve stenosis

A 
Fatigue on exertion
SoB
Dizziness
Fainting
Usually asymptomatic 
Palpable thrill in pulmonary area
Right ventricular heave(RVH)
Raised JVP with giant a waves
61
Q

Pulmonary valve stenosis murmur

A

Ejection systolic murmur
Left sternal edge
Second intercostal space

62
Q

Management of pulmonary valve st3nosis

A

Balloon valvuloplasty

63
Q

Tetralogy of Fallot

A

Pulmonary valve stenosis
Overriding aorta
VSD
RVH

64
Q

Risk factors for ToF

A

Rubella
Increased maternal age
Alcohol consumption in pregnancy
Diabetic mother

65
Q

Investigations ToF

A

Echo, doppler flow study

Boot shaped heart

66
Q

Signs and symptoms

A

Tet spells
Cyanosis
Clubbing
Poor feeding and weight gain

67
Q

Mx of Tet spells

A

Squat or knees to chest if younger
Oxygen
Beta blockers,relax right ventricle
IV fluids, increase pre-load
Morphine, decrease resp driv,e more efficient breathing
Sodium bicarbonate, buffer metabolic acidosis
Phenylephrine infusion, increase systemic vascular resistance

68
Q

Management and prognosis of ToF

A

Prostaglandins infusion in neonates to keep ductus arteriosus open
Total surgical repair by open heart surgery

69
Q

Epstein’s anomaly

A

Tricuspid valve lower, poor flow from RA->LUNG
ASD R->L
WPW

70
Q

Presentation of Epstein’s anomaly

A 
Evidence of heart failure
Gallop rhythm 
Cyanosis
SoB and tachypnoea
Poor feeding
Collaps or cardiac arrest
71
Q

ECG EBSTEINS ANOMALY

A

Arrhythmias
Right atrial enlargement
Right bundle branch block
Left axis deviation

72
Q

CXR ebsteins

A

Cardiomegaly

Right atrial enlargement

Child Health (20 decks)

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