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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the 4 cardiac abnormalities that are classically found in Tetralogy of Fallot?

A

VSD
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

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2
Q

Is Tetralogy of Fallot a cyanotic or acyanotic condition? What determines the extent of cyanosis?

A

Tetralogy of Fallot is a cyanotic lesion

The severity of the pulmonary stenosis is what determines the extent of the cyanosis

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3
Q

What murmur is heard with Tetralogy of Fallot?

A

Ejection systolic

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4
Q

What are the S+S of Tetralogy of Fallot?

A 
Cyanosis
Clubbing
Poor feeding
Poor weight gain/failure to thrive 
Ejection systolic murmur
Tet spells
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5
Q

What is the investigation of choice to diagnose Tetralogy of Fallot?

A

Echocardiogram

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6
Q

What is the characteristic feature seen in CXR with Tetralogy of Fallot?

A

Heart has a “boot-shaped” appearance

This is due to RVH

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7
Q

What are Tet spells?

A

Intermittent periods where the right-to-left shunt becomes temporarily worsened, precipitating a cyanotic episode

Occurs in situations where pulmonary vascular resistance increases or systemic resistance decreases (exercise, walking, crying)

This allows blood to flow from the RV into the aorta

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8
Q

How do Tet spells typically present?

A 
Irritability
Cyanosis
SOB
Reduced consciousness
Seizures

Older children may be squatting (this increases systemic vascular resistance)

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9
Q

How are Tet spells managed?

A

Older children - squat
Younger children - knees to chest

Supplementary O2
Beta blockers
IV fluids
Morphine
Sodium bicarbonate 
Phenylephrine infusion
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10
Q

How is Tetralogy of Fallot managed?

A

Neonates - prostaglandin infusion to maintain PDA

Definitive management - open heart surgery

Prognosis >90%

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11
Q

What is Transposition of the great vessels?

A

Congenital heart defect in which the attachments of the aorta and pulmonary trunk are swapped

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12
Q

Why might babies with Transposition of the great vessels survive immediately after birth?

A

An additional heart defect - PDA, VSD, ASD

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13
Q

How does Transposition of the great vessels present?

A

Presents with cyanosis at birth

If initially compensated by PDA/VSD/ASD:
Respiratory distress
Tachycardia
Poor feeding
Failure to thrive 
Sweating
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14
Q

What is the definitive management for Transposition of the great vessels?

A

Open heart surgery

Cardiopulmonary bypass machine is sued to perform an arterial switch procedure in the first few days of life

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15
Q

How might Transposition of the great vessels be managed until definitive corrective surgery can be performed?

A

Prostaglandin E2 to maintain PDA

Balloon septostomy - create ASD

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16
Q

What is the most common congenital cardiac defect?

A

VSD

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17
Q

What conditions are associated with VSD?

A

Down’s syndrome

Turner’s syndrome

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18
Q

Is VSD a cyanotic or acyanotic lesion?

A

Acyanotic

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19
Q

How does a VSD present?

A

Can be symptomless and only present in adulthood

Typical symptoms:
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive
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20
Q

What type of murmur is typically heard with a VSD?

A

Pan-systolic
Left lower sternal border in the 3rd and 4th intercostal spaces

May be a systolic thrill

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21
Q

How should a small VSD be managed?

A

Watch and wait - may close spontaneously or become smaller

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22
Q

How should larger VSDs be managed?

A

Surgical correction - transvenous catheter closure via femoral vein or open heart surgery

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23
Q

Is ASD a cyanotic or acyanotic lesion?

A

Acyanotic

24
Q

List the types of ASD from most to leas common.

A

Ostium secundum
Patent foramen ovale
Ostium primum

25
Q

How does an ASD present?

A 
SOB
Difficulty feeding 
Poor weight gain/failure to thrive 
LRTI
Murmur
26
Q

What type of murmur is typically heard with an ASD?

A

Mid-systolic, crescendo-decrescendo murmur
Loudest at upper left sternal border
Fixed split second heart sound

27
Q

How are ASDs managed?

A

Small and asymptomatic: Watch and wait

Larger and/or symptomatic: Surgical correction via transvenous catheter closure and anticoagulants (aspirin, warfarin, NOACs)

28
Q

What are the potential complications of ASDs?

A

Stroke
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right-sided heart failure
Eisenmenger syndrome

29
Q

Describe the typical presentation of PDA?

A 
SOB
Difficulty feeding
Poor weight gain 
LRTI
Murmur
30
Q

What type of murmur is typically heard with PDA?

A

Continuous crescendo-decrescendo ‘machinery’ murmur

May be a left subclavicular thrill

31
Q

What is the best imaging modality to diagnose PDA?

A

Echocardiography

32
Q

How are PDAs usually managed?

A

Can monitor until 1 year of age via echo
Administer Indomethacin
Unlikely that a PDA will close spontaneously after 1 year - transcatheter or surgical closure

33
Q

Where does the narrowing in aortic coarctation typically occur?

A

Around the ductus arteriosus

34
Q

Which genetic condition is associated with aortic coarctation?

A

Turner’s syndrome

35
Q

How does aortic coarctation typically present in neonates?

A

Weak femoral pulses

36
Q

What are the signs of aortic coarctation in infancy?

A

Tachypnoea and increased work of breathing
Poor feeding
Grey and floppy baby

37
Q

What are the signs of aortic coarctation in childhood?

A

Left ventricular heave due to LVH
Underdevelopment of the left arm (where there is reduced flow to the left subclavian artery)
Underdevelopment of the legs

38
Q

What would a four limb BP show in aortic coarctation?

A

High BP in limbs supplied by arteries that come before the narrowing
Lower BP in limbs that come after the narrowing

39
Q

What are the management options for aortic coarctation?

A

Prostaglandin E2 to maintain the ductus arteriosus

Surgical

40
Q

How does aortic stenosis present?

A

Mild stenosis: asymptomatic, discovered incidentally

Moderate stenosis: 
Fatigue
SOB
Dizziness
Fainting
Symptoms worse on exertion

Severe stenosis:
Heart failure in the first few months of life

41
Q

What type of murmur is typically heard with aortic stenosis?

A

Ejection systolic, crescendo-decrescendo murmur
Radiates to carotids
Loudest in the 2nd ICS, upper right border of sternum
Ejection click just before murmur
Palpable thrill during systole

42
Q

Describe the pulse felt in aortic stenosis.

A

Slow rising pulse

Narrow pulse pressure

43
Q

What is the gold standard imaging modality for aortic stenosis?

A

Echocardiogram

44
Q

What are the management options for aortic stenosis?

A

Percutaneous balloon aortic valvuloplasty
Surgical aortic valvotomy
Valve replacement

45
Q

What are the potential complications of aortic stenosis?

A 
LV outflow tract obstruction 
Heart failure 
Ventricular arrhythmia 
Bacterial endocarditis 
Sudden death, often on exertion
46
Q

What conditions are associated with pulmonary valve stenosis?

A

Tetralogy of Fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome

47
Q

How does pulmonary stenosis present?

A

Fatigue on exertion
SOB
Dizziness
Fainting

48
Q

What are the signs of pulmonary stenosis?

A

Ejection systolic murmur
Palpable thrill in pulmonary area
Right ventricular heave due to RVH
Raised JVP with giant ‘a’ waves

49
Q

What is the gold standard imaging modality for pulmonary stenosis?

A

Echocardiogram

50
Q

What is the treatment of choice in managing symptomatic/severe pulmonary stenosis?

A

Balloon valvuloplasty (inserting a catheter into the femoral vein, through the IVC and right side of heart to the pulmonary valve)

51
Q

What is Ebstein’s anomaly?

A

Where the tricuspid valve is lower in the right side of the heart, causing a bigger right atrium and small right ventricle

52
Q

Ingestion of which drugs predisposes a foetus to Ebstein’s anomaly?

A

Lithium and benzodiazepines

53
Q

How does Ebstein’s anomaly typically present?

A 
Evidence of heart failure (oedema)
Gallop rhythm and S3 and S4
Cyanosis
SOB
Tachypnoea
Poor feeding
Collapse or cardiac arrest
54
Q

What is the gold standard imaging modality for Ebstein’s anomaly?

A

Echocardiogram

55
Q

How is Ebstein’s anomaly managed?

A

Medical management - treating arrhythmias and heart failure, prophylactic abx to prevent infective endocarditis

Definitive management - surgical correction

Paediatrics (14 decks)

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