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Paeds > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the 3 fetal shunts

A

Ductus venosus

Foramen ovale

Ductus arteriosus

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2
Q

Where does blood get shunted through the ductus venosus

A

From umbilical vein to inferior vena cava

Blood bypasses liver

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3
Q

Where does blood get shunted through the foramen ovale

A

From right atrium to left atrium

Blood bypasses right ventricle and pulmonary circulation

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4
Q

Where does blood get shunted through the ductus arteriosus

A

From pulmonary artery to aorta

Blood bypasses pulmonary circulation

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5
Q

What happens with the first breath at birth

A

Expansion of alveoli

Decreased pulmonary vascular resistance

Fall in pressure in right atrium (now < left atrium)

Foramen ovale closes (takes a few weeks to seal)

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6
Q

What is the role of prostaglandins in fetal circulation

A

Keep ductus arteriosus open

Increased blood oxygenation at birth reduces prostaglandin levels

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7
Q

When does the ductus venosus stop functioning

A

When umbilical cord is clamped (no blood flow through umbilical vein)

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8
Q

What are innocent murmurs

A

Flow murmurs (due to fast blood flow through heart)

Often do not need investigation

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9
Q

What are the typical features of innocent murmurs

A

Soft

Short

Systolic

Symptomless

Situation dependent (quiet on standing, appear when unwell)

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10
Q

When do murmurs need to be referred to paediatric cardiologists

A

Louder than 2/6

Diastolic

Louder on standing

Symptomatic (failure to thrive, difficulty feeding, cyanosis, shortness of breath)

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11
Q

What investigations may be needed for murmurs in children

A

ECG

Chest X-ray

ECHO

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12
Q

What are the pan-systolic murmurs

A

Mitral regurgitation

Tricuspid regurgitation

Ventral septal defects

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13
Q

What are the ejection-systolic murmurs

A

Aortic stenosis

Pulmonary stenosis

Hypertrophic obstructive cardiomyopathy

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14
Q

What causes splitting of the 2nd heart sound

A

Pulmonary valve closing slightly later than aortic valve

Often normal with inspiration

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15
Q

Describe the murmur of atrial septal defect

A

Mid-systolic

Crescendo-decrescendo

Loudest at upper left sternal border

Fixed split second heart sound

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16
Q

Describe the murmur of patent ductus arteriosus

A

Normal first heart sound

Continuous crescendo-decrescendo murmur

Continuation during second heart sound

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17
Q

What is the murmur in tetralogy of Fallot

A

Ejection systolic murmur

Due to pulmonary stenosis

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18
Q

What are the potentially cyanotic heart diseases in babies

A

Due to blood bypassing lungs (right to left shunt)

Ventral septal defect (not cyanotic)

Atrial septal defect (not cyanotic)

Patent ductus arteriosus (not cyanotic)

Transposition of great arteries (cyanotic)

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19
Q

When does the ductus arteriosus normally close

A

Within 1-3 days of birth

Complete closure by 2-3 weeks

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20
Q

If missed in childhood, how may patients with patent ductus arteriosus present as adults

A

With heart failure

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21
Q

How might a patient with patent ductus arteriosus present

A

Murmur

Shortness of breath

Difficulty feeding

Poor weight pain

Lower respiratory tract infections

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22
Q

What investigation is needed for the diagnosis of patent ductus arteriosus

A

ECHO

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23
Q

What is the management for patent ductus arteriosus

A

ECHO monitoring (1 year, after this, unlikely to close spontaneously)

Closure (trans-catheter, surgical)

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24
Q

What are the indications for early treatment of patent ductus arteriosus

A

Evidence of heart failure

Symptomatic

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25
Q

What is the pathophysiology of atrial septal defects

A

Shunting of blood from left atrium to right atrium

Non-cyanotic

Right sided overload (get right heart failure and pulmonary hypertension)

Right heart strain

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26
Q

What are the types of atrial septal defects

A

Ostium primum (fails to close fully)

Ostium secundum (fails to close fully)

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27
Q

How might a patient with an atrial septal defect present

A

Murmur

Antenatal scanning/newborn examination

Symptomatic children (short of breath, difficulty feeding, poor weight gain, LRTIs)

Symptomatic adults (shortness of breath, heart failure, stroke)

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28
Q

What is the management of atrial septal defects

A

Watch and wait (if small and asymptomatic)

Surgery (femoral catheter,, open heart surgery)

Anticoagulation (aspirin, warfarin, NOACs)

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29
Q

What are the potential complications of atrial septal defects

A

Stroke

Atrial fibrillation

Atrial flutter

Pulmonary hypertension

Right sided heart failure

Eisenmenger syndrome

30
Q

What conditions are ventricular septal defects often associated with

A

Down’s syndrome

Turner’s syndrome

31
Q

How is the blood shunted in ventricular septal defects

A

Left to right

Patient not cyanotic

Right sided overload

Right heart failure

32
Q

How might a patient with a ventricular septal defect present

A

Initially asymptomatic (some into adulthood)

Antenatal scanning

Murmur

Symptomatic (poor feeding, dyspnoea, tachypnoea, failure to thrive)

33
Q

What would be found on examination of a patient with a ventricular septal defect

A

Pan-systolic murmur

Systolic thrill on palpation

34
Q

What is the management of ventricular septal defects

A

Watch and wait (if small and asymptomatic)

Surgery (transvenous catheter, open heart surgery)

35
Q

What is the main complication associated with ventricular septal defects

A

Increased risk of infective endocarditis

36
Q

What is Eisenmenger syndrome

A

Due to: atrial septal defect, ventricular septal defect, patent ductus arteriosus

Right to left shunt

Develops at 1-2 years (if defect very small, in adulthood)

More likely in pregnant women

37
Q

What would be found on examination of a patient with Eisenmenger syndrome that is associated with pulmonary hypertension

A

Right ventricular heave

Loud second heart sound

Raised JVP

Peripheral oedema

38
Q

What would be found on examination of a patient with Eisenmenger syndrome that is associated with a septal defect

A

Atrial septal defect: mid-systolic, crescendo-decrescendo murmur

Ventricular septal defect: pan-systolic murmur

Patent ductus arteriosus: continuous crescendo-decrescendo ‘machinery’ murmur

Arrhythmias

39
Q

What would be found on examination of a patient with Eisenmenger syndrome that is associated with chronic hypoxia

A

Cyanosis

Clubbing

Dyspnoea

Red complexion (due to polycythaemia)

40
Q

What is the management for Eisenmenger syndrome

A

Heart-lung transplant (only definitive treatment)

Oxygen

Treat pulmonary hypertension (sildenafil)

Treat polycythaemia (venesection)

Anticoagulation

Prophylactic antibiotics (prophylactic antibiotics)

41
Q

What is the prognosis for Eisenmenger syndrome

A

Reduced life expectancy (by 20 years)

Main causes of death: heart failure, infection, VTE, haemorrhage

42
Q

What is coarctation of the aorta

A

Narrowing of aortic arch

Usually around ductus arteriosus

Increased pressure proximally, reduced pressure distally

43
Q

What syndrome is coarctation of the aorta most commonly associated with

A

Turner’s syndrome

44
Q

How may a patient with coarctation of the aorta present

A

Weak femoral pulses

Systolic murmur

Symptoms in infants (tachypnoea, poor feeding, grey and floppy baby)

Symptoms developing over time (left ventricular heave, underdeveloped left arm, underdeveloped legs)

45
Q

What is the management for coarctation of the aorta

A

Mild cases often do not need management

Prostaglandin E (keep ductus arteriosus open until surgery)

Emergency surgical correction

46
Q

What is aortic valve stenosis

A

Narrowing of aortic valve

Restricted blood flow from left ventricle to aorta

Valve can have 1-4 leaflets (normal is 3)

47
Q

What are the symptoms associated with aortic valve stenosis

A

Mild disease may be asymptomatic (incidental murmur finding)

Fatigue

Shortness of breath

Dizziness

Heart failure

Fainting

Worse on exertion

48
Q

What would be found on examination of a patient with aortic valve stenosis

A

Ejection systolic murmur (crescendo-decrescendo, radiation to carotids)

Ejection click

Palpable systolic thrill

Slow rising pulse

Narrow pulse pressure

49
Q

What main investigation is needed in aortic valve stenosis

A

ECHO

50
Q

What is the management for aortic valve stenosis

A

Regular monitoring (ECHO, ECG, exercise test)

Percutaneous balloon aortic valvuloplasty

Surgical aortic valvotomy

Valve replacement

51
Q

What are the complications of aortic valve stenosis

A

Left ventricular outflow tract obstruction

Heart failure

Ventricular arrhythmia

Bacterial endocarditis

Sudden death (usually on exercise)

52
Q

What conditions are associated with pulmonary valve stenosis

A

Tetralogy of Fallot

William syndrome

Noonan syndrome

Congenital rubella syndrome

53
Q

How might a patient with pulmonary valve stenosis present

A

Often asymptomatic (incidental finding)

Fatigue on exertion

Shortness of breath

Dizziness

Fainting

54
Q

What may be found on examination of a patient with pulmonary valve stenosis

A

Ejection systolic murmur

Palpable thrill

Right ventricular heave

Raised JVP

55
Q

What is the main investigation needed in pulmonary valve stenosis

A

ECHO

56
Q

What is the management for pulmonary valve stenosis

A

Watch and wait (if mild and asymptomatic)

Balloon valvuloplasty (femoral)

Open heart surgery

57
Q

What are the 4 features of tetralogy of Fallot

A

Ventricular septal defect

Overriding aorta

Pulmonary valve stenosis

Right ventricular hypertrophy

58
Q

What happens in severe cases of tetralogy of Fallot

A

Heart failure before age 1

59
Q

What are the risk factors for tetralogy of Fallot

A

Rubella infection

Maternal age > 40

Alcohol during pregnancy

Maternal diabetes

60
Q

How might a patient with tetralogy of Fallot present

A

Cyanosis

Clubbing

Poor feeding

Poor weight gain

Ejection systolic murmur (pulmonary area)

Tet spells

61
Q

What investigations are needed in tetralogy of Fallot

A

ECHO

Chest X-ray (boot shaped heart)

62
Q

What are tet spells

A

Intermittent symptomatic episodes of tetralogy of Fallot

Right to left shunt temporarily worsens

Worsening cyanosis

Due to physical exertion

Reduced consciousness, seizures, death

63
Q

What is the management for tet spells

A

Tell older children to squat, young children knees to chest

Oxygen

Beta blockers

IV fluids

Morphine (decreases respiratory drive)

Sodium bicarbonate (buffer metabolic acidosis)

Phenylephrine infusion (increase systemic vascular resistance)

64
Q

What is the management of tetralogy of Fallot

A

Prostaglandin infusion (maintain ductus arteriosus)

Open heart surgery

65
Q

What is Ebstein’s anomaly

A

Tricuspid valve set low (get big right atrium, small right ventricle)

Poor blood flow from right atrium to right ventricle

Poor blood flow to pulmonary vessels

Right to left shunt (get cyanosis)

Associated with Wolff-Parkinson-White syndrome

66
Q

How might a patient with Ebstein’s anomaly present

A

Evidence of heart failure

Gallop rhythm (3rd and 4th heart sounds)

Cyanosis

Shortness of breath

Tachypnoea

Poor feeding

Collapse

Cardiac arrest

67
Q

What investigation is needed for the diagnosis of Ebstein’s anomaly

A

ECHO

68
Q

What is the management for Ebstein’s anomaly

A

Treat arrhythmia

Treat heart failure

Prophylactic antibiotics (infective endocarditis)

Surgical correction

69
Q

What is transposition of the great arteries

A

Attachments of aorta and pulmonary trunk swapped

Get 2 separate circulations that do not mix

Immediate survival depends on a shunt being present

Often picked up in antenatal scans

70
Q

What conditions are associated with transposition of the great arteries

A

Patent ductus arteriosus

Atrial septal defect

Ventricular septal defect

71
Q

How might a patient with transposition of the great arteries present

A

Cyanosis

Respiratory distress

Tachycardia

Poor feeding

Poor weight gain

Sweating

72
Q

What is the management of transposition of the great arteries

A

Prostaglandin infusion (maintain patent ductus arteriosus)

Balloon septostomy (catheter into foramen ovale, create a large atrial septal defect)

Open heart surgery

Paeds (17 decks)

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