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cardiology Flashcards

1
Q

what is the epidemiology of congenital heart disease?

A
  • 30% of all congenital anomalies
  • incidence of 8 in 1,000 live births
  • 8 common lesions account for 80% cases of congenital heart disease
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2
Q

what are the 8 commonest congenital anomalies?

A
  • ventricular septal defect (VSD)
  • patent ductus arteriosus (PDA)
  • atrial septal defect (ASD)
  • pulmonary stenosis
  • aortic stenosis
  • coarctation of the aorta
  • transposition of the great vessels
  • teratology of fallot
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3
Q

What is the aetiology of congenital heart disease?

A

genetics: trisomy 13, trisomy 18, trisomy 21 (AVSD), turner, noonan, williams, 22q11 deletion syndrome
environment: drugs, infection (TORCH) , maternal (diabetes mellitus, systemic lupus erythematous)

teratogenic insult

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4
Q

What history may a child present with?

A
  • Feeding, Weight and Development issues
  • Cyanosis
  • Tachypnoea, Dyspnoea
  • Exercise Tolerance
  • Chest Pain
  • Syncope
  • Palpitation
  • Joint Problems
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5
Q

What may be found on examination of child with heart issues?

A
  • Abnormal weight or height
  • Dysmorphic features
  • Cyanosis
  • Clubbing
  • Tachypnoea/ dyspnoea
  • Pulses/apex (check femoral pulses)
  • Hear sounds (clicks, splits, 3rd and 4th)
  • Murmurs
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6
Q

What investigations may carried out?

A
  • Blood Pressure
  • O2 saturation, arterial BGA
  • ECG (12 lead, 24hrs, event monitor)
  • CXR
  • Echocardiogram
  • Catheter
  • Angiography
  • MRI/A
  • Exercise testing (ECG, sO2)
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7
Q

What are the treatment principles for paediatric cardiology?

A
  • If you can fix it then do it
  • If you can’t fix it the improve the situation
  • If you can do neither then replace it
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8
Q

Give examples of how paediatric cardiology problems can be improved?

A

Medication

Palliative procedures
-BT shunt, balloon valvoplasty, prostaglandin infusion, pulmonary banding

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9
Q

How can murmurs be characterised?

A

Timing in Cardiac Cycle
-Systole / Diastole / Continuous

Duration

  • Early / Mid / Late
  • Ejection / Holo or Pan Systolic

Pitch / Quality

  • Harsh or Mixed Frequency (Turbulence)
  • Soft or Indeterminate
  • Vibratory / Pure Frequency (Laminar Flow
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10
Q

Name 4 sites to check for murmurs.

A
  • Upper right sternal border
  • Upper left sternal border
  • Lower left sternal border
  • Apex
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11
Q

What proportion of childhood murmurs are innocent?

A

70-80%

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12
Q

What are the 4 innocent murmurs of childhood?

A
  • Still’s murmur (LV outflow murmur)
  • Pulmonary outflow murmur
  • Carotid/brachiocephalic arterial bruits
  • Venous hum
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13
Q

What are the common features of innocent childhood murmurs?

A
  • Systolic murmur (continuous in venous hum)
  • No other signs of cardiac disease
  • Soft murmur, grade 1/6 or 2/6
  • Vibratory, musical
  • Localised
  • Varies with position, respiration, exercise
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14
Q

Who do Still’s murmurs affect?

A

2-7 year olds

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15
Q

What do Still’s murmurs sound like?

A

Soft systolic; vibratory, musical,”twangy”

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16
Q

Where can Still’s murmurs be heard?

A

Apex and left sternal border

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17
Q

When do Still’s murmurs increase?

A

In the supine position and with exercise

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18
Q

Who do pulmonary outflow murmurs affect?

A
  • 8-10 year olds

- Often children with a narrow chest

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19
Q

What do pulmonary outflow murmurs sound like?

A

Soft systolic and vibratory

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20
Q

Where can pulmonary outflow murmurs be heard?

A
  • Upper left sternal border

- They are well localised and do not radiate to the back

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21
Q

When do pulmonary outflow murmurs increase?

A

In the supine position and with exercise

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22
Q

Who do carotid arterial bruits affect>?

A

2-10 year olds

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23
Q

What do carotid arterial bruits sound like?

A

Harsh systolic, 1/6-2/6

24
Q

Where can carotid arterial bruits be heard?

A

Supraclavicular, radiates to the neck

25
When do carotid arterial bruits increase?
With exercise
26
When do carotid arterial bruits decrease?
On turning head or extending neck
27
Who does venous hum usually affect?
3-8 year olds
28
What does venous hum sound like?
- Soft, indistinct | - Continuous murmur, sometimes with diastolic accentuation
29
Where can venous hum be heard?
Supraclavicular
30
When is venous hum heard?
When child is in upright position
31
When does venous hum disappear?
On lying down or turning the head
32
What are the 3 main types of VSD?
- Subaortic - Perimembranous - Muscular
33
What shunt is associated with VSD?
L to R
34
What type of murmur is heard in VSD?
- Pansystolic murmur lower left sternal edge, sometimes with thrill - In very small VSDs, early systolic murmur - In very large VSDs diastolic rumble due to relative mitral stenosis
35
What may there be signs of in large VSDs?
Signs of cardiac failure in large VSDs, eventually leading to biventricular hypertrophy and pulmonary hypertension
36
What is Eisenmenger syndrome?
The process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic right-to-left shunt.
37
How can VSDs be closed?
- Amplatzer device | - Patch closure
38
How are ASD sometimes detected in adulthood?
Patient may present with AF, heart failure or pulmonary hypertension
39
What murmur is associated with ASDs?
Wide fixed splitting of 2nd heart sound, pulmonary flow murmur
40
How do ASDs present in childhood?
Very few clinical signs as there is good chance of spontaneous closure
41
What is atrioventriculo-septal defect associated with?
Trisomy 21
42
What is AVSD?
Singular AV valve with ostium primum ASD and high VSD
43
How can pulmonary stenosis present?
- Mild= asymptomatic | - Moderate/severe= severe exertional dyspnoea and fatigue
44
What murmur is associated with pulmonary stenosis?
Ejection systolic murmur upper left sternal border with radiation to back
45
How can pulmonary stenosis be managed?
Balloon valvoplasty until the child is well past puberty and a replacement can be performed
46
How can aortic stenosis present?
- Mostly asymptomatic | - Severe= reduced exercise tolerance, exertional chest pain, syncope
47
What murmur is associated with aortic stenosis?
Ejection systolic murmur upper right sternal border, radiation into carotids
48
What changes occur in the foetal circulation at birth?
- Pulmonary vascular resistance falls - Pulmonary blood flow rises - Systemic vascular resistance is increased - Ductus arteriosus closes - Foramen ovale closes - Ductus venosus closes
49
Who is PDA common in?
Very common in pre-term infants
50
How is PDA treated in pre term babies?
- Fluid restriction/ diuretics - Prostaglandin inhibitors (indomethacin, ibuprofen) - Surgical ligation
51
How is PDA manages in term babies?
Good chance of spontaneous closure, not prostaglandin sensitive
52
How can coarctation of the aorta be imaged
- ECHO - MRI - 3D MRI - CT angiogram
53
How is coarctation of the aorta managed?
- Re-open PDA with Prostaglandin E1 or E2 - Resection with end-to-end anastomosis - Subclavian patch repair - Balloon Aortoplasty
54
What is the problem in translocation of the great vessels?
- Aorta comes from RV - Pulmonary trunk from LV Essentially means blood circulates without being oxygenated
55
What procedure is carried out in a transposition of the great vessels to allow blood flow through both sides?
Rashkind's atrial septostomy
56
What is the definitive treatment for translocation of the great vessels?
Switch procedure
57
What are the 4 components of teratology of Fallot?
- Pulmonary stenosis - VSD - Right ventricular hypertrophy - Overriding aorta

paediatrics (37 decks)

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