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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Cyanotic Heart Disease

A
  1. Transposition of the great vessels
  2. Tetralogy of Fallot
  3. Total anomalous pulmonary venous return
  4. Truncus arteriosis
  5. Tricuspid atresia
  6. Severe pulmonary stenosis
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2
Q

Duct-Dependent lesions

A

Poor PULMONARY flow requires PDA to preserve blood flow from Aorta to pulmonary circulation

  • Critical pulmonary stenosis
  • Transposition of great vessels
  • Hypoplastic Right Heart Syndrome
  • (TOF)
  • (Tricuspid atresia)

Presentation

  • cyanosis
  • Inc RR without resp distress
  • Adequate perfusion - initial

Poor SYSTEMIC flow requires PDA to preserve blood flow from PA to systemic circulation

  • Coarctation of aorta
  • Interrupted aortic arch
  • Hypoplastic left heart syndrome
  • Critical aortic stenosis

Presentation

  • Cardiac failure with systemic hypoperfusion
  • Poor or absent peripheral pulses
  • Inc metabolic acidosis
  • Cyanosis may not dvp until later

AIMS of Mx

  • Minimise pulmonary blood flow
    • Mod PEEP
    • Ventilate in air if possible
    • CO2 37-45mmHg
    • Sats 75-85%
  • Maximise tissue perfusion
    • Fluid (10mL/kg boluses) if shocked
    • Low dose inotropes - NA 0.1mcg/kg/min
    • NaHCO3 if BE >-10
    • Consider intubation, muscle relaxants and sedation if distressed
    • PGE1 0.05-0.1mcg/kg/min for ductal patency
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3
Q

Cyanotic Heart Dx Table

A
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4
Q

Neonatal cyanosis

A
  1. Congenital Heart disease
  2. Sepsis
  3. Respiratory disorders
  4. Heamoglobinopathies
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5
Q

Tetralogy of Fallot

A
  1. Ventricular Septal defect
  2. RVH
  3. Overriding aorta
  4. Pulmonary stenosis

Functional result => shunt from RV to aorta and small pulmonary artery and oligaemic lungs

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6
Q

TET Spells

A

Baseline depends on degree of Pulmonary stenosis

Mild = normal pulmonary flow

Mod-severe = significant outflow obstruction = > hypoxia

O2 sats range from 70-100% depending on pulmonary stenosis

Causes:

Sepsis, anaphylaxis, hypoxia, tachycardia, hyperventilation

Physiology:

Hypoxia => dec SVR => dec afterload => inc R→ L shunt through the VSD => worsening hypoxia

Dec pO2 / inc pCO2 / dec pH => increased Pulmonary Vascular resistance => inc venous return

Inc venous return => more shunting

Management of cyanotic spells:

  1. Increase SVR OR
  2. Dec VR
  3. Dec Pulmonary VR
  • Oxygen
  • Calm pt
  • Knees to chest
  • Morphine 10-50mcg/kg OR fentanyl 1mcg/kg
  • Volume expansion: 10 ml/kg IV colloid/crystalloid
  • Vasopressor: metaraminol 5-10 mcg/kg IV or phenylephrine 5-10 mcg/kg, then 1-5 mcg/kg/min IV/(SC)
  • Esmolol 100-500 mcg/kg (titratable) +/- infusion
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7
Q

ECGs - Paeds

A

Rate - HR faster

Axis - RV predominance

  • RAD
  • Tall RV1
  • TWI right precordial leads

Intervals - tend to be short

  • PR normalises at adolescence
  • QRS<80ms before 8yrs
  • QT may be up to 490ms before 6/12

Pseudo-ischaemia/infarction

  • Small narrow Q waves inf and lateral leads
  • TWI
    • V1-3
    • Juvenile T-wave abN
    • Upright Ts in V1 - RVH
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8
Q

Eisenmenger Syndrome

A
  • L-R shunt into R-L shunt
  • Irreversible PHTN

Occurs with

  • Large VSD
  • Ostium primum defect (lower septum - malformation of AV valve annulus)
  • Transposition of great vessels with large shunt

Presentation

Cyanosis, CP, SOBOE, haemoptysis

Hyperviscosity, Paradoxical emboli, brain abscess

Mx

IV prostaglandin may reduce Pulmonary vasc pressure

Supportive

  • O2
  • Maintain volume
  • Phlebotomy for hyperviscosity
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9
Q

Ebstein’s Anomaly

A

Septal leaflets of Tricuspid displaced into RV

80% ASD

Range from asymptomatic to severe symptoms

Assessment

Cyanosis proportional to degree of R-L shunt

TR - systolic murmur lower left sternal edge

ECG

P pulmonale, RBBB, 1HBm accessory pathway 20%

CXR

cardiomegaly, RA enlarged, dec pulmonary vascular markings

Mx

Endocarditis prophylaxis

Rx HF

Surgery

  • Temporary shunt from systemic to pulmonary cir to inc pulmonary blood flow
  • Fontan
  • Repair tricuspid + ASD
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10
Q

Transposition Great Arteries

A

Not compatible with life

Large VSD or PDA decreases severity of symptoms

Cyanosis hours after birth

CXR - egg on string

Increased cardiac silhouette

Pulmonary artery and aorta lie in front of each other

Mx

Urgent balloon atrial septoplasty - create large ASD

Arterial switch

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11
Q

Fontan Procedure

A

Create univentricular heart so blood from IVC/SVC diverted from RA to pulmonary arteries

Indications

Single functional ventricle

Tricuspid or mitral atresia

Hypoplastic heart

CI in children with high Pulmonary vascular resistance

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12
Q

Blalog-Tausig shunt

A

Shunt between branch of aorta and pulmonary artery

O2 sats between 70-85% optimal

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13
Q

Incomplete Kawasaki Disease

A
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14
Q

Heart Disease

A
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Paediatrics (12 decks)

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