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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is different about fetal circulation

A

Fetus recieves all blood from placenta - fetal lungs not functional. Shunts allow blood to bypass lungs.

  • left atrial pressure is low (little blood returns from lungs)
  • right atrial pressure is higher (receives all systemic venous return)
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2
Q

What are the 3 shunts important in fetal circulation

A
  • Ductus venosus: allows blood to transfer from umbilical vein into IVC (bypassing liver)
  • Ductus arteriosus: shunts blood from pulmonary artery into aorta (bypassing pulmonary circulation)
  • Foramen ovale: RA -> LA (bypassing RV + pulmonary circulation).
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3
Q

What happens to vascular resistance after first breath and changes in atrial pressure

A
  • alveoli expanded from first breath causing a reduction in pulmonary vascular resistance
  • increases blood flow through the lungs
  • increased blood flow = increased left atrial pressure
  • placenta excluded from circulation = drop in right atrial pressure (as reduction in systemic venous return from placenta)
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4
Q

How are the shunts closed after birth

A
  • LAP > RAP = squashes atrial septum = closure of foramen ovale
  • Prostaglandins decrease due to increase in blood oxygenation = closure of ductus arteriosus
  • Ductus venosus stops functioning after umbilical cord clamped and no flow through umbilical veins.
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5
Q

What does the ductus arteriosus and ductus venosus become

A

ligamentum arteriosus + ligamentum venosum

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6
Q

Common signs of congenital heart disease

A
  • heart murmur
  • heart failure
  • shock
  • cyanosis
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7
Q

Hallmarks of an innocent murmur

A

S for innoSent

  • Symptomless
  • Soft, short murmur
  • Systolic murmur only
  • left Sternal edge
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8
Q

Symptoms and signs of heart failure

A
  • breathless
  • sweating
  • poor feeding
  • tachypnoea, tachycardia
  • heart murmur
  • cool peripheries
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9
Q

Most common cause of heart failure in 1st week of life and after 1st week

A

1st: left heart obstruction e.g. coarctation of aorta

1st+: left to right shunt - pulmonary oedema and breathless

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10
Q

differentials of a pan-systolic murmur and where they are heard loudest?

A
  • Mitral regurgitation heard at mitral area
  • Tricuspid regurgitation heard at tricuspid
  • ventricular septal defect heard at left lower sternal border
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11
Q

differentials of an ejection-systolic murmur and where they are heard loudest?

A
  • Aortic stenosis heard at aortic area
  • Pulmonary stenosis heard at pulmonary area
  • Hypertrophic obstructive cardiomyopathy
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12
Q

What murmur is caused by an atrial septal defect

A

mid-systolic, crescendo-decrescendo, with a fixed split second heart sound.

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13
Q

What murmur is caused by a patent ductus arteriosus

A

Small may not cause any. More significant PDAs cause a continuous crescendo-decrescendo ‘machinery’ murmur

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14
Q

Tetralogy of fallot murmur

A

Murmur arises from pulmonary stenosis, giving an ejection systolic murmur

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15
Q

What causes cyanosis

A

when deoxygenated blood enters the systemic circulation. Occurs when blood is able to bypass the pulmonary circulation and the lungs. This occurs across a right-to-left shunt. A right-to-left shunt describes any defect that allows blood to flow from the right side of the heart (the deoxygenated blood returning from the body) to the left side of the heart (the blood exiting the heart into the systemic circulation) without travelling through the lungs to get oxygenated.

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16
Q

What heart diseases present straight away with cyanosis and what shunts are they?

A
  • Tetralogy of fallot
  • Transposition of the great arteries (if PDA, ASD)
  • Right to left shunt
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17
Q

What congenital heart conditions are left to right shunt?

A
  • ASD, VSD, PDA
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18
Q

Why are patients with ASD, VSD, PDA usually not cyanotic. How can they become cyanotic + what is name for this syndrome?

A
  • pressure in left side of the heart is much greater than the right side, and blood will flow from the area of high pressure to the area of low pressure. This prevents a right-to-left shunt.
  • If the pulmonary pressure increases beyond the systemic pressure blood will start to flow from right-to-left across the defect, causing cyanosis.
  • This is called Eisenmenger syndrome.
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19
Q

What is the pathophysiology of patent ductus arteriosus?

A
  • ductus arteriosus fails to close. Usually within 2-3 days after birth.
  • higher pressure in aorta than pulmonary vessels -> blood flows from aorta to pulmonary artery = Left to right shunt
  • increased pressure in pulmonary vessels = pulmonary hypertension = right heart strain + RVH
  • increased blood returning to heart via pulmonary vessels and returning to left side of heart = LVH
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20
Q

PDA presentation + Dx

A
  • SOB, difficulty feeding, poor weight gain
  • Cyanotic if develops into Left-to-right shunt
  • Later on can show signs of heart failure
  • Dx: echocardiograms
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21
Q

Mx of PDA

A

after 1 year highly unlikely PDA will close spontaneously

- trans-catheter or surgical closure

22
Q

What is an atrial septal defect

A
  • hole in septum between the 2 atria.
  • blood from left atrium (higher pressure) to right atrium (left -> right shunt)
  • (not cyanotic, but increased BF to right side can lead to RHF and pulmonary HTN. Eventually HTN can lead to Eisenmenger syndrome).
23
Q

Presentation of ASD

A
  • May be sympt or asym
  • SOB, difficulty feeding, poor weight gain
  • arrhythmia in later life
24
Q

Mx of ASD

A
  • small + asymp = watch and wait

- transvenous catheter closure or open heart surgery

25
Q

Why is ASD linked with stroke in patients with a DVT

A
  • Normally in DVT -> clot travels to right side and gets stuck in lungs
  • ASD -> Right to left atrium across the ASD. Aorta and up to brain.
26
Q

What is a ventricular septal defect and what is it linked to

A
  • hole in septum between 2 ventricles.
  • Left to right shunt (but can turn to R->L)
  • Can occur in isolation but commonly associated with Down’s and Turners
27
Q

Px of VSD

A
  • often initially symptomless + picked up incidentally in well child (antenatal scans or NIPE)
  • poor feeding, dyspnoea, tachypnoea, failure to thrive
  • hepatomegaly, oedema if heart failure
28
Q

Murmur heard in VSD

A
  • pan systolic murmur heard at left lower sternal border

- systolic thrill

29
Q

Mx of VSD

A
  • small = watch and see if close spontaneously

- surgical transvenous catheter closure or open heart surgery

30
Q

In patients with VSD what is there an increased risk of and how to prevent?

A
  • Infective endocarditis

- antibiotic prophylaxis

31
Q

What is AVSD + why is it a worry

A
  • defect in atrioventricular septal canal -> opening between ventrilces and atrium
  • holes in atrial and ventriuclar septum +/- undeveloped valves
  • can lead rapidly to pulmonary vascular disease
32
Q

What is coarctation of the aorta?

A
  • congenital narrowing of the aortic arch
  • increases pressure in areas proximal to narrowing (heart + first 3 branches of aorta)
  • decreases pressure flowing to arteries distal to narrowing
33
Q

Neonatal presentation variations of aortic coarctation

A
  1. Initially baby may be well, as PDA open (blood flow past narrowing due to open PDA - deox. may blue lower limbs). Only indication may be weak femorals.
    - > Closure of PDA, infant becomes ill abruptly
  2. If severe: poor feeding, lethargy, weak femorals, shock, collapse (heart failure). [If other anomolies e.g. VSD then symptoms accelerated.]
  3. May be asymptomatic
34
Q

Late presentation of aortic coarctation

A
  • Hypertension or murmur (over back)
  • arterial collaterals develop to bypass coarctation
  • weak femorals
  • may see left ventricular heave
35
Q

Mx of aortic coarctation

A
  • Prostaglandin E used to keep ductus arteriosus open if risk of of heart failure
  • surgery - correct coarctation and ligate ductus arteriosus
36
Q

What is transposition of great arteries

A
  • aorta and pulmonary artery are swapped

- 2 seperate circulations that dont mix (RS + systemic, LS + pulmonary).

37
Q

What is the presentation of someone with TGA during pregnancy and once born

A
  • antenatally normal development. Exchange in placenta (dont need lungs)
  • after birth, cyanosed and life threatening. Unless shunt (PDA, ASD, VSD) to allow blood to be oxygenated by lungs.
38
Q

Mx of TGA

A
  • If VSD, allow some mixing of blood. And time for treatment
  • PG infusion - maintain PDA
  • surgery
39
Q

What are the 4 features of tetralogy of fallot

A
  • VSD
  • Overriding aorta
  • Pulmonary valve stenosis
  • RVH
40
Q

Why is tetralogy of fallot a right to left shunt

A
  • pulmonary stenosis + RVH cause a right to left shunt through the VSD.
  • Deoxygenated blood enters systemic and causes cyanosis.
41
Q

Px of tetralogy of fallot

A
  • blue or pink (if stenosis and RVH minimal)
  • severe: cyanosis, collapse, heart failure (tachpnoea, breathless, sweating, collapse)
  • ejection systolic murmur caused by pulmonary stenosis
42
Q

Tx of tetralogy of fallot

A

surgical repair

43
Q

What is congenital aortic valve stenosis

A
  • narrow aortic valve that restricts blood flow from left ventricle into aorta
44
Q

Px of aortic valve stenosis

A
  • can be asymptomatic
  • significant: fatigue, SOB, dizziness, fainting. Worse on exertion
  • severe: heart failure within months of birth
  • ejection systolic murmur heard loudest at aortic area. Crescendo-decrescendo + radiates to carotids
  • slow rising pulse and narrow pulse pressure
45
Q

Dx of aortic valve stenosis and Mx

A
  • gold standard = echocardiogram

- tx = percutaneous balloon aortic valvoplasty, valvotomy, valve replacement

46
Q

What is pulmonary valve stenosis?

A

abnormal development of leaflets, thickened or fused. Narrow opening between RV and PA

47
Q

Px of aortic valve stenosis

A
  • can be asymptomatic
  • significant: fatigue, SOB, dizziness, fainting. Worse on exertion
  • ejection systolic murmur heard loudest at pulmonary area. Raised JVP.
48
Q

Dx + Mx of aortic valve stenosis

A
  • echo

- balloon valvuloplasty

49
Q

What is rheumatic fever?

A

AI condition triggered by streptococcus. Multi-system disorder

50
Q

Px of rheumatic fever

A
  • typically occurs 2-4 weeks following a streptococcal infection, such as tonsilitis
  • JONES-FEAR
    Joint arthritis, Organ inf (carditis), Nodules, Erythema rash, Sydenham chorea-
    Fever, ECG changes, Arthralgia, Raised inflamm markers (CRP)
  • carditis -> tachy/brady, murmurs, pericardial rub, HF
51
Q

Ix for rheumatic fever

A
  • throat swab for bacterial culture
  • Anti-streptococcal antibodies
  • Echo, ECG to assess heart involvement
52
Q

Mx of rheumatic fever

A
  • phenoxymethylpenicillin (penicillin V) for 10 days
  • aspirin and steroids to treat carditis
  • NSAIDs joint pain

Paediatrics (14 decks)

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