Cardiology Flashcards by katie louise

List three red flags in cardiovascular system

 Breathing Difficulty
 Cough
 Wheeze
 Cyanosis
 Lethargy
 Murmur

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After what age does finger clubbing become apparent?

> 1 year

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Which organ aside from the heart can become enlarged in heart failure?

liver

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List two features of an innocent murmur

Asymptomatic
No thrill/no heave
Soft systolic murmur
Varies with position
Localised to one area

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List three acyanotic congenital heart conditions

Ventricular septal defect (VSD)
Pulmonary stenosis
Atrial septal defect (ASD)
Coarctation of the aorta
Patent ductus arteriosus (PDA)

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State three cyanotic congenital conditions

Tetralogy of Fallot
Transposition of the great arteries
Tricuspid atresia
Pulmonary atresia

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List three differentials for cyanosis

Respiratory disease
Cardiac
During a seizure
Stress: infection, hypoglycaemia, adrenal crises
CNS depression: drugs, trauma, asphyxia

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List three common causes of cardiac failure in children

Anaemia
Fluid overload
Stress- infection, hypoxia, acidosis
Cardiac- VSD, AVSD, cardiomyopathy

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List three cardiac causes of cardiac failure in children

VSD, AVSD, cardiomyopathy, coarctation of the aorta

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Name two chromosomal abnormalities associated with cardiac conditions

down’s
edward’s
turner’s
patau’s
di george

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How does atrial septal defect present?

breathlessness and arrhythmia

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What is the outlook of atrial septal defect?

good long term outlook

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How many asymptomatic/small VSD close spontaneously?

80%

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Name a physiological complication of a large VSD?

left ventricular overload and increase pulmonary blood flow, leading to cardiac failure

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What are the clinical findings in patent ductus arteriosus?

bounding femoral pulses and continuous left subclavicular murmur

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Two complications of patent ductus arteriosus?

heart failure and failure to thrive

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How does coarctation of aorta present in neonates?

collapse, cardiac failure or weak/absent femoral pulses

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How does coarctation of aorta present in older children/adults?

raised blood pressure/absent femoral pulses or radio-femoral delay

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Which is the most common neonatal cyanotic condition?

transposition of the great arteries

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Where does mixing of blood occur in transposition of the great arteries?

atrial level and arterial duct

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What are the four features of tetralogy of fallot?

RAPS
Right ventric hypertrophy
Aorta displacement/overriding aorta
Pulmonary stenosis
Septal defect (ventricular)

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Two risk factors for patent ductus arteriosus?

premature birth
maternal rubella

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Which is the most likely organism to cause infective endocarditis in children?

strep viridans

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Name three symptoms of infective endocarditis

fever, malaise, weight loss, haematuria, splenmogealy, arthralgia

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Does a negative echo exclude infective endocarditis?

What is a Tet spell?

rapid drop in amount of oxygen in the blood, obstruction of right ventricular outflow

What is the management of a Tet spell?

lift knee to chest or squat (increases systemic vascular resistance)

Why do toddler squat during a tet spell?

increases blood flow to lungs as afterload is increased, increasing pressure in aorta, less shunting

Which class of drug is administered in tetralogy of fallot to keep ductus arteriosus open?

prostaglandin

Why is tetralogy of fallot a misnomer?

it's due to a single pathological cause, where the septum shifts to the right, which results in four complications

Which shunt occurs in tetralogy of fallot?

right to left (due to pulmonary stenosis, RV hypertrophy, high pressure), therefore mixing of deoxygenated blood- cyanosis

Baby with single palmar crease, upslanting palpebral fissures, flattened facial features. 3/6 pansytolic murmur at left sternal edge. What is the likely congenital defect?

AVSD

What percentage of down's syndrome babies will have AVSD?

40-60%

3 year old with two day history of coryza, sore throat, intermittent fevers. She is pyrexial and tachy on exam. She has a systolic murmur in left lower sternal edge which disappears when the patient sits forward. What is the likely cause of the murmur?

Innocent heart murmur= functional heart murmur, classically change with position, don’t worry about this at all.

Name one trigger for innocent murmur?

infection

Baby girl with 2/6 soft systolic murmur radiating to back. Femoral pulses are weak. She appears pink and well perfused. What is the underlying cardiac issue in this baby?

Coarctation of the aorta

Which syndrome is associated with coarctation of the aorta?

turner's

Name three features of Turner's syndrome

webbed neck, widely space nipples, short stature

What is the definitive treatment of transposition of the great arteries?

arterial switch surgery (prostaglandins are given initially but is only temporary, keeps the ductus arteriosus patent).

Which is the most common cyanotic congenital heart defect?

transposition of the great arteries

CXR shows egg shaped heart. What is the likely diagnosis?

transposition of great arteries

Boot shaped heart on CXR. what is the likely condition?

Tetralogy of fallot. What causes the boot shape? Normal sized heart with upturned apex. Echo confirms diagnosis. Second most common cyanotic condition.

Two causes of splitting of S1?

=differential contraction of left and right ventricles (mitral and tricuspid valves) mechanical: atrial septal defect tricuspid stenosis conduction: RBBB

What causes splitting of S2?

can be normal variant- inspiration= normal mechanical or conduction causes

Barbara is a term baby, who was borderline small for dates during pregnancy. Mum was otherwise well and didn’t take any medications. At her baby check the following is noted: hands/feet appear swollen, excess skin around the neck, 3/6 ejection systolic murmur (loudest at the top of the sternum).What is the most likely cardiac abnormality?

VSD

A GP has noted a new cardiac murmur in a baby’s 6 week check. Which single feature is most suggestive of a pathological murmur

is accompanied by hepatomegaly (3cm below costal margin)

What are the 6 S's of innocent murmurs?

Soft (not >3/6) Sensitive (changes with position) Systolic Short (i.e. not pansystolic) Single (no other added sounds, usually one location, no other symptoms and signs) Sweet (i.e. not harsh sounding)

Name one example of an innocent murmur

Still's murmur Venous hum

Which innocent murmur is louder lyind down and which louder when standing up?

lying down- still's standing up- venous hum

A baby boy born prematurely at 29+3 is on the NICU and is now 2 weeks old. The doctors are struggling to wean him off of the ventilator. Antenatal scans were normal. The chest is clear, but a continuous ‘machine like’ murmur is noted at the left upper sternal edge, which radiates to the back.Which is the most likely lesion found on echocardiogram?

patent ductus arteriosus

How is murmu in VSD described?

pansytolic, harsh sounding, LLSE

How is murmur in tetralogy of fallot described?

ejection systolic

6 Cyanotic congenital heart disease?

5 T's and an H TGA TOF Truncus arteriosus Tricuspid atresia TAPVD HLHS

The CXR appearance 'egg on a string' is indicative of what?

transposition of great arteries

Matilda is 6 weeks old. She is referred to general paediatrics for falling off of her weight centiles. Mum says she is a poor feeder, and is now only managing a few minutes at a time. On examination there is hepatomegaly and a harsh systolic murmur. What is the most likely cardiac lesion?

VSD

List four cause of heart failure in child

Congenital Heart Disease -Left to Right Shunt (VSD/AVSD) -Obstruction (Co-Arctation of the Aorta) Cardiomyopathy Myocarditis Endocarditis Tachyarrhythmias Ischaemic Heart Disease: Kawasaki Disease Hypertension: Renal Disease High Output: Anaemia / Thyrotoxicosis

Annie is a 2 day old who is brought into A&E by ambulance blue and floppy. She is still breathing but looks very unwell. She has good brachial pulses but no femoral pulses on examination. She has a normal blood pressure when taken from her upper limbs. What is the most appropriate initial management plan?

Prostaglandin E2

You see T wave inversion in ECG of child in V1-V3. Are you worried?

no as this is typical in younger children. If you saw this in adult you would be concerned for ischaemia (V1 T wave inversion is normal)

When does coarctation of the aorta present?

25% detectable from birth birth due to severity of narrowing of aorta the majority will present later on in childhood

How does coarctation of the aorta present?

respiratory distress collapse weak or absent femoral pulses

Which medication must be given to child awaiting surgery for transposition of the great arteries?

Prostaglandin E1 should be given to maintain a patent ductus arteriosus in cyanotic congenital heart diseases ALPROSTADIL