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Y4 Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the 3 fetal shunts

A

Ductus arteriosus
Ductus venosus
Foramen ovale

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2
Q

What is the purpose of the ductus arteriosus?

A

The connection between pulmonary arteries and aorta
Allows bypass of lungs
RA > RV > pulmonary artery > aorta

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3
Q

What is the purpose of the ductus venosus?

A

Shunts 20-30% of oxygenated from umbilical vein to IVC

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4
Q

What is the purpose of the foramen ovale?

A

Septum between two atria (RA > LA)
Allows bypass of lungs

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5
Q

What structures are found in adults that are remnants of the fetal shunts?

A

Ligamentum venosus
Ligamentum arteriosus
Fossa ovalis

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6
Q

What is the cause of the fetal shunts closing?

A

Baby’s first breath v pulmonary vascular resistance as alveoli inflate
^ oxygenation > v circulating prostaglandins > DA closing

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7
Q

What are the 5 features of innocent murmurs?

A

soft
short
systolic
symptomless
situation dependent (quieter with standing or only when child is unwell)

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8
Q

Where is a mitral regurgitation murmur heard best?

A

Mitral area
5th IC space, mid-clavicular line

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9
Q

Where is a tricuspid regurgitation murmur heard best?

A

Tricuspid area
5th IC space, L sternal border

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10
Q

Where is a ventricular septal defect murmur heard best?

A

L lower sternal border

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11
Q

What are the differentials for a pan-systolic murmur?

A

Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect

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12
Q

Where is an aortic stenosis murmur heard best?

A

Aortic area
2nd IC space, R sternal border

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13
Q

Where is a pulmonary stenosis murmur heard best?

A

Pulmonary area
2nd IC space, L sternal border

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14
Q

Where is a HOCM murmur best heard?

A

4th IC space, L Sternal border

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15
Q

What are the differentials for an ejection systolic murmur?

A

Aortic stenosis
Pulmonary stenosis
Hypertrophic Obstructive Cardiomyopathy

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16
Q

What murmur is associated with atrial septal defects?

A

Mid-systolic
Crescendo-decrescendo murmur
Fixed split second heart sound

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17
Q

What is the pathophysiology that causes a fixed split second heart sound?

A

ASD > blood from LA > RA > RV
Therefore filling of pulmonary artery takes more time and shutting of pulmonary valve is delayed
The delayed shutting of the pulmonary valve does not change with respiration (fixed)

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18
Q

What is the physiology behind a split second heart sound?

A

Negative intra-throacic pressure (caused by chest wall and diaphragm pulling lungs and heart open) > faster R sided heart filling (blood pulled from venous system)
^ RV volume > ^ time to RV to empty > delayed pulmonary valve closing
Aortic valve closes, then pulmonary valve closes = split second heart sound

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19
Q

What is the murmur heard in patent ductus arteriosus?

A

Small patency > no murmur
Significant patency > continuous crescendo-decrescendo “machinery” murmur
S2 difficult to hear

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20
Q

What is the murmur associated with Tetralogy of Fallot?

A

Arises from pulmonary stenosis
> ejection systolic murmur
At pulmonary area (2nd IC space, L sternal border)

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21
Q

Cyanotic heart disease is associated with what type of shunts?

A

Right-to-left shunts

22
Q

What heart defects produce a right-to-left shunt?

A

Transposition of the great arteries
Tetralogy of Fallot
Eisenmenger syndrome

23
Q

What heart defect always produces cyanotic heart disease?

A

Transposition of the great arteries

24
Q

Why is cyanosis prevented in VSD, ASD, and PDA?

A

Pressure of L side of heart is HIGH (relative to the R side)
Therefore, movement of deoxygenated blood from R to L is prevented and ONLY oxygenated blood moves into the aorta

25
Q

What is Eisenmenger syndrome?

A

^ in pulmonary vascular pressure > ^ pressure of R side of heart
> cyanotic symptoms with VSD, ASD, PDA
Due to movement of deoxygenated blood from R side of heart (HIGHER pressure) to L side of heart (LOWER pressure)

26
Q

What are the risk factors of patent ductus arteriosus?

A

Unclear but genetics and infections (e.g. rubella) have been suggested
Prematurity is a RF

27
Q

What is the diagnostic test used for patent ductus arteriosus?

A

Echocardiogram
(CXR / ECG will be normal)

28
Q

What is the management of patent ductus arteriosus?

A

1 year of regular monitoring
Ibuprofen (prostaglandin inhibition)
Trans-catheter / surgical closure (after 1 year)

29
Q

What are the two types of atrial septal defects?

A

Ostium primum (10%)
Ostium secundum (90%)

30
Q

What are the ECG features associated with the two types of atrial septal defects?

A

Ostium primum = RBBB + LAD with prolonged PR interval
Ostium secundum = RBBB + RAD

31
Q

What is the management of atrial septal defects?

A

Catheterisation with an occlusion device

32
Q

Risk factors for atrial septal defects

A

Genetics
Maternal alcohol consumption

33
Q

What are the potential complications of atrial septal defect?

A

Stroke (VTE)
Pulmonary hypertension
R HF
AF / atrial flutter
Eisenmenger syndrome

34
Q

What is the management of atrial septal defects?

A

Transvenous catheter closure with occlusion device
Anticoagulants (aspirin, warfarin, NOACs)

35
Q

What are the features of a ventricular septal defect?

A

Left-to-right shunt (acyanotic)
Associated with genetic conditions (e.g. Down’s / Turner’s)
> R HF, pulmonary hypertension, right sided overload
Typically asymptomatic, picked up antenatally / newborn baby check

36
Q

What is the treatment of ventricular septal defect?

A

Watchful waiting
Transvenous catheter closure / Open heart surgery
Prophylactic antibiotics (^ risk of infective endocarditis)
Maintain good dental hygiene
If HF: diuretics + captopril (ACEi)

37
Q

What is the treatment for Eisenmenger syndrome?

A

Definitive = Heart-lung transplant
Treat arrhythmias, pulmonary hypertension (sildenafil), polycythaemia (venesection), prevent infective endocarditis (prophylactic Abx)

38
Q

What are the four coexisting pathologies associated with Tetralogy of Fallot?

A

Ventricular Septal Defect
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

39
Q

What is the murmur that would be heard in a patient with Tetralogy of Fallot?

A

Pansystolic murmur (pulmonary stenosis), 2nd IC space L sternal border
Ejection click (dilated aorta)
Loud single S2 (aortic valve closure)

40
Q

What features would be seen in a patient with Tetralogy of Fallot?

A

Thrills (depends on severity of pulmonary stenosis)
Heaves (RVH)
Signs of congestive heart failure (clubbing, hepatosplenomegaly, oedema, BL basal crackles, gallop rhythm)
Cyanosis

41
Q

What investigations can be completed for Tetralogy of Fallot?

A

Echocardiogram (overriding aorta, pulmonary stenosis, VSD, RVH)
CXR (boot-shaped heart)
ECG (RAD)

42
Q

What is the management of Tetralogy of Fallot?

A

Neonates: prostaglandin infusion (maintains DA to move deoxygenated blood from aorta to pulmonary arteries for oxygenation)
Squatting (^ systemic vascular resistance)
Supplemental oxygen
Morphine (v respiratory drive > more effective breathing)
Saline 0.9% bolus (in tet spells as volume expander to ^ pulmonary blood flow)
Transcatheter RVOT stent insertion (palliative)
Modified BT shunt (palliative - mimics PDA)
RV > PA conduit / PA banding
Definitive repair (Heart-lung transplant)

43
Q

What is transposition of the great arteries?

A

Swapping (transposition) of attachment of aorta and pulmonary vessels
RV > aorta
LV > pulmonary trunk

44
Q

What is the presentation of transposition of the great arteries?

A

Typically in antenatal USS (monitoring and arrangements made for management post-birth)
Cyanotic within few days post-birth
IF PDA, VSD, ASD can compensate, then presents as poor weight gain, poor feeding, resp distress, tachycardia, sweating

45
Q

What is the management of transposition of the great arteries?

A

Prostaglandin infusion (maintain DA)
Balloon septostomy (catheter > foramen ovale > large ASD)
Cardiopulmonary bypass switch procedure (open heart surgery)

46
Q

What is coarctation of the aorta and how does it present?

A

= narrowing of aortic arch (typically around the DA)
> ^BP in upper extremities (before arch) and vBP in lower extremities (after arch)

47
Q

What is the management of Coarctation of the Aorta?

A

Prostaglandin infusion (DA maintenance while awaiting surgery)
Open heart surgery (correct coarctation + ligate DA)

48
Q

What murmur is associated with trisomy 21?

A

Down’s syndrome = AVSD

49
Q

What murmur is associated with trisomy 18?

A

Edward’s syndrome = ASD

50
Q

What murmur is associated with 22q11.2 deletion?

A

DiGeorge = interrupted aortic arch +/- VSD, ToF

51
Q

What murmur is associated with Turner’s?

A

Bicuspid aortic valve

Y4 Paediatrics (5 decks)

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