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Med Finals - Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the three fetal shunts

A

Ductus venosus - umbilical vein to inferior vena cava, bypasses the liver
Foramen ovale - right atrium and left atrium, bypasses pulmonary circulation
Ductus arteriosus - pulmonary artery to aorta, bypasses pulmonary circulation

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2
Q

What keeps the ductus arteriosus open

A

Prostaglandins

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3
Q

Define innocent murmurs

A

Also known as flow murmurs, are common in children. Caused by fast blood flow through various areas of the heart during systole

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4
Q

Features of an innocent murmur

A

S
Soft
Short
Systolic
Symptomless
Situation dependant

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5
Q

Examples of a pan systolic murmur

A

Mitral regurgitation - mitral area
Tricuspid regurgitation - tricuspid area
Ventricular septal defect - left lower sternal border

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6
Q

Examples of an ejection systolic murmur

A

Aortic stenosis - aortic area
Pulmonary stenosis - pulmonary area
Hypertrophic obstructive cardiomyopathy

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7
Q

What murmur is heard in an atrial septal defect

A

Mid-systolic, crescendo-decrescendo murmur heard loudest at the upper left sternal border with a fixed split second heart sound

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8
Q

What murmur is heard in a patent ductus arteriosus

A

Continuous crescendo-decrescendo machinery murmur.

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9
Q

What murmur is heard in tetralogy of fallot

A

Ejection systolic murmur heard loudest at the pulmonary area - pulmonary stenosis

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10
Q

Define cyanotic heart disease

A

Where deoxygenated blood enters the systemic circulation - there is a right to left shunt that bypasses the pulmonary circulation

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11
Q

Examples of cyanotic heard disease

A

Transposition of the great arteries

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
(Eisenmenger syndrome)

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12
Q

Define patent ductus arteriosus

A

Ductus arteriosus that fails to close - normal happens within first 2-3 weeks. Often caused by genetics, infection or prematurity

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13
Q

Which direction is the shunt in patent ductus arteriosus

A

Left to right
Aorta at much higher pressure than pulmonary artery.
Shunt increased pressure leading to right heart strain and hypertrophy

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14
Q

Presentation of patent ductus arteriosus

A

Shortness of breath
Difficulty feeding
Poor weight gain
LRTI
Machinery like murmur heard

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15
Q

Investigation in patent ductus arteriosus

A

Echocardiogram

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16
Q

Managment of patent ductus arteriosus

A

Monitoring echos until 1 year when should close
If not - trans-catheter or surgical closure

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17
Q

Define Eisenmenger syndrome

A

Where pulmonary pressure is greater than systemic pressure causing a reversal of a right to left shunt making the patient cyanotic

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18
Q

Examples of atrial septal defects

A

Ostium secondum
Patent foramen ovale
Ostium primum

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19
Q

Complications of atrial septal defects

A

Stroke - VTE
Atrial fibrillation or flutter
Pulmonary hypertension
Eisenmenger syndrome

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20
Q

Presentation of atrial septal defect

A

Mid-systolic murmur with fixed split second heart sound
Shortness of breath
Difficulty feeding
Poor weight gain
LRTI

21
Q

Management of atrial septal defects

A

Conservative
Surgical closure
Anticoagulants in adults

22
Q

What genetic conditions are VSD associated with

A

Down’s and Turner

23
Q

Presentation of a ventricular septal defect

A

Pan-systolic murmur at lower sternal border
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive

24
Q

Management of ventricular septal defects

A

Conservative
Surgical closure
Abx for infective endocarditis

25
Q

Clinical signs of Eisenmenger syndrome

A

Right ventricular heave
Loud P2
Raised JVP
Peripheral oedema
Murmur
Cyanosis
Clubbing
Dyspnoea
Plethoric complexion

26
Q

Management of Eisenmenger syndrome

A

Management of underlying defect
Heart-lung transplant
Oxygen
Treat pulmonary hypertension
Treat arrythmia
Prevent thrombosis
Prevent endocarditis

27
Q

Define coarctation of the aorta

A

Congenital condition where there is narrowing of the aortic arch - usually around the ductus arteriosus

28
Q

What genetic conditions are associated with coarctation of the aorta

A

Turners syndrome¬

29
Q

Presentation of coarctation of the aorta

A

Weak femoral pulses
Four limb blood pressure - variation
Systolic murmur -
Tachypnoea
Poor feeding
Grey and floppy
Left ventricular heave
Underdevelopment

30
Q

Management of coarctation of the aorta

A

Prostaglandin - keep ductus arteriosus open
Surgical correction and removal of ductus arteriosus

31
Q

Presentation of aortic stenosis

A

Fatigue
Shortness of breath
Dizziness
Fainting
Worse on exertion
Ejection systolic murmur
Ejection click
Palpable thrill

32
Q

Management of aortic stenosis

A

Echo!
Balloon aortic valvoplast
Surgical aortic valvotomy
Valve replacement

33
Q

Complications of aortic stenosis

A

Left ventricular outflow tract obstruction
Heart failure
Ventricular arrhythmia
Bacterial endocarditis
Sudden death

34
Q

What conditions are associated with pulmonary valve stenosis

A

Tetralogy of fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome

35
Q

Presentation of pulmonary valve stenosis

A

Fatigue
Shortness of breath
Dizziness
Fainting
Ejection systolic murmur
Palpable thrill
Raised JVP - A waves

36
Q

Management of pulmonary stenosis

A

Echo!
Conservative
Balloon valvuloplasty

37
Q

Define tetralogy of Fallot

A

Ventricular septal defect
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

38
Q

Define overriding aorta

A

An aorta that sits further right overlying a VSD
As a result right ventricular blood passes through VSD and directly up aorta

39
Q

Risk factors for tetralogy of Fallot

A

Rubella
Increased maternal age
Alcohol consumption during pregnancy
Diabetic mothers

40
Q

Investigations in tetralogy of Fallot

A

Echo! - dopple flow
Chest xray

41
Q

What is seen on CXR in tetralogy of Fallot

A

Boot shaped hear - due to right ventricular thickening

42
Q

Clinical signs of tetralogy of Fallot

A

Cyanosis
Clubbing
Poor feeding
Poor weight gain
Ejecction systolic murmur
Tet spells

43
Q

Define tet spells

A

Intermittent symptomatic periods where the right to left shunt becomes worsenedm causing a cyanotic episode. This happens because of increased pulmonary resistance or decreased systemic resistance - during exercise build up CO2 which causes dilation decreasing resistance

44
Q

Management of Tet spells

A

Squat to increase systemic vascula rresistance
Oxygen
Beta blockers
IV fluids - increase preload
Morphine - decrease resp drive,
Sodium bicarbonate
Phenylephrine

45
Q

Management of tetralogy of Fallot

A

Prostaglandin infusion to maintain ductus arteriosus
Total surgical repair

46
Q

Define Ebstein’s anomaly

A

Congenital heart condition where the tricuspid valve is set lower in the right causing a bigger atrium and smaller ventricle.
Leads to poor flow to pulmonary vessels

47
Q

Define transposition of the great arteries

A

Condition where the attachment of the aorta and pulmonary trunk are swapped - the pulmonary and systemic systems are completely separate

48
Q

Presentation of transposition of the great arteros

A

Antenatal scans
Cyanosis at birth - patent shunt allows initial compensation
Respiratory distress
Tachycardia
Poor feeding
Poor weight gain
Sweating

49
Q

Management of transposition of the great arteries

A

Prostaglandin infusion - maintain right to left shunt
Balloon septostomy
Surgical management

Med Finals - Paediatrics (17 decks)

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