Cardiology Flashcards
What are switched in transposition of the great arteries?
Pulmonary artery and aorta - the aorta arises from the RV and PA from the LV
What does survival in transposition of the great arteries depend upon?
A shunt being also present - PDA, ASD, VSD. If there is no shunt, there is no mixing of systemic and peripheral circulations
Describe the presentation of transposition of the great arteries
Cyanosis at birth/ within 24 hours, tachycardia, respiratory distress, sweating, poor feeding and weight gain
What does the CXR show for transposition of the great arteries?
Eggs on a string - narrow mediastinum and cardiomegaly
What is the gold standard diagnosis for transposition of the great arteries?
ECHO
What is given to maintain the ductus arteriosus?
Prostaglandin infusion
Name 3 causes of infective endocarditis
Strep viridans (dental work), staph aureus (IV DU), staph epidermis (prosthetic heart valves)
What does FROM JANE stand for in IE?
Fever, Roth spots, Osler nodes, Murmur (new), Janeway lesions, anaemia, nails (splinter haemorrhages) and emboli
What is the gold standard diagnosis for IE?
Echo shows vegetation on the pulmonary valve
Describe the treatments for IE dependent on cause
IV ben pen for strep, IV fluclox for staph aureus and IV amox for unknown
What is rheumatic fever?
A type 2 hypersensitivity reaction that can occur 2-4 weeks after strep pyogenes infection (tonsilitis)
What is an atrial septal defect?
A hole in the septum between the two atria connecting left and right sides causing a left to right shunt
What is the most common form of ASD?
ostium secondum
What is the murmur of ASD?
Mid systolic crescendo-decrescendo murmur loudest at the upper left sternal border
What is a ventricular septal defect?
A hole in the septum between the two ventricles
What is often underlying in VSD?
A genetic condition such as Downs or Turners
What is the murmur of VSD?
Pansystolic murmur heard loudest at the left lower sternal border in the 3rd and 4th intercostal spaces
Name the 4 co-existing pathologies of tetralogy of fallot
Pulmonary Valve Stenosis, Right Ventricular Hypertrophy, Overriding Aorta and VSD
What is the overall direction of the Tetralogy of Fallot shunt?
right to left
What are tet spells?
Periods where the shunt worsens when pulmonary vascular resistance increases or systemic decreases causing a cyanotic episode
What is shown on CXR for T of F?
Boot shaped heart
What is the gold standard management for T of F?
total surgical repair via open heart surgery
What is PDA?
Persistent connection between aorta and pulmonary artery which normally closes permanently within 2-3 weeks
How does PDA present?
SOB, difficulty feeding, poor weight gain, tachypnoea, lower RTI
What is the murmur of PDA?
Continuous machinery murmur crescendo-decrescendo
What can be given in PDA to inhibit prostaglandin?
Indomethacin
What is Eisenmenger Syndrome?
Blood flows from the right side of the heart to the left across a structural heart lesion, bypassing the lungs causing by PDA, ASD, VSD
What is aortic valve stenosis?
Narrow aortic valve restricting blood flow from LV to aorta. The aortic valve normally has 3 leaflets called the aortic sinuses of Valsalva
What is the presentation of AVS?
Mild can be asymptomatic
More significant - fatigue, SOB, dizziness, fainting, worse on exertion
What is the murmur of AVS?
Ejection systolic loudest at the aortic area with an ejection click
What is the presentation of heart failure?
Sweating, SOB, poor weight gain and feeding, tachypnoea, hepatomegaly, cardiomegaly, tachycardia, gallop rhythm and older children can present with adult signs such as raised JVP, oedema and paroxysmal nocturnal dyspnoea
What is the most common abnormal rhythm in children?
supraventricular tachycardia
What does ECG of SVT show?
Narrow complex tachycardia of 250-300 bpm
What is the treatment for SVT?
Carotid sinus massage, IV adenosine and maintenance with solatol or flecanide
What is Wolff Parkinson White?
Pre-excitation syndrome due to abnormal re-entry circuit of the AV node accessory pathway (Bundle of Kent)
What does the ECG of Wolff Parkinson White show?
Short PR interval and delta wave
What is the definitive management of Wolff Parkinson White?
Catheter ablation of the extra pathway
What is long QT syndrome?
Autosomal dominant - causes blackouts and palpitations
What is the most common cardiac defect in babies of diabetic mothers?
Transposition of the great arteries
