Cardiology Flashcards
Which maternal condition can increase chances of the baby developing cardiac anomalies?
Diabetes
Thin long fingers can be a sign of which syndrome?
Marfan’s syndrome
->also high arched palate
In which heart disease may non-purulent conjunctivitis be seen?
Kawasaki heart disease
Which heart problem is seen in children with William’s syndrome?
Supravalvular aortic stenosis
What are some of the cardiac abnormalities seen in children with DiGeorge syndrome?
Interrupted aortic arch
What are some of the cardiac abnormalities Turner syndrome has an association with?
Bicuspid aortic valve
Aortic coarctation
Where may pace-makers been seen in younger infants and neonates?
Abdomen
Which type of murmur are always pathological- systolic or diastolic?
Diastolic
Features when describing a murmur?
Systolic or diastolic
Site
Loudness
Radiation
Character- harsh, blowing, high-pitched, low-pitched
What are innocent murmurs?
Harmless sounds made by the heart
Common in infancy and childhood, disappear in adulthood
->one of the commonest reasons for cardiology referral
When may an innocent murmur become more obvious?
Fever
Anaemia
Anxiety
Infections
Characteristics of an innocent murmur?
Soft
Systolic, except venous hum with is a continuous murmur
Varies with posture
No thrill
Short duration
Child asymptomatic
Which is the commonest innocent murmur heard in children?
Still’s murmur
->most common in school age children
Where is Still’s murmur best heard?
Left lower sternal edge
When is Still’s murmur more obvious?
Supine position
->decreased in standing, sitting, Valsalva
Physiological pulmonary stenosis is common in newborns, and can last until 3-6 months of age.
Where is it best heard?
Left upper sternal edge
->will radiate to back
What position can cervical venous hum be heard in?
Only sitting position
Which age group is cervical venous hum most common in?
Young school age children
Where is cervical venous hum heard?
Anterior neck to infraclavicular area
R>L
In which age group would pulmonary flow murmurs be heard?
Older children and teenagers
->more common in those with thin chest walls
Where is pulmonary flow murmur best heard?
Left upper sternal edge
Carotid bruits can be heard in children and young adults. When is it louder?
Anxiety/asthma
Moving on from innocent murmurs..
Mild pulmonary stenosis can be asymptomatic.
Moderate and severe pulmonary stenosis can cause which symptoms?
Exertional dyspnoea and fatigue
Where is pulmonary stenosis heard and where does it radiate to?
Upper left sternal border
Radiates to back
->ejection systolic murmur
Intervention is required in moderate and severe pulmonary stenosis.
What is most commonly done?
Balloon valvoplasty
What happens as a consequence to balloon valvoplasty?
Catheter put through femoral vein up to RA, RV and then through the pulmonary valve.
This fixes stenosis but causes some pulmonary regurgitation.
Pulmonary regurgitation is well tolerated.
Aortic stenosis is also asymptomatic if mild.
What symptoms can be experienced in moderate to severe aortic stenosis?
Reduced exercise tolerance
Exertional chest pain
Syncope
Where is aortic stenosis best heard, and where does it radiate to?
Right upper sternal border
Radiates to carotids
Management of moderate-severe aortic stenosis?
Similarly, balloon valvoplasty can be attempted but is higher pressure environment so aortic regurgitation is common.
->aortic regurgitation is not tolerated as well as pulmonary regurgitation
Does umbilical vein carry oxygenated or deoxygenated blood?
Oxygenated blood
Name three aspects of the heart which are part of embryological development but close after birth.
Ductus arteriosus
Foramen ovale
Ductus venosus
What is it called if the ductus arteriosus doesn’t close after birth?
Patent ductus arteriosus
Which infants is patent ductus arteriosus more common in?
Pre-term infants
Treatment of patent ductus arteriosus?
Fluid restriction/diuretics
Prostaglandin inhibitors
Surgery
What happens in coarctation of the arota?
Narrowing of a segment of the aorta
Clinical presentation of coarctation of the aorta?
Weak or absent femoral pulses
Radio-femoral delay (chronic co-arctation only)
Systolic murmur- loudest on back
Sudden deterioration and collapse
->femoral pulses are checked in first day baby checks
Management of coarctation of the aorta?
Surgery
Balloon aortoplasty
What is one of the important features of cyanotic heart defects?
Central cyanosis- tongue/lips must be blue
Fallot’s tetralogy?
Combination of four congenital heart defects that affect infants and children
When is full correction of Fallot’s tetralogy done?
When infant is at 5kg body weight, around six months
How does heart failure present in an infant?
Tachypnoea on feeding, panting with feeds. Suck-rest pattern, need to take breaks from feeding.
Tachycardia
Hepatomegaly
Cardiomegaly, faltering growth
->peripheral oedema associated with adults, not babies
If a baby has Down syndrome, which cardiac anomaly are they most likely to have?
AVSD
Symptoms of coarctation of aorta in neonates?
Presents acutely unwell, severe metabolic acidosis
Symptoms of coarctation of aorta in older children?
Hypertension
->congenital narrowing of descending aorta which increases afterload on heart
Investigations if you suspect coarctation of the aorta?
CVS exam
Check femoral pulses
Check BP
ECHO is diagnostic
Okay just to check, which test is diagnostic of coartation of the aorta?
ECHO
Four anomalies in Fallot’s tetralogy?
Ventricular septal defect
Overriding of aorta
Right ventricular hypertrophy
RVOT obstruction
Investigations for Fallot’s tetralogy?
Oxygen sats
CXR
ECHO
Presentation of Fallot’s tetralogy?
Cyanosis
Faltering growth
Old child-squatting
Treatment of Fallot’s tetralogy?
Corrective surgery around 6 months
In few patients- BT shunt
What is meant by transposition of the great arteries?
Pulmonary artery and aorta are swapped over.
This means that blood flows to lungs and picks up oxygen but is pumped back to lungs rather than the rest of the body.
->pulmonary artery arises from LV
Aorta arises from RV
Presentation of transposition of the great arteries?
Cyanosis in the immediate neonatal period
Investigations of transposition of the great arteries?
Saturations
CXR
ECHO
Treatment of transposition of the great arteries?
Commence prostaglandins- keeps the duct open
Corrective surgery- arterial switch
