Cardiology

Question 1

How do heart problems in children present?

Answer 1

Arrhythmia
Heart failure
Cyanosis
Murmurs

Question 2

Signs of HF in children?

Answer 2

Tacky cardiac
Tachypnoea
Hepatomegaly

Question 3

What are the types of acyanotic heart disease?

Answer 3

3 holes - ASD, VSD, PDA

3 blocked pipes - AS, PS and coarctation

Question 4

Which murmurs are ejection systolic?

Answer 4

AS (upper RSE)

PS (upper LSE)

Question 5

What clinical signs are there in transposition of the great arterties?

Answer 5

Cyanosis
PDA murmur - only way of oxygenated blood getting into systemic circulation.
Death

Question 6

Tetralogy of fallot has which 4 features?

Answer 6

VSD
Overriding aorta
Pulmonary stenosis
Hypertrophy right ventricle?

Question 7

What are the signs and symptoms of an ASD?

Answer 7

Feeding difficulty, sweating on forehead, FTT
?pulmonary murmur from increased flow
Wide fixing splitting of the 2nd heart sound

Question 8

What is eisenmenger syndrome?

Answer 8

When a long standing L-R shunt (VSD, ASD, pda) reverses to a R-L shunt due to pulmonary hypertension (from excess pulmonary blood flow)

Question 9

Describe the flow of blood through the normal heart

Answer 9

Deoxygenated blood from the vena cava enters the RA –> tricuspid valve –> RV –> pulmonary artery to the lungs –> returns oxygenated blood to heart into the LA –> mitral valve –> LV –> aorta takes oxygenated blood to the body

Question 10

Is you expect there is a cyanotic heart defect which has been masked by a PDA, how would you manage them when the PDA closes?

Answer 10

Prostaglandin E - to re open the duct. (S/e PG-E can cause apnoea)

Question 11

What is a modified blalock-taussig shunt?

Answer 11

Artificially connect subclavian artery to the pulmonary artery to establish pulmonary blood flow in cyanotic heart disease

Question 12

What are the innocent murmurs?

Answer 12

Systolic
Soft
A symptomatic

No added sounds 
No radiation 
Increases during exercise or illness 
Musical (eg stills)
Left sternal edge

Question 13

What is the hyperoxia (nitrogen washout) test?

Answer 13

Full blast oxygen
Tell difference between heart and lung cyanosis

Heart - no different
Lung - improve?

Question 14

What is a, blalack tausigg shunt?

Answer 14

Transfers blood to the lungs

Question 15

What the most common cause of right ventricular outflow obstruction in ToF?

Answer 15

Infundibilar stenosis 50%
Pulmonary valve stenosis 10%
Combination of the two 30%

Question 16

What’s the treatment for hypercyanotic spells in cyanotic heart disease(ToF)?

Answer 16

Morphine - for pain and hyperpnoea.
Sodium bicarb - for acidosis
Propranolol - peripheral vasoconstriction and relieve infundibular spasms.

Definitive treatment is surgery (4-6months old)

Question 17

What is rheumatic fever?

Answer 17

Group A B-haemolytic streptococcal infection (eg s. Pyogenes)

Immune response (type 2 sensitivity reaction) attacks own cells - in heart, joints, skin and brain

Rx- bed rest plus symptom control

Question 18

What happens to the heart in rheumatic fever?

Answer 18

Pan-carditis (all layers affected)
Endocarditis- of mitral and aortic valve, causing murmurs
Myocarditis - see Aschoff bodies in muscle (fibriniod necrosis and immune cells, anitschkow cells-large macrophages with catapillar center) van cause heart failure.
Pericarditis- pain and friction rub, and effusion

Question 19

What are the extra-cardial features of rheumatic fever?

Answer 19

Subcutaneous nodules

Erthyma marginatum (rings)

Late : Sydenham’s chorea (rapid movements of face and arms, caused by damage to BG in brain)

Question 20

What’s included in the duckett jones criteria for rheumatic fever?

Answer 20

Major (carditis, polyarthritis, chorea, erthyma marginatum, subcutaneous nodules)

Minor (fever, arthraligia, previous RF, raised ESR/CRP/leucocytosis, prolonged P-R on ECG.

Question 21

Diagnosis of infective endocarditis in children?

Answer 21

Blood culture - Strep viridans (a-haemolytic strep)90%.
Echo - vegetations (cannot exclude Dx)
Bloods (acute phase reactants eg ESR and CRP)

Question 22

Management of infective carditis?

Answer 22

IV Abx - ampicillin and aminoglycoside.

Question 23

Causes of infective carditis in normal, IVDU and people with prosthetic values, and bowel disease ?

Answer 23

Normal - Viradans (from mouth)
IVDU - staph areus from skin
PRosthtic valves - staph epidermidis from surgery or Iv catheter
Bowel - enterococcus faecalis, strep bovis