Cardiology Flashcards
How do heart problems in children present?
Arrhythmia
Heart failure
Cyanosis
Murmurs
Signs of HF in children?
Tacky cardiac
Tachypnoea
Hepatomegaly
What are the types of acyanotic heart disease?
3 holes - ASD, VSD, PDA
3 blocked pipes - AS, PS and coarctation
Which murmurs are ejection systolic?
AS (upper RSE)
PS (upper LSE)
What clinical signs are there in transposition of the great arterties?
Cyanosis
PDA murmur - only way of oxygenated blood getting into systemic circulation.
Death
Tetralogy of fallot has which 4 features?
VSD
Overriding aorta
Pulmonary stenosis
Hypertrophy right ventricle?
What are the signs and symptoms of an ASD?
Feeding difficulty, sweating on forehead, FTT
?pulmonary murmur from increased flow
Wide fixing splitting of the 2nd heart sound
What is eisenmenger syndrome?
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)
Describe the flow of blood through the normal heart
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
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?
Prostaglandin E - to re open the duct. (S/e PG-E can cause apnoea)
What is a modified blalock-taussig shunt?
Artificially connect subclavian artery to the pulmonary artery to establish pulmonary blood flow in cyanotic heart disease
What are the innocent murmurs?
Systolic
Soft
A symptomatic
No added sounds No radiation Increases during exercise or illness Musical (eg stills) Left sternal edge
What is the hyperoxia (nitrogen washout) test?
Full blast oxygen
Tell difference between heart and lung cyanosis
Heart - no different
Lung - improve?
What is a, blalack tausigg shunt?
Transfers blood to the lungs
What the most common cause of right ventricular outflow obstruction in ToF?
Infundibilar stenosis 50%
Pulmonary valve stenosis 10%
Combination of the two 30%
What’s the treatment for hypercyanotic spells in cyanotic heart disease(ToF)?
Morphine - for pain and hyperpnoea.
Sodium bicarb - for acidosis
Propranolol - peripheral vasoconstriction and relieve infundibular spasms.
Definitive treatment is surgery (4-6months old)
What is rheumatic fever?
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
What happens to the heart in rheumatic fever?
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
What are the extra-cardial features of rheumatic fever?
Subcutaneous nodules
Erthyma marginatum (rings)
Late : Sydenham’s chorea (rapid movements of face and arms, caused by damage to BG in brain)
What’s included in the duckett jones criteria for rheumatic fever?
Major (carditis, polyarthritis, chorea, erthyma marginatum, subcutaneous nodules)
Minor (fever, arthraligia, previous RF, raised ESR/CRP/leucocytosis, prolonged P-R on ECG.
Diagnosis of infective endocarditis in children?
Blood culture - Strep viridans (a-haemolytic strep)90%.
Echo - vegetations (cannot exclude Dx)
Bloods (acute phase reactants eg ESR and CRP)
Management of infective carditis?
IV Abx - ampicillin and aminoglycoside.
Causes of infective carditis in normal, IVDU and people with prosthetic values, and bowel disease ?
Normal - Viradans (from mouth)
IVDU - staph areus from skin
PRosthtic valves - staph epidermidis from surgery or Iv catheter
Bowel - enterococcus faecalis, strep bovis
