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Child Health > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the 2 main (general) causes of congenital heart disease? (2)

A

Genetics (mono/poly)

External teratogens

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2
Q

How may congenital heart disease initially present? (5)

A

Antenatal Dx
Detection of heart murmur (NB innocents)

Heart failure
Shock
Cyanosis

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3
Q

What are the symptoms of a L-R shunt?

Give some egs (3)

A

Breathless

ASD
VSD
PDA

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4
Q

What are the symptoms of a R-L shunt

Give some egs (2)

A

Blue

ToF
TGA

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5
Q

What are some symptoms of common mixing

Give an eg

A

Breathless + blue

AVSD

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6
Q

Give egs (2) of heart conditions seen in well children with obstrn

A

Aortic stenosis

Pulm stenosis

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7
Q

In sick neonates with obstrn heart disease
How would they present?
Give some egs (2)

A

Collapsed with shock

Coarc of Ao
HLHS

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8
Q

List the causes of heart failure in:
Neonates (3)
Infants (3)
Older children / adolescents (3)

A

Neonates - obstruction / duct dependant lesions:
Hypoplastic LH
Critical Aortic Stenosis
Severe coarctation of Ao

Infants - high plum flow:
VSD
AVSD
Large PDA

Older - L/R heart failure:
Eisenmengers (R HF only)
Rheumatic heart disease
Cardiomyopathy

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9
Q

List some symptoms (4) of heart failure in children

List some signs (6)

A

SOB
Poor feeding
Sweating
Recurrent chest infections

Tachypnoea/tachycardia
Poor wt gain
Heart murmur / gallop
Enlarged heart
Hepatomegaly
Cool peripheries
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10
Q

What types of drugs may be used in heart failure for infants (L-R shunt / high plum flow) (3)

A

Diuretics
ACEi (captopril)
+ poss B-blocker/digoxin

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11
Q

What are the features of an innoSent murmur (4S’s +3)

A

Soft
Systolic
aSymp
left Sternal edge

+ no parasternal thrill
+ no added sounds
+ no radiation

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12
Q

What ages are innocent murmurs often heard?

What other scenarios / conditions may one be heard in? (2)

A

30% of 3-4y/o

Febrile illness / Anaemia (due to increased CO)

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13
Q

When / where may a venous hum be heard

A

Common + harmless
May disappear on supine/ jugular occlusion/ head sideways
Heard over R clavicle

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14
Q

List the diff types of acyanotic heart disease (7)

A 
ASD
VSD
AVSD
PDA
AS
PS
Coarc of Ao
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15
Q

List the diff types of cyanotic heart disease (5)

A 
Hypoplastic LH
ToF
Transposition of Great Vessels
Pulm atresia
Tricuspid atresia
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16
Q

What are the 2 diff types of ASD

How do they present? (6)

A

Secundum (80%) - involves foramen ovale
or Partial AVSD (pAVSD)
→ Both sim presentation:

Usually asymp
Recurrent chest infections/wheeze
Ejection systolic (L sternal edge - pulm valve flow)
Split 2nd heart sound
pAVSD - apex pansystolic (AV valve regurg)
Arrhythmias when middle aged

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17
Q

What 3 Ix can be done into ASD?

+ what would be seen in each?

A

CXR: enlarged heart / enlarged pulm aa’s / increased pulm vasc markings

ECG:
Secundum; RBBB / R axis deviation
pAVSD; -ve deflection in aVF (displaced AV node)

ECHO - confirms anatomy (Dx)

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18
Q

How is a secundum ASD managed?

How is a pAVSD managed?

A

Secundum → catheter device closure/occlusion at 3-5yrs

pAVSD → surgical correction at 3yrs

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19
Q

What is the proportion of small VSDs to large?

How small is considered a small VSD?

A

VSDs are 30% all congenital heart disease
Small VSDs - 80-90% VSDs
Large VSDs - 10-20%

Small VSDs are <3mm (smaller than aortic valve)

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20
Q

What will be seen O/E + CXR/ECG/ECHO in a small VSD

A

O/E: loud pansystolic (L lower sternal edge)
CXR: normal
ECG: normal
ECHO: shows anatomy w. no pulm HT (+doppler echo assess haemodynamic effects)

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21
Q

How are small VSDs managed?

A

Will close spontaneously

Ensure good dental hygiene to prevent endocarditis

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22
Q

What are the features of a large VSD?

A 
Heart failure symptoms:
SOB
Poor feeding / failure to thrive after 1wk old
Tachypnoea/cardia
Recurrent chest infections
Hepatomegaly

Heave
Soft (large) pan systolic at LLSE
Apical pan-diastolic (mitral flow)
Loud pulm 2nd sound (pulm aa BP)

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23
Q

What will be seen on CXR/ECG/ECHO in large VSD?

A 
CXR - Similar to ASD:
Enlarged heart
Enlarged pulm aa's
Increased pulm vascular markings
\+ Pulm oedema (not in ASD)

ECG: bilateral hypertrophy (upright T wave) (pulm HT)

ECHO: shows defect

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24
Q

What is the risk of not surgically treating large VSDs early enough?

A

Must be done by 3-6m otherwise → chronic pulm HT → Eisenmengers

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25
Q

What signs may be elicited O/E in pulmonary stenosis? (3)

What may be seen on CXR/ECG?

A

Ejection systolic murmur (+click) at ULSE
Poss thrill
Poss heave (in severe)

CXR: Normal OR Pulm aa dilation

ECG: RV hypertrophy (upright T in V1)

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26
Q

How is pulmonary stenosis surgically managed?

A

Balloon valvotomy (trans-catheter balloon dilation)

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27
Q

What other cardiac structural defects can be assoc w. aortic stenosis in children?

A

AS can be individual

or assoc w. mitral stenosis + Ao Coarc

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28
Q

How does Aortic Stenosis present?

A 
Most are asymp
Severe: 
Reduced exercise tolerance 
Chest pain on exertion 
Syncope
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29
Q

What signs can be elicited O/E in Aortic Stenosis (5)

A 
Carotid thrill (always)
Slow-rising pulse
Ejection-systolic at URSE
2nd Ao sound
Apex ejection click
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30
Q

What may be seen on CXR / ECG in Aortic Stenosis

A

CXR:
Normal
OR Enlarged LV ± Dilated ascending aorta

ECG: 
LV hypertrophy (Deep S in V2 + Tall R in V6)
LV strain (downwards T) (severe AS)
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31
Q

What % of Down’s syndrome kids have AVSD?

A

15-20%

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32
Q

What other cardiac structural defect is seen in AVSD?

A

Also obliteration of pulm/aortic valves

+ only AV valves left (but often v leaky)

33
Q

What are some possible murmur characteristics that may be seen in AVSD? (3)

A 
Systolic ejection (pulm valve flow + S2 splitting)
Mid-diastolic (LLSE - mitral flow)
Apical holosystolic (radiating to L axilla - mitral insuff)
34
Q

What will be seen on CXR in AVSD? (2)

+ on ECG? (5)

A

Cardiomegaly + Increased pulm vasculature

L axis deviation
RA enlarged
Bi-ventricular hypertrophy
Incomplete RBBB
Prolonged PR interval (1st degree block - abnorm AVN)
35
Q

How is AVSD managed?

A

Medically treat heart failure

Surgically repair defect at 3-6m

36
Q

What lesions may cause outflow obstruction in a well child? (3)

A

Pulm stenosis
Aortic stenosis
Coarctation

37
Q

What signs seen in Aortic Stenosis? (2)
+ in Pulm Stenosis? (1)
+ in Coarctation? (2)

A

Murmur URSE + carotid thrill

Murmur ULSE (+ no carotid thrill)

Systemic hypertension + Radio-femoral delay

38
Q

How does Coarctation of Aorta occur (pathophysiology)?

What other conditions is is assoc w.? (3)

A

Arterial duct tissue encircling aorta at ductus arteriosus → aorta constriction when duct closes
→ severe LV outflow obstrn

Assoc w. VSD, Turners, Bicuspid aortic valve

39
Q

How does coarctation of aorta present?

A 
Normal Ex on 1st day
2nd day (duct closing) → acute circulatory collapse:
Severe heart failure
Absent femoral pulse
Severe metab acidosis
Poss ULSE murmur
40
Q

What will be seen on CXR + ECG in Coarctation?

A

CXR - cardiomegaly from HF/shock

ECG - normal

41
Q

How is Coarctation of Aorta managed?

A

Prostaglandins
HF drugs
Surgical repair: angioplasty ± stenting

42
Q

What is tricuspid atresia?

A

Valve absent/abnormal → blood flow from RA-RV blocked

Must have ASD+VSD to survive (+ usually has PDA)

43
Q

What is pulmonary atresia?

How will it present?

A

Valve absent/abnormal → blood flow heart-lungs blocked

No prob in utero but after birth quickly cyanosed (only thing providing O2 to lungs is PDA)

44
Q

List some duct-dependant lesions (7)

A 
Coarctation
TGA
HLHS
PA
TA
AS
PS
45
Q

What is the immediate management for duct-dependant lesions? (2)

A

IV prostaglandins short term

Formaldehyde infiltration longer-term

46
Q

What time frame is classed as persistent patent ductus arteriosus?
Why does it occur?

A

Persistent = not closed within 1m of EDD (common in pre terms)
Due to failed mechanism constricting duct

47
Q

What are the features seen in PDA? (4)

A

Breathlessness (L-R shunt)

Continuous murmur behind L clavicle
Raised pulse pressure (collapsing/bounding pulse)
Pulm HT ± HF (if duct v large)

48
Q

What is seen in PDA on CXR / ECG / ECHO?

A

CXR: normal
ECG: normal (if v big - sim features to large VSD)
ECHO: duct easily seen

49
Q

What are the risks if PDA is not closed up? (2)

How is it closed?

A

Bacterial endocarditis
Pulmonary vascular disease

Closure done trans-catheter - coil/occlusion device at 1y/o
Occasionally surgical ligation req

50
Q

List some causes for cyanosis in newborn/infants

A 
Cyanotic congenital heart disease
Resp: 
Surfactant defc
Meconium asp
Pulm hypoplasia

Persistent pulm HT of newborn (pulm resisx failed to fall)
Infection / septicaemia (GrpB Strep etc)
Metab acidosis + shock

51
Q

What are the 4 features in Tetralogy of Fallot?

A

Large VSD
Overriding of Aorta (w. respect to vent septum)
Subpulmonary Stenosis (RV outflow obstrn)
RV hypertrophy (as result)

52
Q

How may ToF present?

A 
Antenatal Dx
OR
Dx after murmur in 1st 2m life
OR
Hypercyanotic spells in 1st few days (irritability/SOB/pallor)
53
Q

What clinical signs may be seen in ToF?

A

Clubbing (fingers + toes)
Loud harsh ejection systolic murmur (L sternal edge)
Cyanosis + shortening murmur (as RB outflow obstrn worsens)

54
Q

What is seen on CXR in ToF? (5)

A

EGG ON SIDE
Relatively small heart
Uptilted apex (RB hypertrophy)
Pulmonary aa ‘bay’ - concavity on L heart border
R sided aortic arch (poss)
Reduced pulm vasc markings (reduced flow)

55
Q

What is seen on ECG in ToF?

A

Normal at birth

RV hypertrophy when older (upright T wave in V1)

56
Q

How is ToF managed initially/medically? (5)

A

Hypercyanotic spells usually self-limiting
Any hyper cyanotic spells >15mins req prompt Tx:
Sedation
IV propanolol
IV fluids
HCO3- (for acidosis)
Paralysis + ventilation

57
Q

How may ToF be surgically managed?

A

VSD/Pulm valve repair (using patch)

V cyanosed infants → BT shunt (subclav aa → pulm aa)

58
Q

What are the main features of TGA?

A

Cyanosis***: profound + presents 2nd day (ductal closure)
Less severe if more mixing/other abns

Usually no murmur (poss from LV/pulmonary high flow)

59
Q

What would be seen on CXR in TGA? (3)

+ on ECG

A

Narrow upper mediastinum (pedicle)
Egg on side contour (RV hypertrophy)
Increased pulm vasc markings

ECG usually normal

60
Q

How is TGA managed? (3)

A

IV prostaglandins
Balloon atrial septostomy (reverses foramen ovale valve)
Later arterial switch (+ coronary aa transfer)

61
Q

What congenital heart lesion is commonly seen in Turners?

A

Coarctation of Ao

62
Q

What congenital heart lesions may be seen in Noonan’s syndrome?

A

Pulmonary stenosis* (usually asymp)
Hypertrophic cardiomyopathy (infancy HF)
ASD/VSD

63
Q

What are the 4 features of a hypoplastic L heart?

A

Mitral valve small/atretic
LV v small
Aortic atresia
Coarctation of Aorta

64
Q

What would be the presentation of a neonate after birth, with hypoplastic L heart? (3)

A

V SICK
Ductal constriction → profound acidosis / rapid CV collapse
Weak/absence of all peripheral pulses

65
Q

What are the cardiac effects in Marfans? (2)

A

Weakened walls of aorta (→ aneurysm/dissection)

Mitral/tricuspid prolapse → regurg

66
Q

What are the ECG features of supra ventricular tachycardia (SVT)? (3)

A

Narrow complex tachycardia at 250-300bpm
T wave inversion (occurs w. HF)
Short PR if in sinus rhythm

67
Q

What are the possible effects of SVT in utero?

How does SVT present in a neonate?

A

Can → hydrous fetalis / intrauterine death

Neonate: poor CO + pulm oedema → HF

68
Q

How is immediate management of SVT managed? (4)

A

Circulatory (correct acidosis) + Resp support (vent if req)
Vagal stimulation manouvres (carotid sinus massage)
IV adenosine - 1st line (induces AV block)

Electrical cardioverion w. synchronised DC shock - if adenosine fails

69
Q

How is SVT managed once sinus rhythm is restored?

+ how managed if WPW syndrome?

A

Maintenance therapy e.g. flecainide / sotalol

WPW - atrial pacing / ablation of accessory pathway

70
Q

List some causes of myocarditis

A

Viruses: influenza / coxsackie / adenovirus
Rubella / polio / Lyme

Medication allergies
Exposure to certain chems/fungi/parasites/radiation/drugs

71
Q

What is myocarditis?

Which age group is it more severe in?

A

Immune chemical + disease/infection damage → swollen/thick myocardium → HF

Affects infants more severe > children

72
Q

List some symptoms of myocarditis in infants (7)

A

Failure to thrive
Feeding probs
HF
Fever

Low urine output
Pale peripheries
Anxiousness

73
Q

List some symptoms of myocarditis in children > 2yrs (6)

A 
Nausea
Fatigue
Cough
Chest pain
Belly ache
Swelling (legs, feet, face)
74
Q

What Ix can be done into myocarditis? (8 (5 bloods))

A

CXR (enlarged borders)
ECHO (Dx)

Blood cultures
LFTs
U&amp;Es
FBC
Ab screen
Heart biopsy
75
Q

How is myocarditis managed (4)

A 
NO CURE - treat symps/minimise damage until resolves
Diuretics
ACEis
B-Blocker (carvedilol)
Abx/Steroids/NSAIDs/IVIGs
76
Q

What are the main cardiac-related RFs for subacute bacterial endocarditis (SBE)? (4)

A 
Turbulent flow:
VSD
Coarctation
PDA
Prosthetics
77
Q

What are the classical signs of SBE? (5)

+ any peripheral signs that may be present? (7)

A 
Fever
Malaise
Raised ESR
Anaemia 
Haematuria
Always consider SBE with these features + excluded other DDx
Clubbing (late sign)
Splinter haemorrhages
Necrotic skin lesions
Signs of neuro infarcts
Retinal infarcts
Arthritis/arthralgia
Splenomegaly
78
Q

What is the commonest cause of SBE?

A

Streptococcus viridians (a-haemolytic)

79
Q

How is SBE managed?

A

High-dose IV penicillin/aminoglycoside (genta) 6wks

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