Cardiology Flashcards
1
Q
What are features of heart failure in infants?
A
- Poor feeding/faltering growth
- Sweating
- Tachypnoea
- Tachycardia
- Gallop rhythm
- Cardiomegaly
- Hepatomegaly
2
Q
What maternal disorders can cause congenital heart abnormalities?
A
- Rubella infection - Peripheral pulmonary stenosis, PDA
- SLE - complete heart block
- Diabetes
3
Q
What drugs can cause congenital heart abnormalities if taken by the mother during pregnancy?
A
- Warfarin - Pulmonary valve stenosis, PDA
- Alcohol - ASD, VSD, Tetralogy of Fallot
- Amphetamines
- Cocaine
- Ecstasy
- Phenytoin
- Lithium
4
Q
What Cardiac abnormality is Trisomy 21 associated with?
A
AVSD - Singular AV valve with ostium primum ASD and high VSD
5
Q
What cardiac abnormalities is Trisomy 13 (Patau syndrome) associated with?
A
- VSD
- ASD
6
Q
What cardiac abnormalities is trisomy 18 (edward’s syndrome) associated with?
A
- VSD
- PDA
7
Q
What cardiac abnormalities is turner’s syndrome associated with?
A
- Pre-ductal Co-arctation of aorta
- Aortic stenosis
8
Q
What cardiac abnormalities is Noonan’s syndrome associated with?
A
- Pulmonary stenosis
- Hypertrophic cardiomyopathy
- ASD
9
Q
What cardiac abnormalities is Williams syndrome associated with?
A
- Supravalvular AS
- Peripheral pulmonary artery stenosis
10
Q
What cardiac abnormalities is 22q11 deletion associated with?
A
- Aortic arch anomalies
- Tetralogy of Fallot
- Common arterial trunk
11
Q
What is a VSD?
A
Ventricular septal defect
Defect anywhere in the interventricular septum;
3 main types - perimembranous, muscular or subaortic
12
Q
What is classed as a small VSD?
A
<3mm
13
Q
What are the clinical features of a small VSD?
A
Asymptomatic
14
Q
What phsyical signs would you see/hear for a small VSD?
A
- Loud pansystolic murmur LLSE
- Quiet P2
15
Q
What symptoms would you see in a child with a large VSD?
A
- Heart failure - Breathlessness and faltering growth after 1 weeks
- Recurrent chest infections
16
Q
What physical signs would you see in a child with a large VSD?
A
- Tachypnoea, tachycarida and enlarged liver
- Thrill
- Soft pansystolic murmur/no murmur
- Diastloic rumble - Increased flow across the relatively stenosed mitral valve
- Loud P2
17
Q
What type of shunt can occur in VSD?
A
Left to right shunt - breathlessness
18
Q
What could you see on radiograph in VSD?
A
- Cardiomegaly
- Enlarged pulmonary arteries
- Increased pulmonary vascular markings
- Pulmonary oedema
19
Q
What investigations would you do if you suspected a congenital heart defect??
A
- Blood Pressure
- O2 saturation, arterial BGA
- ECG (12 lead, 24hrs, event monitor)
- CXR
- Echocardiogram
- Angiography
- MRI
- Exercise testing (ECG, sO2)
20
Q
What is eisenmenger syndrome?
A
Process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect (typically by a VSD, ASD, or less commonly, PDA) causes pulmonary hypertension (due to thickening of the pulmonary arteries, and eventual reversal of the shunt into a cyanotic right-to-left shunt - blue teenager
21
Q
How would you manage VSD?
A
- Heart failure therapy if needed
- Additional calorie input
-
Surgery - 3-6 months
- Amplatzer device
- Patch device
22
Q
What is patent ductus arteriosus?
A
When the ductus arteriosus fails to close within 1 month of birth
23
Q
What is ductus arteriosus closure mediated by?
A
Prostaglandins
24
Q
What is the pathophysiology of PDA?
A
PDA allows a portion of the oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta (which has higher pressure) to the pulmonary artery. If this shunt is substantial, the neonate becomes short of breath: the additional fluid returning to the lungs increases lung pressure, which in turn increases the energy required to inflate the lungs. This uses more calories than normal and often interferes with feeding in infancy. This condition, as a constellation of findings, is called congestive heart failure.
25
What type of shunt occurs in PDA?
Left-to right shunt
26
What are the symptoms seen in PDA?
Asymptomatic
27
What signs would you see with PDA?
* **Continuous murmur at ULSE**
* **Bounding/collapsing pulse**
28
How would you manage PDA?
* **Fluid restriction/diuretics**
* **Prostaglandin inhibitors (Indomethacin, Ibuprofen)**
* **Surgical ligation**
29
What is an atrioseptal defect?
Defect in the interatrial septum allowing blood to flow between the two atria
30
What are the main types of ASD?
* **Secundum ASD (80%)**
* **Partial atrioventricular septal defect**
31
How does ASD present symptomatically?
* **None**
* **Recurrent chest infection/wheeze**
* **Arrythmias (4th decade onwards)**
32
What signs would be seen with an ASD?
* **Ejection systolic murmur** - ULSE
* **Fixed and Widely split second heart sound** - right ventricular SV being equal in both inspiration and expiration
33
If you heard the following heart sound over the ULSE, what defect would you suspect?
**ASD**
Ejection systolic murmur
Wide fixed splitting of 2nd heart sound
34
If you heard the following murmur over the LLSE, what defect may you be thinking of?
**VSD**
Pansystolic murmur - Louder the narrower
Quiet P2
35
If you heard the following murmur at the ULSE, what defect would you be thinking of?
PDA - continuous murmur
36
If you heard the following murmur at the ULSE, what other signs could help you make a diagnosis?
**PDA**
Assess pulses - bounding/collapsing
37
IF you heard the following heart sound at LLSE, what else could you look for on examination to assess the severity of the suspected defect?
***_VSD_***
Thrill
Heart failure signs - Tachypnoea, Hepatomegaly
38
What is pulmonary stenosis?
A dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery.
In children, this is most often caused by partly fused leaflets, giving a restrictive exit from the right ventricle
39
What clinical symptoms are seen in pulmonary stenosis?
* **Mild** - Asymptomatic in mild stenosis
* **Moderate and severe** - exertional dyspnoea and fatigue
40
What clinical signs would you see/hear in pulmonary stenosis?
**Ejection systolic murmur** - ULSE
Radiates to the back
41
If you heard the following murmur over the ULSE, what would you be thinking of?
**Pulmonary stenosis**
Ejection systolic murmur
42
If you heard the following murmur over the ULSE, what other signs/symptoms could you look for to confirm your diagnosis?
***_Pulmonary stenosis_***
Dyspnoea
Fatigue
Check murmur at the back - radiates to the back
43
How would you manage a child with pulmonary stenosis?
**Baloon valvuloplasty** - causes pulmonary regurg, which is well compensated for in children. Valve replacement after puberty ends (stopped growing)
44
What is Aortic Stenosis?
Narrowing of the aortic valve
45
How does Aortic stenosis present symptomatically?
* **Asymptomatic**
* **Reduced exercise tolerance**
* **Exertional chest pain**
* **Syncope**
46
What signs would you see/hear on examination for Aortic Stenosis?
* **Ejection Systolic murmur** - maximal at URSE
* Radiation to the carotids
* **Small volume, slow rising pulse**
* **Apical ejection click**
47
If you heard the following murmur at the URSE, what defect would you be thinking of?
**Aortic Stenosis**
With a bit of regurg
48
If you heard the following murmur at the ULSE, where would you check for radiation?
***_Pulmonary stenosis_***
To the back
49
If you heard the following murmur at the URSE, where would you check for radiation?
***_Aortic stenosis_***
The carotids
50
How would you treat aortic stenosis in a child?
* **Regular checks and ECHO**
* **Balloon valvotomy** - symptomatic on exercise/high resting pressure gradient (\>64 mmHg)
51
If you heard the following murmur at the URSE, what other signs would you expect to see?
* **Slow rising, small volume pulse**
* **Apical ejection click**
52
What is coarctation of the aorta?
During aortic arch formation, muscle tissue from the DA may be incorporated into the wall of the aorta. When the DA constricts at birth, so does the muscle in the aortic wall.
When the tissue encircling the aorta constricts, severe obstruction of the left ventricular outflow occurs.
53
When does coarctation normally present?
Circulatory collapse at 2 days of age when the duct closes
54
How does coarctation of the aorta present?
* **No murmer/ESM between shoulder blades or URSE**
* **Shock/collapse**
* **Signs of severe heart failure**
* **Absent femoral pulses/Radiofemoral delay**
* **Systemic HTN**
55
What biochemical changes might be seen in coarctation of the aorta?
Severe metabolic acidosis
56
If you saw a child with circulatory collapse, what would you check to focus your diagnosis?
**Femoral pulses** - if absent - coarctation of of aorta
**Radio-femoral delay**
57
How would you manage a child with coarctation of the aorta?
* **Re-open PDA with Prostaglandin E1 or E2**
* **Surgical options**
* Resection of stenotic tissue with end-to-end anastomosis
* Subclavian patch repair
* Balloon Aortoplasty
58
What is transposition of the great arteries?
A congenital deformity where the Aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle. Deoxygenated blood is therefor returned to the body and oxygenated blood is retunred to the pulmnary circuit
59
How does transposition of the great arteries occur?
Thought to occur due to the aorticopulmonary septum failing to spiral during partitioning of the bulbus cordis and TA. The conus arteriosus fails to develop normally during incorporation of the bublus cordis into the ventricles (due to defective neural cell migration)
60
Why does radio-femoral delay occur in coarctation of the aorta?
Due to blood bypassing the obstruction via collateral vessels in the chest wall and hence th pulse in the legs becomes delayed
61
How does transposition of the great arteries present?
* **Cyanosis** - blue baby
* Usually on day 2 of life after DA closure
* Usually no murmur
62
How would you investigate a blue child?
* **ECHO**
* **CXR**
* **ECG**
* **Bloods**
63
How would you manage a child with transposition of the great arteries?
* **MAINTAIN PDA - Prostaglandin infusion**
* **Rashkinds Atrial Septostomy** - Stabilising Procedure for transfer
* **Switch Procedure**
64
What is tetralogy of fallot and what are the defects it's associated with?
Congenital heart disease which occurs when the truncus arteriosus is unequal and the pulmonary trunk is stenotic.
4 main deformities:
* **Overriding aorta**
* **Right ventricular hypertrophy**
* **Right ventricular outflow tract obstruction secondary to Subpulmonary stenosis**
* **VSD**
65
How does tertralogy of fallot present?
* **Severe cyanosis/hypercyanotic spells**
* **Finger/toe clubbing in older children**
* **Loud ESM over ULSE** - PS
66
In tetralogy of fallot, why are hypercyanotic spells associated with irritability or inconsolable crying?
Combination of severe hypoxia, breathlessness and pallor due to tissue acidosis
67
What would you see on CXR if a child had Tetralogy of fallot?
**Egg on side/boot shaped heart**
68
How would you manage a child with tetralogy of fallot?
**Before 6 months**
* **Close VSD**
* **Relieve RV outflow obstruction**
**Sugery** - definitive treatment
69
How would you treat hypercyanotic spells in children with tetralogy of fallot that last longer than 15 minutes?
* **Sedation and pain relief**
* **IV propranalol**
* **IV fluids**
* **Bicarbonate** - correct acidosis
* **Muscle paralysis** - decrease oxygen demand
* **Artificial ventilation**
70
What peercentage of heart murmurs are pathological?
20-30%
71
What type of shunt occurs in transposition of the great arteries?
Rigt-to-left shunt
72
What type of shunt occurs in tetralogy of fallot?
Right-to-left shunt
73
What are the general clinical features of innocent heart murmurs?
* **Systolic murmur**
* **No other signs of cardiac disease**
* **Soft murmur, grade 1/6 or 2/6**
* **Vibratory, musical**
* **Localised**
* **Varies with position, respiration, exercise**
74
What age range does a still's murmur occur in?
2-7 years
75
Where would you find a Still's murmur?
* Soft systolic, vibratory
* Apex/left sternal border
76
What is a pulmonary outflow murmur?
**Soft systolic; vibratory murmur - ULSE - NON RADIATING**
77
When can pulmonary outflow murmur be heard most?
Supine or on exercise
More audible in children with narrow chest
78
What age range does pulmonary outflow murmur occur in?
8-10 years
79
What are brachiocephalic arterial bruits?
Harsh systolic supraclavicular murmurs which radiate to neck
80
When can brachiocephalic arterial bruits be heard best?
Increases with exercise
81
What can help distinguish a brachiocephalic arterial bruit from a pathological murmur?
**Ask child to turn head** - if it disappears - brachiocephalic bruit
82
What is a venous hum?
**Soft, indistinct, Supraclavicular continuous murmur -** sometimes with diastolic accentuation
83
What age range does brachiocephalic bruits occur in?
2-10 years
84
What age range does venous hum occur in?
3-8 years
85
When is venous hum most apparent?
Only when sitting upright
86
When does venous hum disappear?
Lying down or when turning head
