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CP2 Paeds > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Abbrevations; VSD, ASD, PDA, TGA, AVSD, AS, PS, HLHS, FTT, LLSE, SVT

A

VSD-ventricular septal defect

ASD-Atrial septal defect

PDA-Patent ductus arteriosus

TGA-Transposition of great arteries

AVSD-Atrioventricular septal defect

AS-Aortic stenosis

PS-Pulmonary stenosis

HLHS-Hypoplastic left heart syndrome

FTT-Failure to thrive

LLSE-Lower left sternal edge

SVT-Supraventricular tachycardia

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2
Q

Draw and label fetal circulation

A
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3
Q

Signs and symptoms of heart failure

A

Symptoms

  • Breathlessness esp. on feeding/exertion
  • Sweating
  • Poor feeding
  • Recurrent chest infection

Signs

  • Poor wght gain
  • Tachypnoea
  • Tachycardia
  • Heart murmour/ gallopp rhythm
  • Hepatomegaly
  • Cool peripheries
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4
Q

History taking and examinations for cardiac disease

A

History Taking

  • SOCRATES +
  • HxPC
    • Feeding
    • Wght loss
    • Lethargy
    • Sweating
    • SOB
    • Chest infections
  • PSHx, e.g. VSD,
  • PMHx e.g. downs,
    • Obs Hx abnormalities on scan?
  • DHx,
  • FHx e.g. VSD,
  • SHx e.g. smoking and alcohol during preg
  • ICE parents

Examinations

  • CV incl BP, pulses, CAP, HR
  • Resp incl. SATS, RR
  • Wght Hgt
  • Abdo
  • Temp
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5
Q

DD for heart failure

A
  • Anaemia - tachcardia and SOB
  • Reflux - poor feeding + breathlessness
  • CF - recurrent chest infection w/ poor wght gain
  • Shock - tachyopneoa, tachycardia
  • Sepsis - tachyopneoa, tachycardia
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6
Q

Initial management of heart failure

A

ABCDE

  • Oxygen
  • As required
    • Digoxen
    • Furosemide
    • Fluids
  • If necesarry intubation and morphine for sedation

Case by case find cause and treat

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7
Q

Cardiac causes of heart failure

A

Neonates: obstructed systemic circulation e.g. aortic valve stenosis, hypoplastic left heart synrome

Infants: high pulmonary blood flow e.g. VSD, AVSD

Children/adolescents: R/L heart failure e.g. Eisenmengers syndrome, rheumatic heart disease

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8
Q

Signs of an innocent heart murmour

A

The S’s

  • aSymptomatic
  • Soft blowing murmour
  • Systolic
  • left Sternal edge
  • no abnormal heart Sounds

Being febrile/anaemic can make innocent murmours worse

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9
Q

What is venous hum

A

Sound heard above R clavicle radiating into neck

Continuous unchanging

Commonly mixed up with PDA

Sound can be stopped by pressure on internal jugular vein on the same side

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10
Q

Draw a labelled diagram of the heart cycle

A
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11
Q

What murmour do you get in AS

A

Ejection systolic with non-fixed splitting of second heart sound loudest at the upper right sternal edge

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12
Q

What murmour do you get in VSD

A

Pan systolic murmour at the lower left sternal edge

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13
Q

What murmour do you get in ASD

A

Ejection systolic murmour with fixed splitting of second heart sound best heard at the upper left sternal edge

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14
Q

What murmour do you get in PDA

A

Continuous left subclavian murmour

(sound is from different areas on chest)

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15
Q

What murmour do you get in AVSD

A

YOU DONT!!!! haha lol

or at least it’s very quiet

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16
Q

What murmour do you get in tetralogy of Fallot

A

Harsh ejection systolic murmour at the left sternal edge from day 1 of life

(sound also contains pulmonic regurg)

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17
Q

What murmour do you get in TGA

A

Mixed

  • Loud single second heart sound
  • Usually no murmour
  • Sometimes systolic murmour
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18
Q

What murmour do you get in PS

A

Ejection systolic murmour best heard at the upper left sternal edge

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19
Q

Draw and label the valve areas on the chest wall

A
20
Q

Draw and label where murmour are best heard on the chest wall

A
21
Q

List 5 acyanotic/pink/breathless/left to right heart defects

A
  1. AS/coarc
  2. PS
  3. VSD
  4. ASD
  5. PDA
22
Q

List the mixed presentation of blue and breathless heart defects

A

AVSD

23
Q

Epidemiology, features, ECG, CXR, Echo and management of VSD

A

Epidem

  • 30% of congenital cardiac defects are VSD
  • Common w/ downs T21 and fetal alcohol syndrome

Features

  • Small-asymptomatic
  • Large-heart failure, breathlessness, FTT after 1 week, recurrent chest infections
  • Signs-pan systolic murmour at LLSE
    • Large-tachycardia, tachypnoea, hepatomegaly,

ECG

  • Biventricular hypertrophy by 2/12

CXR

  • Cardiomegaly
  • Enlarged pulomary aa
  • Increased pulomary vascular markings
  • Pulmonary odema

Echo

  • Demonstrates anatomy of defect, haemodynamic effect and pulmonary HTN

Management

Small

  • Will close spontaniously
  • Whilst still patent prevent bacterial endocarditis through good dental hygiene

Large

  • Heart failure-diuretics + captopril (ACE inhibitor)
  • Calorie input PRN
  • Surgery at age 3-6 months to prevent Einsenmengers syndrome
24
Q

Epidemiology, features, ECG, CXR, Echo and management of ASD

A

Epidem

  • Fetal alcohol syndrome, Noonans syndrome

Features

Symptoms

  • Usually none
  • Recurrent chest infections/wheeze
  • Arrhythmias in fourth decade on

Signs

  • Ejection systolic murmour hears over pulmonic area ULSE
  • Fixed split second heart sound

ECG

  • Partial RBBB, RAD (RV hypertrophy)

CXR

  • Cardiomegaly
  • Enlarged pulm. aa’s
  • Incr. pulm. markings

Echo

  • Delineate anatomy mainstay diagnostic tool

Management

  • Cardiac catheterisation and insertion of occlusive device
25
Q

Epidemiology, features and management of AS

A

Epidem

  • Turner syndrome 45XO, Williams syndrome

Features

Symptoms

  • Usually asymptomatic
  • Reduced exercise tolerance
  • Chest pain on exertion
  • Syncope on exertion
  • Neonates w/ critical AS - heart failure and shock

Signs

  • Carotid thrill
  • Ejection systolic murmour in aortic area

Management

  • In more sever cases balloon valvotomy
  • Eventually probably gonna need aortic valve replacement
26
Q

Epidemiology, features and management of PS

A

Epidem

  • Warfrin during pregnancy, Noonan syndrome

Features

Symptoms

  • Most asymptomatic
  • Severe duct depedant PS in neonates-cyanosis in first few days

Signs

  • Ejection systolic murmour pulmonic area
  • When severe RV heave

Management

  • When pressure gradient across valve becomes marked - trans-catheter balloon dilation
27
Q

What genetic disorder is AVSD most common in

A

Downs T21

28
Q

Features, ECG, CXR of AVSD

A

Features

  • Usually present at antenatal screening
  • Symptoms
    • Cyanosis at birth OR
    • Heart Failure at 2-3 weeks
  • Signs
    • No murmour
    • Usually Downs

ECG

  • Superior axis (LAD)

CXR

  • Non specific
  • Cardiomegaly
  • Pulmonary hypertension (harsh vascular markings)
29
Q

When do the fetal circulatory aspects close?

A

Ductus arteriousus-2-3 days after birth

Foramen ovale-with first few breaths

Ductus venosum-4 days ish

30
Q

Features and management of PDA

A

Features

  • Continuous murmour L subclavicular
  • Heart failure
  • Pulmonary HTN

Management

  • Closure with occlusive device via cardiac catheter at age 1
31
Q

Features, associated features/syndromes, diagnosis, and management of coarcation of aorta

A

Features

  • Usually presents at 2/7
  • Acute circulatory collapse due to closure of PDA–duct dependant lesion
  • Signs
    • Sick baby
    • Heart failure
    • Absent femorals (in exam this is either coarc or HLHS, supposed to be slightly stronger in coarc)
    • Severe metabolic acidosis

Associated features/syndromes

  • Bicuspid aortic valve
  • Turner syndrome 45XO
  • Williams syndrome

Diagnosis

  • History, echo, CXR, ECG

Management

  • ABC
  • Prostaglandin infusion
  • Early surgical intervention balloon dilation may be used
32
Q

List 5 duct-dependant lesion

A
  1. Interuption of aortic arch
  2. Coarctiation of aorta/stenosis
  3. Pulmonary stenosis
  4. TGA
  5. HLHS
33
Q

Immediate management of closure of duct dependant lesions

A

ABC

Prostaglandin infusion (5ng/kg/min)

34
Q

Aetiology, Features, ECG, Management of SVT

A

Aet

  • Accessory conduction pathway is set up –> premature activation of atria
  • Usually no structural abnormalities

Features

Child is classically well with only fast heart rate

  • Symptom
    • Heart failure
  • Sign
    • 250-300 BPM
    • Pulmonary odema

ECG

  • Complex tachycardia
  • May have absent/obscured P waves
  • If severe may have ischaemic changes + t wave inversion in lateral leads

Management

Pharm

  • IV adenosine

Non-Pharm

  • Positive pressure ventilation
  • Vagal stimulation manouvers e.g. carotid sinus massage/ice water to face
  • Electrical cardioversion (shock em)
35
Q

List 2 cyanotic/blue/right to left heart defects

A

ToF

TGA

36
Q

List key features of Fallots

A
  1. Pulmonary stenosis
  2. Overriding aorta
  3. VSD
  4. RV hypertrophy
37
Q

Early and Late management of fallots

A

Early

  • Initially medical
  • If cyanosed may require shunt (Blalock–Taussig shunt) /ballooning of R outflow early
  • If hypercyanotic episode lasts more than 15 mins: give sedation+pain relief (morphine), IV propanolol, IV fluids, bicard for acidosis, reduce o2 demand through ventilation and mm paralysis

Late

  • Definitive surgery at 6 months
38
Q

What is TGA and how is a PDA important

A
  • The aortic like structure drains R heart (deox) to systemic circulation
  • The pulmonary aa structure drains the L heart (ox) to lungs

I.E. THE GREAT ARTERIES ARE SWITCHED

Not so much a problem when ductus arteriosus is open as it allows some ox blood to body and some deox blood to lungs.

This stops when it closes. Two closed circuits are created deox blood will onle flow round body and ox blood will only flow round lungs.

39
Q

Management of TGA

A

In acutely sick cyanosed child mixing must be immediatly improved:

  1. Keep arteriousus patent –> prostaglandin
  2. Balloon atrial septostomy (blow a whole in the atrial septum–> balloon through femoral vv into R heart, through foramen ovale, inflated and pulled back through

Eventually all patient need definitive surgery in neonatal period–> arterial switch procedure (exactly what is sounds like)

40
Q

List syndromes associated with cardiac disease

A

Turners - 45XO webbed neck slow development of girls, becomes apprant around 5

  • Aortic valve stenosis/coarc

Noonans - short stature, learning issues, concave chest, webbed neck + flat nose bridge, in girls and boys

  • ASD, pulmonary stenosis

Williams - short, neonate hypercalcaemia, mild LD, elfin face, small upturned nose, wide mouth and full lips

  • Aortic stenosis (supravalvular)

Downs - brachycephaly, single palmar crease, epicanthic folds (hooded lids), usually require neonatal gut surgery

  • ASVD, VSD

Marfans - disorder of CT, tall, thin, flexible joints

  • Aortic root dilation, mitral regurg
41
Q

Features and management of HLHS

A

Features

May be detected antenatally

Most sever duct dependant lesion as there is almost no flow through L heart

Symptoms

  • Sick
  • Heart failure
  • Shock

Signs

  • Severe acidosis
  • Circulatory collapse
    • Weakness/absence of peripheral pulses esp femoral

Management

  • ABC
  • Prostaglandin
  • Difficult operation –> Norwood procedure
42
Q

Causes and features of myocarditis

A

Causes

  • 2ary to metabolic disease
  • Viral infection of myocardium e.g. rheumatic

Features

  • Previously well child
  • Cardiomyopathy
  • Heart failure
  • Fever
43
Q

Risk factors, causes and management of subacute bacterial endocarditis in children

A

Risk factors

  • Artificial valves
  • IV drug users (mum) or IV use in hospital
  • Catheter
  • Bad oral hygiene (thrush)
  • Congenital heart defect esp. VSD, coarc aorta, PDA
  • Valve defect

Causes

  • Most common - streptococci viridans (a α-
    haemolytic streptococcus) in mouth
  • streptococcus intermedius
  • enterococci (UTI/gut)
  • coagulase negative staphylococci

Management

  • High dose IV penicillin with aminoglycodside e.g. gentamicin for 6 weeks
  • If prosthesis exist eradication is difficult, surgical removal may be required
  • Prophylaxis - good oral hygiene, avoid piercings
44
Q

Recite the rule of threes pneumonic

A

3 holes

  • VSD
  • ASD
  • PDA

3 blocked pipes

  • Aortic stenosis
  • Pulmonary stenosis
  • Coarc aorta

3 blue babies

  • Fallots
  • TGA
  • Complex CHD (this is just to make the pneumonic really)
45
Q

Divide the common congenital heart issues into cyanotic and acyanotic

A

Cyanotic

  • Fallots
  • TGA

Acyanotic

  • ASD
  • VSD
  • Pulmonary stenosis
  • Aortic stenosis
  • Coarc aorta

CP2 Paeds (8 decks)

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