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Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Hallmarks of an innocent murmur

A 
The5 Ss
InnoSent:
1.  ASymptomatic
2. Soft blowing murmur
3. Only Systolic murmur (not diastolic)
4. Left Sternal edge
- Other: No thrill, no radiation
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2
Q

Symptoms of heart failure

A
  • Breathlessness
  • Sweating
  • Poor feeding
  • Recurrent chest infections
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3
Q

What is the most probable cause of HF during the first week of life?

A

Left heart obstruction

  • Coarctation of the aorta
  • Hypoplastic left heart syndrome
  • Aortic valve stenosis
  • Interruption of the aortic arch
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4
Q

The cyanotic heart diseases

A

The 5 Ts:

  1. Tetralogy of Fallot
  2. Transposition of great vessels
  3. Truncus arteriosis
  4. Total anomalous pulmonary venous return
  5. Tricuspid atresia
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5
Q

Types of ASD

A
  1. Secundum ASD - most common (80%)

2. Partial atrioventricular septal defect (AVSD) or primum ASD

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6
Q

Symptoms of ASD

A
  • None (commonly)
  • Recurrent chest infections/wheeze
  • Arrhythmias
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7
Q

Physical signs in ASD

A
  • Ejection systolic murmur, upper left sternal border - due to increased flow across the pulmonary valve
  • Fixed and widely split second heart sound
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8
Q

Physical signs of small VSD

A
  • Loud pansystolic murmur at the lower left sternal edge (loud murmur implies smaller defect)
  • Quiet pulmonary second sound
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9
Q

Clinical features of large VSD

A

Symptoms:
- HF - breathlessness and faltering growth
- Recurrent chest infections
Signs:
- Tachypnea, tachycardia, enlarged liver from HF
- Active precordium
- Soft pan systolic murmur or no murmur
- Apical mid-diastolic murmur (from increased flow through the mitral valve)
- Loud pulmonary second sound

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10
Q

Left-to-right shunt disorders

A
  • ASD (secundum 80%)
  • VSD (small 80-90%)
  • Persisten ductus arteriosis
  • Endocardial cushion defect
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11
Q

When should the ductus arteriosis close, and when can you say that it is a PDA?

A

Should close shortly after birth.

In PDA is has failed to close by 1 month

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12
Q

Clinical features of PDA

A
  • Continuous murmur beneath the left clavicle
  • Increased pulse pressure, causing a collapsing or bounding pulse
  • If duct is large - increased pulmonary blood flow with HF and pulmonary HTN
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13
Q

Management of PDA

A
  • Preterm infants: Indomethacin (PGe inhibitor)

- Term infants: Coil or occlusion device, surgical ligation

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14
Q

Right-to-left shunt disorders

A
  • Tetralogy of Fallot

- Transposition of the great vessels/arteries

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15
Q

What is hyperoxia (nitrogen washout) test?

A

Test to determine presence of heart disease in a cyanotic neonate.
- Placed in 100% oxygen for 10 min. - if <15 kPa / 113 mmHg - diagnosis of ‘cyanotic’ congenital heart disease (lung diseases must be excluded)

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16
Q

Side-effects of prostaglandin infusion

A
  • Apnea
  • Jitteriness
  • Seizures
  • Flushing
  • Vasodilation
  • Hypotension
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17
Q

Most common cause of cyanotic congenital heart disease?

A

Tetralogy of Fallot

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18
Q

What are the features of Tetralogy of Fallot?

A
  1. Large VSD
  2. Overriding of the aorta
  3. Subpulmonary stenosis (right ventricular outflow obstruction)
  4. Right ventricular hypertrophy
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19
Q

Classic old signs of Tetralogy of Fallot

A
  1. Severe cyanosis
  2. Hypercyanotic spells
  3. Squatting on exercise
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20
Q

What is a hypercyanotic spell?

A

Rapid increase in cyanosis

  • Severe hypoxia causing:
  • Irritability
  • Inconsolable crying
  • Tissue acidosis causing:
  • Breathlessness
  • Pallor
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21
Q

Signs of Tetralogy of Fallot

A
  • Clubbing of the fingers and toes
  • Loud harsh ejection murmur at the left sternal edge from day 1 of life
  • Systolic thrill
22
Q

Management of Tetralogy of Fallot

A
  • Surgical correction at around 6 months - closing VSD and relieving right ventricular outflow tract obstruction
  • If very cyanosed - shunt between the subclavian artery and the pulmonary artery
23
Q

Management of a hypercyanotic spell

A

Usually self-limiting, if >15 min:

  • Sedation and pain relief
  • IV propranolol
  • IV fluids
  • Bicarbonate
  • Muscle paralysis and artificial ventilation
24
Q

Symptoms of transposition of the great arteries

A
  • Cyanosis - present of day 2 of life when duct close
25
Q

Physical signs of transposition of the great arteries

A
  • Cyanosis
  • Loud and single second heart sound
  • Usually no murmur
26
Q

Eisenmenger syndrome

A

Left-to-right shunt –> increased pulmonary blood flow –> medial hypertrophy of pulmonary vessels –> increased pulmonary vascular resistance –> right-to-left shunt

Shunt reverses at about 10-15 years of age - teenagers become blue, need transplantation

27
Q

Pathophys of endocardial cushion defect

A
  1. Both ASD and VSD

2. Abnormal atrioventricular valves

28
Q

What is a Blalock-Taussig shunt?

A

Shunt between subclavian and pulmonary arteries

29
Q

Clinical features of aortic stenosis

A
  • Most asymptomatic. May present with reduced exercise tolerance, chest pain on exertion or syncope
  • Carotid thrill (always)
  • Ejection systolic murmur, upper right sternal edge radiating to neck
  • Delayed and soft aortic second sound
  • Apical ejection click
30
Q

Features of pulmonary stenosis

A
  • Most asymptomatic
  • Ejection systolic murmur, upper left sternal edge, thrill may be present
  • Ejection click, upper left sternal edge
31
Q

Most common type of coarctation of aorta

A

90% juxtaductal coarctation (adult-type)

Narrowing below left subclavian artery at origin of ductus arteriosus

32
Q

Clinical features of coarctation of the aorta - adult type

A
  • Asymptomatic
  • Systemic HTN in the right arm
  • Ejection systolic murmur at upper sternal edge
  • Radio-femoral delay
  • Collateral blood vessels heard at the back
33
Q

Features at chest x-ray in coarctation of aorta

A
  • ‘Rib-notching’ - development of large collateral intercostal arteries running under the ribs
  • ‘3-sign’ - visible notch in the descending aorta at site of the coarctation
34
Q

What is the most common cause of collapse due to left outflow obstruction?

A

Coarctation of aorta - infantile type (preductal, tubular hypoplasia)

35
Q

Clinical features of coarctation of aorta - infantile type

A

First day normal, acute circulatory collapse at 2-days of age

  • A sick baby, with severe HF
  • Absent femoral pulses
  • Severe metabolic acidosis
36
Q

Which syndrome is associated with interruption of the aortic arch?

A

DiGeorge syndrome

37
Q

Features of hypoplastic left heart syndrome

A
  • Mitral valve is small or atretic
  • Diminutive left ventricle
  • Aortic valve atresia
  • Very small ascending aorta
  • Invariably coarctation of the aorta
38
Q

Clinical features in hupoplastic left heart syndrome

A
  • Profound acidosis
  • Rapid cardiovascular collapse
  • Weakness or absence of all peripheral pulses (in contrast to weak femoral pulses in coarctation)
39
Q

The surgical procedure of hypoplastic left heart syndrome

A

Three-stage Norwood procedure

40
Q

What is the most common childhood arrhythmia?

A

Supraventricular tachycardia

250-300 beats/minute

41
Q

Causes of syncope

A

Usually benign

  • Neurally mediated - in response to a range of provocations and stressors
  • Cardiac - arrhythmic, heart block, QT syndrome, aortic stenosis, etc.
42
Q

Features indicating a cardiac cause of syncope

A
  • Symptoms on exercise
  • Family history of sudden unexplained death
  • Palpitations
43
Q

Pathophys. of rheumatic heart disease

A

Short-lived, multisystem autoimmune response to a preceding infection with group A beta-hemolytic streptococcus

44
Q

Clinical features of rheumatic fever

A
  • Latent interval of 2-6 weeks following a pharyngeal or skin infection (pharyngitis/scarlet fever)
  • Polyarthritis
  • Mild fever
  • Malaise
45
Q

Rheumatic fever, JONES criteria

A

J - joints (migratory arthritis)
O - Carditis (endocarditis, myocarditis, pericarditis)
N - Nodes (subcutaneous nodules, extensor surfaces)
E - Erythema marginatum (rash on trunk and limbs)
S - Sydenham chorea (involuntary movements)

46
Q

Most frequent affected valve in rheumatic fever?

A

Mitral valve

- Long-term damage from scarring and fibrosis - mitral stenosis

47
Q

Management of rheumatic fever

A
  1. Bed rest, limitation of exercise
  2. Anti-inflammatory agents - Aspirin
    - Corticosteroids may be required
    - Treatment of heart failure
48
Q

Clinical signs of infective endocarditis

A
  • Fever
  • Anemia and pallor
  • Splinter hemorrhages in nailbed
  • Clubbing (late sign)
  • Necrotic skin lesions
  • Changing cardiac signs
  • Splenomegaly
  • Neurological signs from cerebral infarction
  • Retinal infarcts
  • Arthritis/arthralgia
  • Microscopic hematuria
49
Q

What does the vegetations in endocarditis contain?

A
  • Fibrin
  • Platelets
  • Infecting organisms
50
Q

What is the most common pathogen causing endocarditis?

A

Alpha-hemolytic streptococcus (Streptococcus viridans)

51
Q

Causes of pulmonary hypertension

A
  • Pulmonary arterial HTN
  • Idiopathic
  • Cardiac (post-tricuspid shunts: VSD, AVSD, PDA)
  • HIV
  • Peristen pulmonary HTN of the newborn
  • Pulmonary venous HTN
  • Left-sided heart disease
  • Pulmonary vein stenosis
  • With respiratory disease
  • Cohronic obstructive disease, BPD
  • Interstitial lung disease

Pediatrics (9 decks)

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