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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the definition of an acceleration of CTG?

A

An abrupt increase in the baseline foetal HR of > 15 bpm for > 15 seconds

Reassuring. Occur alongside uterine contractions

Their absense is not necessarily bad

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2
Q

What murmur is heard in an ASD?

A

Systolic ejection murmur over the left second ICS sternal border

Widely split second heart sound which is fixed

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3
Q

What congenital heart defect will cause a boot-shaped heart on CXR?

A

Tetralogy of Fallot

Right ventricular hypertrophy

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4
Q

What is Eisenmenger syndrome?

A

A left-to-right shunt becomes a cyanotic right-to-left shunt

Left-to-right shunt → increased pulmonary flow → pulmonary hypertension → right ventricle hypertrophy → right ventricular pressure exceeds left ventricle pressure → the shunt reverses → right to left shunt → cyanosis

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5
Q

What is the tetralogy of Fallot?

A
  1. Pulmonary valve stenosis
  2. Right ventricular hypertrophy
  3. Ventricular septal defect
  4. Overriding aorta (above VSD)
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6
Q

How are murmurs graded?

A
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7
Q

What is a normal foetal baseline rate?

A

>32 weeks 110-160 bpm

<32 weeks 125-160 bpm

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8
Q

What is the definition of a deceleration on CTG?

A

An abrupt decrease in baseline HR of > 15 bpm for > 15 seconds

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9
Q

What is the cause of this CTG abnormality?

A

Early decelerations

Uterine contraction → increased ICP → increased vagal tone

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10
Q

What is more common, an ostium primum or secundum ASD?

A

Secundum (70%)

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11
Q

Which pneumonic is used for cardiotocohraphy (CTG) interpretation?

A

DR C BRAVADO

DR - define risk

C - contractions

BRa - baseline rate

V - variability

A - accelerations

D - decelerations

O - overall impression

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12
Q

What causes closure of the foramen ovale?

A

Expansion of the lungs at birth → increased pulmonary blood flow → increased pressure in the RA → apposition of the septum primum and secundum

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13
Q

What is the most common congenital heart defect?

A

VSD

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14
Q

Name 4 non-cyanotic congenital heart diseases

A
  1. ASD
  2. VSD
  3. PFO
  4. PDA
  5. Coarctation of the aorta
  6. Endocardial cushion defect
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15
Q

What are 2 risk factors for a patent ductus arteriosus?

A
  1. Prematurity (ductus arteriosus in a preterm is less responsive to O2 and is less likely to constrict after birth)
  2. Maternal rubella infection
  3. Maternal prostaglandin administration
  4. Trisomies
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16
Q

What murmur is heard in a VSD?

A

Holosystolic mumur over the left sternal border

Mid-diastolic murmur over the cardiac apex (increased flow through the mitral valve)

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17
Q

What causes of closure of the ductus arteriosis?

A

O2 levels rise → vasoconstriction

Lungs release bradykinin → vasoconstriction

Prostaglandin E2 levels drop → vasoconstriction

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18
Q

What features suggest a benign paediatric murmur?

A

Grade 2 or less intensity

Short systolic duration (not holosystolic or diastolic)

Minimal radiation

Musical or vibratory (not harsh or blowing)

Softer intensity when sitting upright

Normal S2

Go gallop, click or rub

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19
Q

What is the definition of prolonged severe bradycardia?

A

Less than 80 bpm for more than 3 minutes

20
Q

Children with Tetralogy of Fallot will often do what to decrease R-L shunting?

A

Squat

Increases systemic vascular resistance → increases LV pressure

21
Q

Which congenital heart diseases are associated with Turner syndrome?

A

Coarctation of the aorta

Bicuspid aortic valve

22
Q

Which cardiac murmurs are associated with Marfan syndrome?

A

Mitral valve prolapse

Aortic root dilation

Aortic regurgitation

23
Q

Pre-syncope or syncope is associated with which congenital heart diseases?

A

Aortic stenosis

Hypertrophic cardiomyopathy

24
Q

Weak or absent femoral pulses is associated with which congenital heart disease?

A

Coarctation of the aorta

25
Q

What is the best sign of heart failure in children?

A

Hepatomegaly

26
Q

When does the foramen ovale close?

A

At birth

27
Q

When does the ductus arteriosus close?

A

2-3 days following birth

28
Q

What are some of the adverse effects associated with symptomatic PDAs in preterm infants?

A

Pulmonary hyperperfusion

  • Pulmonary haemorrhage
  • Bronchopulmonary dysplasia

Cerebral, mesenteric and renal hypoperfusion

  • Metabolic acidosis
  • Intracranial haemorrhage
  • Periventricular leukomalacia
  • Necrotising enterocolitis
  • Oliguria
29
Q

Which cardiac disorder is associated with fixed splitting of the S2 heart sound?

A

Atrial septal defect

There is a left to right shunt through the ASD which results in increased RA and RV volumes. As a result, there is increased flow through the pulmonic valve such that, regardless of breath, the pulmonic valve closes later every time.

30
Q

What is the structual difference between an ASD and a PFO?

A

The septal defect in ASD is due to missing tissue

PFO results from an unfused septa

31
Q

An egg-shaped heart on CXR is characteristic of which condition?

A

Transposition of the great vessels

32
Q

What congenital heart disease may have this CXR?

A

Total anomalous pulmonary venous return

33
Q

A machinery murmur is characteristic of which congenital heart disease?

A

PDA

34
Q

What might the findings on clinical examination of a child with a PDA be?

A

Heavy “machinery” continuous murmur

Tachycardia

Wide pulse pressure, bounding pulse

Hyperactive precordium

35
Q

How can cardiac and other causes of cyanosis be differentiated?

A

Hyperoxic test

Obtain preductal right radial ABG in RA → repeat after child inspires 100% oxygen

If PaO2 improves significantly, cyanosis is unlikely cardiac

36
Q

What is auscultated in tetralogy of fallot?

A

Harsh systolic murmur

Due to right ventricular outflow obstruction (pulmonary stenosis)

37
Q

What is auscultated in transposition of the great vessels?

A

Single S2

Holosystolic murmur if VSD is also present

38
Q

A systolic ejection murmur and fixed splitting of S2 is characteristic of which cardiac condition?

A

ASD

39
Q

What heart condition is fragile X associated with?

A

Mitral valve prolapse

40
Q

What is Ebstein’s abnormality?

A

Malformed and displaced tricuspid valve leaflets causing tricuspid valve regurgitation and right heart enlargement

41
Q

A continuous blowing noise heard below the clavicles is characteristic of which murmur?

A

Venous hum

42
Q

What are the clinical features of Still’s murmur?

A

Vibratory or muscial quality along the left lower sternal border

Louder when supine or during hyperdynamic states

Benign

43
Q

What is the most significant risk factor for Ebstein’s abnormality?

A

Prenatal lithium exposure

44
Q

What is the most common cause of cyanosis in the first few weeks of life?

A

Tetralogy of Fallot

45
Q

How might a left ventricular free wall rupture present following an MI?

A

Chest pain, dyspnoea

Cardiac tamponade (hypotension, distended neck veins, muffled heart sounds)

Paediatrics (24 decks)

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