Cardiology Flashcards
What is the epidemiology of congenital heart disease?
- Accounts for 30% of congenital anomalies
- Incidence of 8 in 1,000 live births
- 8 most common lesions account for 80% of the cases of congenital heart disease
What are the 8 commonest congenital anomalies?
- Ventricular septal defect
- Patent ductus arteriosus
- Atrial septal defect
- Pulmonary stenosis
- Aortic stenosis
- Coarctation of the aorta
- Transposition of the great vessels
- Teratology of Fallot
What is the aetiology of congenital heart disease?
- Genetic susceptibility with environmental hazard
- Teratogenic insult 18-60 days post conception
What environmental factors can increase the risk of congenital heart disease?
Drugs
-Alcohol, amphetamines, cocaine, ecstasy, phenytoin, lithium
Infections
-Toxoplasma, rubella, CMV, Herpes, other
Maternal
-Diabetes, SLE
What is the association between CHD and chromosomal abnormalities?
- 6-10% of all CHD have underlying chromosomal problem
- 30% of chromosomal abnormalities have CHD
Give examples of syndromes and their associated CHD.
Trisomy 13
-VSD and ASD
Trisomy 18
-VSD and PDA
Trisomy 21
-AVSD
Turner
-Co-arctation of the aorta
Noonan
-Pulmonary stenosis
Williams
-Supraclavicular AS
22q11 deletion syndrome
-Teratology of Fallot
What history may a child present with?
- Feeding, Weight and Development issues
- Cyanosis
- Tachypnoea, Dyspnoea
- Exercise Tolerance
- Chest Pain
- Syncope
- Palpitation
- Joint Problems
What may be found on examination of child with heart issues?
- Abnormal weight or height
- Dysmorphic features
- Cyanosis
- Clubbing
- Tachypnoea/ dyspnoea
- Pulses/apex (check femoral pulses)
- Hear sounds (clicks, splits, 3rd and 4th)
- Murmurs
What investigations may carried out?
- Blood Pressure
- O2 saturation, arterial BGA
- ECG (12 lead, 24hrs, event monitor)
- CXR
- Echocardiogram
- Catheter
- Angiography
- MRI/A
- Exercise testing (ECG, sO2)
What are the treatment principles for paediatric cardiology?
- If you can fix it then do it
- If you can’t fix it the improve the situation
- If you can do neither then replace it
Give examples of how paediatric cardiology problems can be improved?
Medication
Palliative procedures
-BT shunt, balloon valvoplasty, prostaglandin infusion, pulmonary banding
How can murmurs be characterised?
Timing in Cardiac Cycle
-Systole / Diastole / Continuous
Duration
- Early / Mid / Late
- Ejection / Holo or Pan Systolic
Pitch / Quality
- Harsh or Mixed Frequency (Turbulence)
- Soft or Indeterminate
- Vibratory / Pure Frequency (Laminar Flow
Name 4 sites to check for murmurs.
- Upper right sternal border
- Upper left sternal border
- Lower left sternal border
- Apex
What proportion of childhood murmurs are innocent?
70-80%
What are the 4 innocent murmurs of childhood?
- Still’s murmur (LV outflow murmur)
- Pulmonary outflow murmur
- Carotid/brachiocephalic arterial bruits
- Venous hum
What are the common features of innocent childhood murmurs?
- Systolic murmur (continuous in venous hum)
- No other signs of cardiac disease
- Soft murmur, grade 1/6 or 2/6
- Vibratory, musical
- Localised
- Varies with position, respiration, exercise
Who do Still’s murmurs affect?
2-7 year olds
What do Still’s murmurs sound like?
Soft systolic; vibratory, musical,”twangy”
Where can Still’s murmurs be heard?
Apex and left sternal border
When do Still’s murmurs increase?
In the supine position and with exercise
Who do pulmonary outflow murmurs affect?
- 8-10 year olds
- Often children with a narrow chest
What do pulmonary outflow murmurs sound like?
Soft systolic and vibratory
Where can pulmonary outflow murmurs be heard?
- Upper left sternal border
- They are well localised and do not radiate to the back
When do pulmonary outflow murmurs increase?
In the supine position and with exercise
