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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What happens when you take your first breath

A

Utero circulation changes
Forman ovale closes when L atrial P > RA pressure
Becomes fibroses 10-14
Ductus venous becomes a ligament
PDA closes at day 2-3 when Aorta pressure > pulmonary (requires prostaglandins to keep open)
If doesn’t close blood goes from A to P and overloads

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2
Q

What happens to pulmonary pressure

A

4-6 weeks it drops
High in utero to protect lungs
If high pressure in lungs then VSD / ASD not significant as little blood goes to lung
When pressure drops this leads to pulmonary oedema as L side pressure > R sided pressure

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3
Q

What are signs of cardiac disease in children

A 
Tachypnoea
Tachycardia
Sweating
Poor feed due to SOB 
Vomiting
Lethargy
Cyanosis
Hepatomegaly if pulmonary oedema 
FTT 
Hypoxic spells
Recurrent chest
Older
Decreased exercise
Fatigue 
Syncope 
Palpitations
Chest pain  
Oedema
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4
Q

What are signs of HF

A

SOB - poor feed
Sweating in feed
Recurrent chest infections

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5
Q

What are RF for cardiac disease

A

FH cardaic

Drugs / infection / asphyxia in pregnancy

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6
Q

How do you Dx

A 
History+ exam
Growth chart
O2 sats
BP
ABG 
Blood glucose
CXR
ECG
ECHO
Cardiac Cath
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7
Q

What do you look for in examination

A 
Pulses
BP
Oedema
Clubbing
DYsmorphism
Signs of HF / shock
CVS
Murmur 
Tachycardia / HSM
Height and weight
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8
Q

What are you listening for with murmur

A

Location
Radiation
Intensity
Quality

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9
Q

What is most common arrhythmia in children

A

SVT = most common
Extra systole
Sinus

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10
Q

How do you treat

A

Digoxin

Ablation

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11
Q

What is usually preserved in children

A

BP and oedema

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12
Q

What is the most common heart defect

A

VSD

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13
Q

What type of VSD can you get

A

Subaortic
Muscular - usually closes
Perimembranous - unlikely to close

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14
Q

What causes VSD

A

Idiopathic
Congenital - Down’s / Turner’s
Post MI

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15
Q

How does VSD present

A 
Asymptomatic
May hear murmur at routine check 
Present at 3rd week when pulmonary pressure drops and increase flow
Tachypnoea
Tachycardia 
Poor feed
Sweating 
FTT
Irritable
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16
Q

What does a smaller hole lead too

A

Louder murmur

The bigger the defect the slower the murmur

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17
Q

What are signs of VSD

A 
Pansystolic murmur
LL sternal edge
\+- thrill
Heaving apex
Split S2
Signs of pulmonary hypertension or HF
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18
Q

How do you Dx and what does it show

A

ECG - RVH / LAD
CXR - cloudy as lungs flooded
ECHO - confrims

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19
Q

How do you treat

A 
Optimise feed to increase weight
Diuretics for overload
ACEI - decrease afterload 
Surgical 
- Surgical patch closure 
- Bypass if doesn't close
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20
Q

What do you have to balance

A

Risk of endocarditis vs surgical risks if small defect

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21
Q

Complications of VSD / what does it lead too

A 
L-R shunt as greater pressure in LV 
Pulmonary overload, hypertension and RHF 
Systemic ischaemia
Eisenmenger
Infective endocarditis
Aortic regurgitation
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22
Q

What happens if very large defect

A 
Haemodynamic unstable
Cardiac failure
RV hypertrophy
Pulmonary oedema
Pulmonary hypertension = late sign
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23
Q

What is AVSD

A

Fusion of tricuspid and mitral valve

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24
Q

How does AVSD present

A

Mimics large VSD at 3rd week

Murmur may not be as prominent

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25
Q

How do you Dx

A

ECG
CXR
ECHO = gold standard

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26
Q

How do you treat

A

Same as VSD
REQUIRES SURGICAL
Valve replacement

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27
Q

Where does ASD arise

A

Hole on osteom secundum (atrial septum) so blood can flow between two atria
Blood will move from LA-RA as pressure higher in LA
Causes pulmonary hypertension
Likely to close itself

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28
Q

How does ASD present in childhood and why

A 
Asymptomatic 
Pressure diff so small in atria unlikely to hear murmur 
FTT 
Poor feeding 
Tachycardia and tachypnoea
SOB
Lethargy
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29
Q

How does it present in adulthood

A 
Dyspnoea
Chest pain
Palpitations
Haemoptysis if pulmonary hypertension
Heart failure
Stroke due to DVT / AF and able to travel into LA and go to the brain to
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30
Q

What are signs of ASD

A

Ejection systolic due to pulmonary flow

Wide fixed split S2 due to increased venous return / overloaded RV

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31
Q

How do you Dx

A

CXR - globular heart
ECG - RVH
ECHO

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32
Q

How do you treat

A

Occulusion device
No open heart
Anti-coagulation in adult due to VTE risk

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33
Q

What are complications if ASD doesn’t close

A 
Eisenmenger
Tricuspid regurg
Pulmonary hypertension and RHF  
AF due to RA hypertrophy
Stroke due to AF or DVT passing 
PATIENTS WITH DVT DEVELOP STROKE IF HAVE ASYMPTOMATIC ASD
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34
Q

When does PDA usually close and what happens if it doesn’t

A

Day 2-3 due to increased pulmonary flow
If doesn’t close = L-R shunt leading to pulmonary oedema and hypertension
Pulmonary hypertension -> RVH -> LVF

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35
Q

How does PDA present

A 
Asymptomatic if at term
Can't wean of ventilator
Resp distress 
SOB / tachy 
Poor feeding
FTT
Bounding pulse
Collapsing pulse
Wide pulse pressure on BP 
Heavy apex
Thrill
Low renal and GI perfusion
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36
Q

What increases risk

A

Pre-term

Maternal rubella

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37
Q

What is the murmur like in PDA

A

Continuous murmur - venous hum

Huge pressure diff between aorta and Pa

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38
Q

How do yo Dx

A

ECHO

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39
Q

How do you Rx

A

Fluid restrict
Diuretic
Prostaglandin inhibitor - Iburpofen / Indomethacin
Umbrella closure device

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40
Q

What are complications

A

Lungs compromised already if pre-term
Pulmonary hypertension
R and L HF

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41
Q

What is most common valve defect and what is it associated with

A

Pulmonary stenosis

  • Tetraology
  • Noonan
  • William
  • Congenital Rubella
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42
Q

How does PS present

A 
Asymptomatic
Exertional SOB
Fatigue
Syncope 
Cyanosis depends on severity
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43
Q

How does AS present and complications

A 
Decreased exercise
Fatigue 
SOB
Chest pain
Syncope
Typically worse on exertion 
Complications
LV outflow obstruction
Heart failure
Arrhythmia
Endocarditis
Sudden death
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44
Q

Murmur of PS

A 
Ejection systolic
UL sternal 
Radiates to back
RVH
Raised JVP
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45
Q

Murmur of AS

A

Ejection systolic
UR sternal
Radiate to carotid
Slow rising, narrow pulse pressure

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46
Q

How do you Dx and treat valve defect

A

ECHO = gold standard
Screen as may worsen as get older - regular follow up, ECHO, ECG and ETT
Balloon valvuloplasty in Cath lab
Can’t replace as still growing

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47
Q

When and why does coarctation of aorta arise

A

Present in 1st week when PDA closes as no blood getting from lungs to systemic circulation
Narrowing of proximal thoracic aorta where ductus arteriosus inserts

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48
Q

How does coarctation present

A

Collapse as blood can’t circulaate
SOB
Poor feed
High BP upper limb because supplied by artery before defect
Hypotension in LL
Radio-femoral delay
Weak or absent femoral pulses - may be only sign

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49
Q

Murmur in coarctation

A

Systolic

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50
Q

What is a late sign of coarctation

A

Rib notch due to collateral circulation arising

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51
Q

How does coarctation present in adulthood

A

Arterial insufficiency
Claudication
Syncope
Murmur

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52
Q

What increases risk of coarctation

A

Bicuspid aortic
Turner
Berry aneurysm
Neurofibromatosis

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53
Q

How do. you Dx

A

USS
ECG
ECHO
May need MRI

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54
Q

How do you Rx

A

Prostaglandin to reopen PDA
Ventilation
Transfer to CCU
Surgical

55
Q

How do you treat in adulthood

A

Angioplasty

Surgical resection

56
Q

What happens / complications of coarctation

A 
Activation of RAAS as hypoxia leads to hypertension upper limb
HF as high afterload
Hypertension
IE
Haemorrhage
57
Q

Ddx

A

Sepsis
More common cause of collapse
Consider cardiac if not responding

58
Q

What causes Ebstein

A

Lithium in utero

59
Q

How does Ebstein present

A 
Low insertion tricuspid
Tricuspid regurgitation 
Tricuspid stenos 
Large atrium
Small ventricle
60
Q

Murmur

A

Pansystolic if regurgitation

Diastolic if stenosis

61
Q

How do you Dx

A

ECHO

62
Q

Complications

A

WPW

Tricuspid incompetence

63
Q

What causes cyanotic HD and what are duct dependent conditions and what is protective

A

R-L shunt (blood flow to lungs from RV interrupted so no oxygenation so deoxygenated blood enters systemic circulation)
At birth PDA open so allows blood from aorta to pulmonary artery but will close in 1st 24 hours

Transposition
Tetralogy 
Total Anomalous Pulmonary Venous Return
Pulmonary / tricuspid atresia
Eisenmenger

Duct dependent

  • All cyanotic
  • Hypolpastic L heart
  • Severe congenital AS
  • Coarctation - acynaotic but duct dependent to allow blood from lungs to reach systemic
64
Q

How do you Dx cyanotic HD

A 
O2 sats
ABG
BP
Blood glucose
CXR
ECG
ECHO 
Cath lab
MRI 
Exercise testing
65
Q

How do you Rx cyanotic HD (often unable to tell at first but if cyanotic baby in resp distress / low sats = treat as duct dependent)

Classic presentation

  • Collapse day 1 with cyanosis
  • Hypotension and hypoxia not improving with 100% O2 in 1st 24 hours of life
A 
Admit neonatal
Volume expansion
Correct acidosis / hypocalcaemia 
Inotropes
IV prostaglandins to mix blood (keeps ductus arteriosus open) 
Ventilate
Surgery
66
Q

What is transposition of great arteries

A

No connection between circulation
Aorta out of R ventricle - no O2
Pa out of L - O2 filled
No connection between

67
Q

How do they present

A

CYANOTIC at birth
Resp distress
Cool clammy skin
If associated defect e.g. ASD / VSD may present later as blood can mix

68
Q

How do you Dx

A

Often Dx ante-natal

CXR

69
Q

How do you Rx

A

Emergency
O2 won’t help as don’t get
Need ASD / VSD / PDA short term to mix so often associated with this
Prostaglandin infusion through umbilical catheter
Rashing Atrial Septostomy to make larger PDA or create an ASD
Switch procedure in 1st month

70
Q

DDx

A

RDS is much more common

71
Q

What do all children with heart conditions get

A

Clinic follow up

72
Q

What tests should all children with heart get

A

CXR
ECG
ECHO
Cardiac Cath - if surgery to see pressures

73
Q

What do you do if a hole is very small

A

Should close itself
ECHO before school to check its closed
Surgery before school if large

74
Q

When can you replace valves that are stenosed

A

Once fully grown
Put patch in place to help
BP medications
If severely affecting can replace

75
Q

What is more common than transposition

A

Tetralogy

Presents later

76
Q

What is tetralogy

A 
Large VSD
Pulmonary stenosis (whole RVOT)  
Overriding aorta
RVH
The bigger the shunt the more cyanosed
77
Q

How does tetralogy present

A 
Usually picked up ante-natal 
1st month - irritated / cry / poor feed
Mild cyanosis 
Episodic cyanosis as RVOT spasm - tet spell 
Clubbing 
Seizure / LOC due to hypoxia / spasm
78
Q

What murmur

A

Ejection systolic due to PS

79
Q

What increases risk

A 
Rubella
Maternal age
Alcohol 
DM
Down's
80
Q

How do you Dx

A

CXR
ECHO
ECG

81
Q

What does CXR show

A

Boot shape heart

Black lungs as no blood

82
Q

How do you treat

A

Prostaglandin in neonate to keep open

Spasm Rx
Morphine to decrease resp drive
O2
IV BB to decrease cyanosis / improve flow to lungs

Definite Rx
Surgery before age 1, usually 6 months
BT shunt to buy time if severe

83
Q

What does prognosis depend on

A

Extend of RVOT narrowing

84
Q

What will adult present with

A 
Pulmonary regurgitation
RHF due to VSD
LDH due to PS 
AR 
PR 
Arrythmia
85
Q

What causes Eisenmenger

A

R-L shunt due to long standing L-R causing increased pressure in pulmonary which becomes greater than systemic so then blood bypass the lungs and become cyanotic

  • VSD
  • ASD
  • PDA
86
Q

What does it cause

A

Pulmonary hypertension
Polycythaemia to respond to chronic hypoxia
Makes blood hyperviscous and increased risk of stroke

87
Q

What are the symptom

A 
Original murmur may disappear
Hypoxia
Cyanosis
Clubbing 
Dyspnoea due to underlying hypoxia 
Plethora
Pulmonary hypertension - RV heave, loud P2, raised JVP and peripheral oedema and haemoptysis 
RVF
Emboli due to polycythaema
88
Q

How do you Dx

A 
ECG = RVH
CXR = cardiomegaly and pulmonary engorgement
89
Q

How do you Rx

A 
Correct underlying defect to prevent developing
Once developed can't reverse 
Lung and heart transplant = only curative 
Oxygen
Rx pulmonary hypertension - sidenafil
Venesection for polycythaemia
Anti-coagulation 
Prevent endocarditis
90
Q

What are complications

A

Hypertrophy of L and R ventricle

Pulmonary hypertension

91
Q

What is an innocent murmur

A 
Soft 
Systolic - except venous hum
Symptomless / No cardiac signs
Vary with position 
Grade 1 -2 
Vibratory
Localised with no radiation
92
Q

What do you do if in doubt

A

If clearly innocent = no investigation
If unsure = refer to paediatric cardiology
ECHO = best test
CXR and ECG will mislead but can still do

93
Q

What is Still’s (LV outflow)

A 
Age 2-7
Soft, systolic, vibratory
Apex and LL sternal border
No radiation
Increase supine and with exercise
94
Q

What is pulmonary flow murmur

A 
Age 8-10
Narrow chest
Soft, systolic, vibratory
UL sternal border
No radiation
Increase supine and with exercise
95
Q

What is venous hum

A 
Age 3-8
Soft and continuous
Diastolic accentuation
Supraclavicular
Only upright
96
Q

What is carotid bruit

A 
Age 2-10
Hard systolic
Supraclavicular
Radiates to neck
Increases exercise
Decreases with neck movement
97
Q

How do you characterise murmur

A

Timing.- S vs D vs continuous
Duration - early / mid / late
Ejection vs pansystolic
Pitch - harsh / soft / vibratory

98
Q

What causes congenital heart disease

A 
Genetic syndromes - see genetics 
Environment
Drugs
Infection
DM - HCM
SLE - heart block (only cause of Brady)
Teratogen
Chromosomal
99
Q

What is only cause of Brady

A

Heart block

100
Q

What infections

A 
Toxoplasmosis
Rubella
CMV
Herpes
Paravirus B19
101
Q

What cardiac does Downs have

A

AVSD
TOF
PDA

102
Q

What is Edward syndrome

A

Trisomy 18
VSD
PDA

103
Q

What is Patau

A

Trisomy 13
VSD
ASD

104
Q

What is cardiac manifestation William

A

Supravalvular AS
MR
Facial dysmorphism

105
Q

What is Noonan syndrome

A

Pulmonary stenosis

106
Q

What is Fragile X associated with

A

MVP

107
Q

What cardiac conditions associated with Turner

A

Cortication of aorta
Bicuspid valve
AS
VSD

108
Q

What gene causes Marfan’s

A

AD fibrin 1

109
Q

What are cardiac manifestations of Marfan

A 
Aortic root dilatation
Aortic regurgitation
Aortic dissection
Aortic aneurysm 
Mitral valve prolapse - MR
110
Q

What are orthopaedic

A 
Tall stature
Hypermobility leading to dislocation - Beighton score 
Long fingers, neck and limbs 
Scolisois 
Kyphosis
Pectus excavatum 
Protrusia acetablia (hip)
111
Q

What are other manifestations

A 
Ectopic lentis - lens dislocation
Pneumothorax - repeated 
GORD 
High arch palate 
Dural ectasia
Striae
112
Q

How do you Dx

A

Calculate Ghent score >7 = +ve but not diagnostic
- Need ectopic lentil, aortic dilatation or FBN1 variant /FH

FH
MRI spine
Pelvic X-ray
ECHO - regular 
ECG
Genetic test for gene mutation - FBN1
113
Q

How do you Rx

A 
BB / ACEI to decrease BP
GTN spray
Prophylactic aortic surgery
Physio for joints 
Yearly ECHO and ophthalmology 
Genetic counselling
114
Q

What causes HCM

A

Genetic

Maternal DM

115
Q

What does HCM lead to

A

Decreased compliance in diastole

Systolic preserved

116
Q

How does it present

A 
Fatigue
SOB
Chest pain
Palpitations
Exertional syncope
Increased JVP
VT 
AF
MR murmur
117
Q

How do you Dx

A

ECG
ECHO
MRI
Genetics

118
Q

How do you Rx

A 
BB - increase relaxation
CCB - Verapamil
Anti-coagulant if AF
Surgical resection
ICD
119
Q

What causes primary pulmonary hypertension

A

Drugs in pregnancy

- SSRI

120
Q

How does endocarditis present

A 
Fever
New murmur
Clubbing
Splenomegaly 
Splinter haemorrhage
Anaemia
Rash 
Microscopic haematuria 
HF
121
Q

How do you Dx

A

3 blood cultures

ECHO

122
Q

How do you Rx

A

IV benpen and gent

123
Q

What is Rheumatic fever

A

Cross sensitivity reaction to group B strep in valve tissure
Presents 2-4 weeks after infection
Type 2 hypersensitivity

124
Q

How do you Dx

A

Recent strep Dx +
2+ major
1+ major / 2 minor

125
Q

How do you Dx strep

A

+ve throat
Rapid strep antigen
Elevated ASO
Recent scarlet fever

126
Q

What is major criteria

A

JONES

  • J = joint arthritis
  • O = heart shape (myocarditis)
  • N = nodules, subcutaneous
  • E = erythema marginatum
  • S = syndeham’s chorea
127
Q

What is minor criteria

A

C - CRP increased
A - arthralgia
F - fever
E - elevated ESR

P - prolonged PR or previous
A - anaemia
L - leucocytosis

128
Q

What other tests

A

ECG
ECHO - look at valves
CXR

129
Q

How do you treat

A 
Rest
Immobilise
Aspirin 
Prednisolone
Ax
130
Q

What are complications

A

Permanent damage to heart valve
Aortic most common
Mitral stenosis

131
Q

What is symptoms of carditis

A 
Tachycardia
MR / AR
Pericardial rub
Cardiomegaly
CCF
132
Q

What is syndeham chorea

A

Involuntary semi-purposeful movements

133
Q

What can all congenital cause

A

Clubbing

Paediatrics (35 decks)

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