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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
How do you Dx
ECG CXR ECHO = gold standard
26
How do you treat
Same as VSD REQUIRES SURGICAL Valve replacement
27
Where does ASD arise
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
28
How does ASD present in childhood and why
``` Asymptomatic Pressure diff so small in atria unlikely to hear murmur FTT Poor feeding Tachycardia and tachypnoea SOB Lethargy ```
29
How does it present in adulthood
``` 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 ```
30
What are signs of ASD
Ejection systolic due to pulmonary flow | Wide fixed split S2 due to increased venous return / overloaded RV
31
How do you Dx
CXR - globular heart ECG - RVH ECHO
32
How do you treat
Occulusion device No open heart Anti-coagulation in adult due to VTE risk
33
What are complications if ASD doesn't close
``` 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 ```
34
When does PDA usually close and what happens if it doesn't
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
35
How does PDA present
``` 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 ```
36
What increases risk
Pre-term | Maternal rubella
37
What is the murmur like in PDA
Continuous murmur - venous hum | Huge pressure diff between aorta and Pa
38
How do yo Dx
ECHO
39
How do you Rx
Fluid restrict Diuretic Prostaglandin inhibitor - Iburpofen / Indomethacin Umbrella closure device
40
What are complications
Lungs compromised already if pre-term Pulmonary hypertension R and L HF
41
What is most common valve defect and what is it associated with
Pulmonary stenosis - Tetraology - Noonan - William - Congenital Rubella
42
How does PS present
``` Asymptomatic Exertional SOB Fatigue Syncope Cyanosis depends on severity ```
43
How does AS present and complications
``` Decreased exercise Fatigue SOB Chest pain Syncope Typically worse on exertion ``` ``` Complications LV outflow obstruction Heart failure Arrhythmia Endocarditis Sudden death ```
44
Murmur of PS
``` Ejection systolic UL sternal Radiates to back RVH Raised JVP ```
45
Murmur of AS
Ejection systolic UR sternal Radiate to carotid Slow rising, narrow pulse pressure
46
How do you Dx and treat valve defect
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
47
When and why does coarctation of aorta arise
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
48
How does coarctation present
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
49
Murmur in coarctation
Systolic
50
What is a late sign of coarctation
Rib notch due to collateral circulation arising
51
How does coarctation present in adulthood
Arterial insufficiency Claudication Syncope Murmur
52
What increases risk of coarctation
Bicuspid aortic Turner Berry aneurysm Neurofibromatosis
53
How do. you Dx
USS ECG ECHO May need MRI
54
How do you Rx
Prostaglandin to reopen PDA Ventilation Transfer to CCU Surgical
55
How do you treat in adulthood
Angioplasty | Surgical resection
56
What happens / complications of coarctation
``` Activation of RAAS as hypoxia leads to hypertension upper limb HF as high afterload Hypertension IE Haemorrhage ```
57
Ddx
Sepsis More common cause of collapse Consider cardiac if not responding
58
What causes Ebstein
Lithium in utero
59
How does Ebstein present
``` Low insertion tricuspid Tricuspid regurgitation Tricuspid stenos Large atrium Small ventricle ```
60
Murmur
Pansystolic if regurgitation | Diastolic if stenosis
61
How do you Dx
ECHO
62
Complications
WPW | Tricuspid incompetence
63
What causes cyanotic HD and what are duct dependent conditions and what is protective
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
How do you Dx cyanotic HD
``` O2 sats ABG BP Blood glucose CXR ECG ECHO Cath lab MRI Exercise testing ```
65
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
``` Admit neonatal Volume expansion Correct acidosis / hypocalcaemia Inotropes IV prostaglandins to mix blood (keeps ductus arteriosus open) Ventilate Surgery ```
66
What is transposition of great arteries
No connection between circulation Aorta out of R ventricle - no O2 Pa out of L - O2 filled No connection between
67
How do they present
CYANOTIC at birth Resp distress Cool clammy skin If associated defect e.g. ASD / VSD may present later as blood can mix
68
How do you Dx
Often Dx ante-natal | CXR
69
How do you Rx
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
DDx
RDS is much more common
71
What do all children with heart conditions get
Clinic follow up
72
What tests should all children with heart get
CXR ECG ECHO Cardiac Cath - if surgery to see pressures
73
What do you do if a hole is very small
Should close itself ECHO before school to check its closed Surgery before school if large
74
When can you replace valves that are stenosed
Once fully grown Put patch in place to help BP medications If severely affecting can replace
75
What is more common than transposition
Tetralogy | Presents later
76
What is tetralogy
``` Large VSD Pulmonary stenosis (whole RVOT) Overriding aorta RVH The bigger the shunt the more cyanosed ```
77
How does tetralogy present
``` 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
What murmur
Ejection systolic due to PS
79
What increases risk
``` Rubella Maternal age Alcohol DM Down's ```
80
How do you Dx
CXR ECHO ECG
81
What does CXR show
Boot shape heart | Black lungs as no blood
82
How do you treat
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
What does prognosis depend on
Extend of RVOT narrowing
84
What will adult present with
``` Pulmonary regurgitation RHF due to VSD LDH due to PS AR PR Arrythmia ```
85
What causes Eisenmenger
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
What does it cause
Pulmonary hypertension Polycythaemia to respond to chronic hypoxia Makes blood hyperviscous and increased risk of stroke
87
What are the symptom
``` 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
How do you Dx
``` ECG = RVH CXR = cardiomegaly and pulmonary engorgement ```
89
How do you Rx
``` 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
What are complications
Hypertrophy of L and R ventricle | Pulmonary hypertension
91
What is an innocent murmur
``` Soft Systolic - except venous hum Symptomless / No cardiac signs Vary with position Grade 1 -2 Vibratory Localised with no radiation ```
92
What do you do if in doubt
If clearly innocent = no investigation If unsure = refer to paediatric cardiology ECHO = best test CXR and ECG will mislead but can still do
93
What is Still's (LV outflow)
``` Age 2-7 Soft, systolic, vibratory Apex and LL sternal border No radiation Increase supine and with exercise ```
94
What is pulmonary flow murmur
``` Age 8-10 Narrow chest Soft, systolic, vibratory UL sternal border No radiation Increase supine and with exercise ```
95
What is venous hum
``` Age 3-8 Soft and continuous Diastolic accentuation Supraclavicular Only upright ```
96
What is carotid bruit
``` Age 2-10 Hard systolic Supraclavicular Radiates to neck Increases exercise Decreases with neck movement ```
97
How do you characterise murmur
Timing.- S vs D vs continuous Duration - early / mid / late Ejection vs pansystolic Pitch - harsh / soft / vibratory
98
What causes congenital heart disease
``` Genetic syndromes - see genetics Environment Drugs Infection DM - HCM SLE - heart block (only cause of Brady) Teratogen Chromosomal ```
99
What is only cause of Brady
Heart block
100
What infections
``` Toxoplasmosis Rubella CMV Herpes Paravirus B19 ```
101
What cardiac does Downs have
AVSD TOF PDA
102
What is Edward syndrome
Trisomy 18 VSD PDA
103
What is Patau
Trisomy 13 VSD ASD
104
What is cardiac manifestation William
Supravalvular AS MR Facial dysmorphism
105
What is Noonan syndrome
Pulmonary stenosis
106
What is Fragile X associated with
MVP
107
What cardiac conditions associated with Turner
Cortication of aorta Bicuspid valve AS VSD
108
What gene causes Marfan's
AD fibrin 1
109
What are cardiac manifestations of Marfan
``` Aortic root dilatation Aortic regurgitation Aortic dissection Aortic aneurysm Mitral valve prolapse - MR ```
110
What are orthopaedic
``` Tall stature Hypermobility leading to dislocation - Beighton score Long fingers, neck and limbs Scolisois Kyphosis Pectus excavatum Protrusia acetablia (hip) ```
111
What are other manifestations
``` Ectopic lentis - lens dislocation Pneumothorax - repeated GORD High arch palate Dural ectasia Striae ```
112
How do you Dx
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
How do you Rx
``` BB / ACEI to decrease BP GTN spray Prophylactic aortic surgery Physio for joints Yearly ECHO and ophthalmology Genetic counselling ```
114
What causes HCM
Genetic | Maternal DM
115
What does HCM lead to
Decreased compliance in diastole | Systolic preserved
116
How does it present
``` Fatigue SOB Chest pain Palpitations Exertional syncope Increased JVP VT AF MR murmur ```
117
How do you Dx
ECG ECHO MRI Genetics
118
How do you Rx
``` BB - increase relaxation CCB - Verapamil Anti-coagulant if AF Surgical resection ICD ```
119
What causes primary pulmonary hypertension
Drugs in pregnancy | - SSRI
120
How does endocarditis present
``` Fever New murmur Clubbing Splenomegaly Splinter haemorrhage Anaemia Rash Microscopic haematuria HF ```
121
How do you Dx
3 blood cultures | ECHO
122
How do you Rx
IV benpen and gent
123
What is Rheumatic fever
Cross sensitivity reaction to group B strep in valve tissure Presents 2-4 weeks after infection Type 2 hypersensitivity
124
How do you Dx
Recent strep Dx + 2+ major 1+ major / 2 minor
125
How do you Dx strep
+ve throat Rapid strep antigen Elevated ASO Recent scarlet fever
126
What is major criteria
JONES - J = joint arthritis - O = heart shape (myocarditis) - N = nodules, subcutaneous - E = erythema marginatum - S = syndeham's chorea
127
What is minor criteria
C - CRP increased A - arthralgia F - fever E - elevated ESR P - prolonged PR or previous A - anaemia L - leucocytosis
128
What other tests
ECG ECHO - look at valves CXR
129
How do you treat
``` Rest Immobilise Aspirin Prednisolone Ax ```
130
What are complications
Permanent damage to heart valve Aortic most common Mitral stenosis
131
What is symptoms of carditis
``` Tachycardia MR / AR Pericardial rub Cardiomegaly CCF ```
132
What is syndeham chorea
Involuntary semi-purposeful movements
133
What can all congenital cause
Clubbing

Paediatrics (35 decks)

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