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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What 8 types of cardiac anomalies account for congenital heart disease

A
  1. Ventricular Septal Defect
  2. Patent Ductus Arteriosus
  3. Atrial Septal Defect
  4. Pulmonary Stenosis
  5. Aortic Stenosis
  6. Coarctation of Aorta
  7. Transposition of Great Arteries
  8. Teratology of Fallot
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2
Q

Which anomaly is associated with Down Syndrome

A

Atrio-ventricular Septal Defect

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3
Q

Which anomaly is associated with Trisomy 18/Edward Syndrome

A

CSD

Patent ductus arteriosus

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4
Q

Which anomaly is associated with Trisomy 13/Patau syndrome

A

Ventricular septal defect

Atrial septal defect

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5
Q

Which anomaly is associated with Turner Syndrome

A

Co-arctation aorta

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6
Q

Which anomaly is noonan syndrome associated with

A

Pulmonary stenosis

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7
Q

Which anomaly is William syndrome associated with

A

Supravalvular Aortic stenosis

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8
Q

General signs of CHD

A 
Feeding, weight and development 
Cyanosis 
Tachypnoea 
Dypsnoea 
Exercise tolerance
Chest pain 
Syncope 
Palpitations
Joint problems
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9
Q

4 types of innocent murmurs

A

Still’s

Pulmonary Outflow

Carotid/Brachiocephalic Arterial Bruits

Venous hum

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10
Q

What % of new murmurs are innocent in children

A

70-80%

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11
Q

Describe Stills murmur

A

Soft systolic; vibratory musical ‘twangy’
Apex, left sternal border
increases in supine position
increases with exercise

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12
Q

Describe Pulmonary outflow murmur

A

Soft systolic; vibratory
Upper, left sternal border, well localised, not radiating to back
increases in supine position
increases with exercises

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13
Q

Describe carotid bruits

A

1/6-2/6 systolic: harsh
Supraclavicular, radiates to neck
increases with exercise
decreases on turning head or extending neck

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14
Q

Describe venous hum

A

Soft indistinct
Continuous murmur, sometimes with diastolic accentuation
Supraclavicular
Only in upright position
Disappears on lying down or when turning head

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15
Q

What is the commonest innocent murmur

A

Still’s Murmur

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16
Q

Common features of innocent murmurs

A 
Systolic murmur
No other signs of cardiac disease
Asymptomatic 
Soft murmur 
Graded 1/6
Vibratory, musical 
Localised 
Varies with position, respiration and exercise 
Normal Ix
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17
Q

Ix for innocent murmurs

A

Clinical Dx

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18
Q

Describe grade 1/6 murmur

A

Faintest murmur which can be heard with only special effort

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19
Q

Describe grade 2/6 murmur

A

Soft but readily audible

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20
Q

Describe 3/6 murmur

A

Loud without thrill

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21
Q

Describe 4/6 murmur

A

Loud with thrill

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22
Q

Describe 5/6 murmur

A

Heard with stethoscope partially of the chest

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23
Q

Describe 6/6 murmur

A

Heard with stethoscope off the chest wall

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24
Q

What is a VSD

A

Ventricular septal defect

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25
Q

What are the 3 main types of VSD

A

Sub aortic
Perimembranosus
Muscular

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26
Q

Clincial features of VSD

A

Pansystolic murmur: Lower sternal edge

Sometimes with thrill

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27
Q

Triad of HF in children

A

Tachypnoea
Tachycardia
Hepatomegaly

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28
Q

Ix for VSD

A

ECHO

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29
Q

Rx for HF due to VSD

A

Pulmonary vasodilators

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30
Q

Rx for large VSD

A

Amplatzer device

Patch closure

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31
Q

Describe pathophysiology of Eisemenger Syndrome

A

In late stages
Sig. pulmonary hypertension occurs
Pulmonary vascular resistance increases (=> right sided hypertrophy)
Pulmonary vascular resistance rises to the point that shunt reverses
From right to left

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32
Q

What is an ASD

A

Atrial septal defect

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33
Q

4 types of ASD

A

Ostium Secundum
Ostium Primum
SInus Venosus Unroofed Coronary sinus

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34
Q

Clinical features of ASD

A

Few clinical signs in early childhood

Wide fixed splitting 2nd heart sounds
Pulmonary flow murmur
Upper left sternal edge

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35
Q

Ix for ASD

A

Often incidental finding
Clinical (O/E):
Murmur

ECHO
ECG
CXR

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36
Q

Rx for small ASD

A

Observation

Small defects often spontaneously close

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37
Q

Rx for large ASD

A

Occlusion device in situ

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38
Q

What is Ostium Secundum

A

Most common type of ASD

Central defects of atrial wall

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39
Q

What is Ostium Primum

A

Type of ASD

Low defects of atrial wall

40
Q

What is Sinus Venosus

A

Type of ASD

high defect of atrial wall

41
Q

When is ASD often picked up

A

Incidentally on ECHO

42
Q

What is an atrioventricular septal defect

A

Defect between the atrial and ventricular septal defect

43
Q

Associations of AVSD

A

Trisomy 21

44
Q

2 types of AVSD

A

Partial

Complete

45
Q

Describe partial AVSD

A

Defect in primum of atrial septum

But no direct intraventricular communication

46
Q

Describe complete AVSD

A

Large defect allows blood to travel between all 4 chambers

47
Q

Ix for AVSD

A 
Can be made in utero or after birth 
ECG 
CXR 
ECHO 
Cardiac catheterisation
48
Q

Rx for AVSD

A

Closure surgical

49
Q

Which valve is most commonly affected in children

A

Pulmonary

50
Q

What is pulmonary stenosis

A

Narrowing of pulmonary valve

51
Q

Murmur in pulmonary stenosis

A

Ejection systolic murmur
Upper left sternal border
Radiation to the back

52
Q

Rx for pulmonary stenosis if asymptomatic

A

Often if asymptomatic:
No need for intervention

But observe:
Re-scan as the child gets older/grows

53
Q

2 types of systolic murmur

A

Ejection

Pansystolic

54
Q

surgical Rx for pulmonary stenosis

A

Balloon dilation

Balloon valvoplasty

55
Q

Why is valve replacement not recommended in children with pulmonary stenosis

A

Because children are growing

56
Q

What is the 2nd commonest valve problem in childhood

A

Aortic stenosis

57
Q

Murmur heard in aortic stenosis

A

Ejection systolic murmur:
Upper right sternal border
Radiation to carotids

On palpation:
Suprasternal thrill

58
Q

Clinical features of aortic stenosis

A

Mostly asymptomatic

Severe:
 exercise tolerance 
Exertional chest pain 
Syncope
Fatigue
59
Q

Rx for aortic stenosis children

A

Mild:
Regular observation

Surgery:
Balloon Aortic Vulvoplasty

60
Q

Who is Patent Ductus arteriosus very common in

A

Pre-term infants

61
Q

RF for PDA

A

Prematurity
Maternal rubella
F>M

62
Q

What is PDA

A

When the ductus arteriosus persists

Allowing oxygenated blood to flow back to the lungs

63
Q

When is the ductus arteriosus meant to close

A

<48hrs after birth

64
Q

Rx for PDA

A 
Fluid restriction
Diuretics
Prostaglandin inhibitors (Indomethacin, Ibuprofen)

Surgical ligation

65
Q

What does the ductus arteriosus become normally once closed

A

Ligamentum arteiousum

66
Q

Is PDA cyanotic or acyanotic

A

Acyanotic

67
Q

Clinical features of persisting PDA

A

Increase in pulmonary pressures (pulmonary hypertension)

68
Q

What is co-arctation of the aorta

A

Narrowing of the aorta

69
Q

RF for co-arctation of the aorta

A 
M
Young age
Turner 
22Q11 deletion 
Hypoplastic left heart syndrome 
FH
70
Q

Clinical features co-arctation of the aorta

A 
Fluid restriction
Diuretics
Prostaglandin inhibitors (Indomethacin, Ibuprofen)
71
Q

Rx for critical co-arctation

A

Re-open PDA with Prostaglandin E1 E2

Resection with end to end anastomosis

72
Q

Surgical Rx for co-arctation of the aorta

A 
Subclavian patch repair
Balloon Aortoplasty (recurrent)
73
Q

Types of transposition of great arteries

A

Complete

Congenitally corrected TGA

74
Q

Describe complete TGA

A

Aorta connected to right ventricle
Pulmonary artery connected to left ventricle
Incompatible with prolong life unless mixing of oxygenated and de-oxygenated blood occurs at some level (ASD, VSD, PDA)

75
Q

Describe incomplete TGA

A

Not cyanotic
Aorta arises from morphologic right ventricle and pulmonary artery arises form morphological left ventricle
Circulation is preserved

76
Q

CXR sign of TGA

A

Egg on a string

77
Q

Ix for TGA

A

CXR
ECG
ECHO
Cardiac catheterisation

78
Q

Rx for TGA

A

Prostaglandin E:
Keeps Ductus arteriosus open

Switch procedure
Rashkind’s Balloon

79
Q

What is the most common cyanotic heart defect

A

Teratology of Fallot

80
Q

4 Structural defects in teratology of fallot

A
  1. Pulmonary stenosis
  2. Right Ventricular Hypertrophy
  3. Over-riding aorta
  4. Large VSD
81
Q

Describe a Fallot (Tet) Spell

A

Episodes of severe cyanosis due to spasm of subpulmonary muscles
Occur e.g during crying or bowel movements
Turn very blue
Dyspnoea
Potential loss of consciousness

82
Q

How are Tet spells Releived

A

by squatting

83
Q

Signs of Teratology of Fallot

A 
Clubbing 
Cyanosis (lips, fingertips)
Blue baby 
Fatigue 
Failure to thrive
84
Q

Ix for teratology of fallto

A

ECHO

85
Q

Surgical Rx for teratology of fallot

A

Blalock Taussig Operation

86
Q

Jones Criteria for RF

A

Elicit 2 major
Or
1 major 1 minor

87
Q

Which criteria is used for RF

A

Jones Criteria

88
Q

Major Jones criteria for RF

A 
Carditis
Polyarthritis 
Erythema marginatum 
Subcutaneous nodules 
Sydenham’s Chorea
89
Q

Minor Jones criteria for RF

A 
Fever
ESR>20mm or CRP 
Arthralgia 
ECG: PR interval >0.2 sec
Previous rheumatic fever or rheumatic heart disease
90
Q

Pathology of RF

A

Cross-sensitivity reaction to group A beta-haemolytic strep infection (e.g Pharyngitis)

91
Q

What can RF lead to permanenet damage of

A

Heart valves

92
Q

Rx for RF

A

Rest
Immobilisation
Aspirin

Severe:
Prednisolone

Phenoxy- methylpenicillin
Benzylpenicillin

93
Q

What can prescribing aspirin in RF cause

A

Reye syndrome

94
Q

Clinical features of TGA

A

Newborn cyanosis:
Prominent
Progressive

Tachypnoea
Tachycardia
Failure to thrive

95
Q

Outcome of small VSD

A

Can sometimes close spontaneously

Paediatrics (13 decks)

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