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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
What are the 3 main types of VSD
Sub aortic Perimembranosus Muscular
26
Clincial features of VSD
Pansystolic murmur: Lower sternal edge | Sometimes with thrill
27
Triad of HF in children
Tachypnoea Tachycardia Hepatomegaly
28
Ix for VSD
ECHO
29
Rx for HF due to VSD
Pulmonary vasodilators
30
Rx for large VSD
Amplatzer device | Patch closure
31
Describe pathophysiology of Eisemenger Syndrome
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
32
What is an ASD
Atrial septal defect
33
4 types of ASD
Ostium Secundum Ostium Primum SInus Venosus Unroofed Coronary sinus
34
Clinical features of ASD
Few clinical signs in early childhood Wide fixed splitting 2nd heart sounds Pulmonary flow murmur Upper left sternal edge
35
Ix for ASD
Often incidental finding Clinical (O/E): Murmur ECHO ECG CXR
36
Rx for small ASD
Observation | Small defects often spontaneously close
37
Rx for large ASD
Occlusion device in situ
38
What is Ostium Secundum
Most common type of ASD | Central defects of atrial wall
39
What is Ostium Primum
Type of ASD | Low defects of atrial wall
40
What is Sinus Venosus
Type of ASD | high defect of atrial wall
41
When is ASD often picked up
Incidentally on ECHO
42
What is an atrioventricular septal defect
Defect between the atrial and ventricular septal defect
43
Associations of AVSD
Trisomy 21
44
2 types of AVSD
Partial | Complete
45
Describe partial AVSD
Defect in primum of atrial septum | But no direct intraventricular communication
46
Describe complete AVSD
Large defect allows blood to travel between all 4 chambers
47
Ix for AVSD
``` Can be made in utero or after birth ECG CXR ECHO Cardiac catheterisation ```
48
Rx for AVSD
Closure surgical
49
Which valve is most commonly affected in children
Pulmonary
50
What is pulmonary stenosis
Narrowing of pulmonary valve
51
Murmur in pulmonary stenosis
Ejection systolic murmur Upper left sternal border Radiation to the back
52
Rx for pulmonary stenosis if asymptomatic
Often if asymptomatic: No need for intervention But observe: Re-scan as the child gets older/grows
53
2 types of systolic murmur
Ejection | Pansystolic
54
surgical Rx for pulmonary stenosis
Balloon dilation | Balloon valvoplasty
55
Why is valve replacement not recommended in children with pulmonary stenosis
Because children are growing
56
What is the 2nd commonest valve problem in childhood
Aortic stenosis
57
Murmur heard in aortic stenosis
Ejection systolic murmur: Upper right sternal border Radiation to carotids On palpation: Suprasternal thrill
58
Clinical features of aortic stenosis
Mostly asymptomatic ``` Severe: exercise tolerance Exertional chest pain Syncope Fatigue ```
59
Rx for aortic stenosis children
Mild: Regular observation Surgery: Balloon Aortic Vulvoplasty
60
Who is Patent Ductus arteriosus very common in
Pre-term infants
61
RF for PDA
Prematurity Maternal rubella F>M
62
What is PDA
When the ductus arteriosus persists | Allowing oxygenated blood to flow back to the lungs
63
When is the ductus arteriosus meant to close
<48hrs after birth
64
Rx for PDA
``` Fluid restriction Diuretics Prostaglandin inhibitors (Indomethacin, Ibuprofen) ``` Surgical ligation
65
What does the ductus arteriosus become normally once closed
Ligamentum arteiousum
66
Is PDA cyanotic or acyanotic
Acyanotic
67
Clinical features of persisting PDA
Increase in pulmonary pressures (pulmonary hypertension)
68
What is co-arctation of the aorta
Narrowing of the aorta
69
RF for co-arctation of the aorta
``` M Young age Turner 22Q11 deletion Hypoplastic left heart syndrome FH ```
70
Clinical features co-arctation of the aorta
``` Fluid restriction Diuretics Prostaglandin inhibitors (Indomethacin, Ibuprofen) ```
71
Rx for critical co-arctation
Re-open PDA with Prostaglandin E1 E2 | Resection with end to end anastomosis
72
Surgical Rx for co-arctation of the aorta
``` Subclavian patch repair Balloon Aortoplasty (recurrent) ```
73
Types of transposition of great arteries
Complete | Congenitally corrected TGA
74
Describe complete TGA
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
Describe incomplete TGA
Not cyanotic Aorta arises from morphologic right ventricle and pulmonary artery arises form morphological left ventricle Circulation is preserved
76
CXR sign of TGA
Egg on a string
77
Ix for TGA
CXR ECG ECHO Cardiac catheterisation
78
Rx for TGA
Prostaglandin E: Keeps Ductus arteriosus open Switch procedure Rashkind’s Balloon
79
What is the most common cyanotic heart defect
Teratology of Fallot
80
4 Structural defects in teratology of fallot
1. Pulmonary stenosis 2. Right Ventricular Hypertrophy 3. Over-riding aorta 4. Large VSD
81
Describe a Fallot (Tet) Spell
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
How are Tet spells Releived
by squatting
83
Signs of Teratology of Fallot
``` Clubbing Cyanosis (lips, fingertips) Blue baby Fatigue Failure to thrive ```
84
Ix for teratology of fallto
ECHO
85
Surgical Rx for teratology of fallot
Blalock Taussig Operation
86
Jones Criteria for RF
Elicit 2 major Or 1 major 1 minor
87
Which criteria is used for RF
Jones Criteria
88
Major Jones criteria for RF
``` Carditis Polyarthritis Erythema marginatum Subcutaneous nodules Sydenham’s Chorea ```
89
Minor Jones criteria for RF
``` Fever ESR>20mm or CRP Arthralgia ECG: PR interval >0.2 sec Previous rheumatic fever or rheumatic heart disease ```
90
Pathology of RF
Cross-sensitivity reaction to group A beta-haemolytic strep infection (e.g Pharyngitis)
91
What can RF lead to permanenet damage of
Heart valves
92
Rx for RF
Rest Immobilisation Aspirin Severe: Prednisolone Phenoxy- methylpenicillin Benzylpenicillin
93
What can prescribing aspirin in RF cause
Reye syndrome
94
Clinical features of TGA
Newborn cyanosis: Prominent Progressive Tachypnoea Tachycardia Failure to thrive
95
Outcome of small VSD
Can sometimes close spontaneously

Paediatrics (13 decks)

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