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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Causes of CHD

A

Genetic Susceptibility + Environmental Factors

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2
Q

Name some Environmental Factors of CHD

A

Drugs - Alcohol, Amphetamines, Cocaine, Ecstasy, Lithium

Infections - TORCHES

Teratogenic Insult - occurs most commonly 18-60 days post conception

Chromosomal Abnormalities -
Trisomy 21 (downs): AVSD
Trisomy 18: VSD and PDA
Trisomy 13 (pataus): AVD or VSD

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3
Q

Other Less Common Chromosomal defects

A

Turners - Coarctation (particularly Females)
Noonan - Pulmonary Stenosis
Williams - Supravalvular AS
22q11, De George syndrome : Interrupted Aortic Arch

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4
Q

Concepts to look at with Murmur chatacterisation

A

Timing within cycle - Diastolic Versus Systolic
Duration: Pan/Holo, Ejection, Early/mid/late
Pitch/Quality - Harsh or mixed frequency, Soft, Vibratory etc.

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5
Q

Common Features of Innocent Murmurs

A 
Systolic
soft
Localised
No other cardiac signs
Vibratory/Melodic
Varies with Position and Respiration
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6
Q

What are the Features of STILL’s murmur (Innocent)

A

2-7 years
Soft, ‘Twangy’ Systolic Murmur
Heard best a LLSE
increased when Supine

THINK STILL's 
S - Supine/systolic
T - Twangy
I - Infant
LL - Lower Left
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7
Q

What are the Features of Pulmonary Outflow Murmur (innocent)

A 
Age 8-10
'Vibratory' systolic
ULSE with no radiation
Increased when supine and with exercise
Narrow Chest
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8
Q

What are the Features of Carotid/Brachiocephalic arterial Bruits (Innocent)

A 
Age 2-10 years
1 or 2 out of 6 HARSH
Supraclavicular and Neck 
increased with Exercise
Decreased by turning head and extending neck
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9
Q

Characteristics of a Venous Hum (innocent)

A 
Age 3-8
Soft and indistinct
Continuous hum, Often with Diastolic accentuation
Supraclavicular
ONLY HEARD IN UPRIGHT POSITION
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10
Q

What are the 3 main Types of ventricular septal Defect

A

Perimembranous (most common) -
Muscular
Subaortic

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11
Q

Clinical Presentation of VSD

A

Pansystolic murmur - LLSE (sometimes with a Thrill)
If very small –> Early Systolic Murmur - Asymptomatic

When large –> mitral stenosis occurs –> diastolic murmur

Exercise intolerance, increased resp effort and tachypnoea, poor feeding, failure to thrive
poor weight gain is a good indication of HF in Paeds
Parasternal Heave (L) - Excessive pulmonary blood flow may lead to increased pulmonary vascular resistance and HTN. –> EISENMENGERS syndrome
Chest Px, Syncope, Dyspnoea and Cyanosis

Biventricular Hypertrophy and Pulmonary HTN
Loud Pansystolic murmur
Clubbing

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12
Q

Ix and treatment of VSD

A

CXR
ECHO
Patch closure
Amplatzer device Closure

NOTE: VSD may lead to congestive heart failure.

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13
Q

Clinical Signs in Atrial Septal Defects

A

Very Few in early childhood - may result in spontaneous closure
Detected in Adulthood as AF or pulmonary HTN
Palpatations, dyspnoea, cyanosis
Wide splitting of H2 and a pulmonary flow murmur - this is late stage
Left parasternal Heave due to RVH

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14
Q

Clinical Features of Pulmonary Stenosis

A

Mild = Asymptomatic
Moderate - Severe = SOB on exertion
Ejection systolic murmur - heard at ULSE
radiation to the Back

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15
Q

Treatment of Pulmonary Stenosis

A

Balloon Valvostomy

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16
Q

Clinical Features of Aortic Stenosis

A

mostly Asymptomatic in children
If severe - Reduced exercise tolerance. Chest pain and Syncope
Ejection ‘Click’ systolic murmur
URST radiating to carotids

17
Q

Treatment of Aortic Stenosis

A

Balloon Valvostomy

18
Q

What are the 5 changes of Fetal Circulation at Birht

A 
Pulmonary vascular resistance decreases (and flow increased)
systemic Vascular resistance increases
DA closure
Foramen Ovale Closure
Ductous Venosus closure
19
Q

Patent Ductus Arteriosus

A

Failure of DA to close after birth –> persistent communication between aorta and pulmonary artery

Allows blood to Shunt from Systemic Circulation into Pulmonary (L to R) –> Excessive pulmonary flow

20
Q

Aortic Coarctation Treatment

A

Re-open DA with Prostiglandin E1 or E2
Resection and end to end anastomsis
Subclavian patch Repair
Balloon Aortoplasty

21
Q

Tetralogy of Fallot

A

Overriding aorta
Pulmonary Stenosis
RV hypertrophy
VSD

All Leads to Cyanosis (especially when crying or upset) as the O2 poor Blood Mixes with O2 Rich blood and leaves via the aorta.

Assoc. W/ DiGeorge syndrome

22
Q

Clinical Features of Aortic Coarctation

A

Weak/Absent Femoral Pulses
HTN in arms but not legs
Severe –> neonatal Shock when Ductus Closes
Less Severe –> HF, Murmur heard on back, HTN
X - Ray Rib Notching

SOB
Tachypnoea
FTT
Poor Apettite
Dizzy
Chest Px
Fatigue 
intermittent claudication
23
Q

Treatment of Teralogy of Fallot

A

Acute Spells - O2, analgesia, Beta blocker.

Sx repair by 6 months

24
Q

Classifications of ASD

A

Ostium Primum - AKA endocardial Cushion defect - Less common but most serious
lies adjacent to AV valves
A/W Down’s Syndrome

Ostium Secondum - More Common but less serious
Mid septum around foramen ovale - makes up
around 70% of cases

25
Q

How Does splitting of Heart Sound 2 occur in ASD

A

Shunting of blood left to right –> more blood encouraged into right side of the heart –> RVH due to pressure –> pulmonary valve forced to close later that aortic valve –> 2 dubs.

26
Q

Ix of ASD`

A

Auscultation
ECG
Ostium Primum - Left axis deviation
Osteum Secondum - Right axis deviation
Right Bundle Branch Block may indicate RV and RA
hypertrophy

CXR
Large Hilar Arteries, enlarged RA and RV, increased
pulmonary vasculature

Echo

27
Q

Mx of ASD

A

Can Leave is small

Symptoms in Adults or Teens –> Sx closure

28
Q

presentation of a PDA

A

Machinery murmur - May be asymptomatic if small
Murmur heard loudest below left clavicle - radiates to back

Bounding/Collapsing pulse - strong in radial (not normal for paeds)
Wide Pulse Pressure due to collapse

29
Q

Ix and management of PDA

A

ECHO
CRX
ECG

Fluid restriction
Prostoglandin Antagonist (indomethacin) 
SX - Ligation of Duct/ Trans catheter occlusion
30
Q

Clinical Features of ToF

A 
Symptoms 
   Cyanosis
   SOB
   tachypnoea
   Loss of Conscousness
   Poor Feeding and WEight Gain 
   Crying and irritable 
Signs
   Clubbing
   Ejection systolic murmur at LLSE
   Single Heart SOund
   Child may SQUAT to increase venous pressure
31
Q

Ix of Tof`

A

High risk Mothers Get foetal USS (if +ve for trisomy 21)
Normal aortic root makes ToF Dx unlikely

AP CXR will show heart shape - Boot shape due to RVH

EXG - Right axis deviation - RVH + dominant R wave in R precordial chest lead

Transthoracic Echo

32
Q

Transpostion of the Great Arteries TPGA)

A

Aorta arises from Right Ventricle and Pulmonary artery arises from left ventricle–> creates 2 parallel circulations

Most common congenital heart lesion presenting in neonates.

33
Q

Symptoms of TPGA

A

cyanosis with closed DA
As pulmonary flow increases, HF may occur at 3-6wks
May present similarly to ToF

34
Q

Signs of TPGA

A

Tachycardia and Tachypnoea
Ejection systolic murmur if Left ventricular outflow obstruction
Otherwise HS normal - no audible murmus

35
Q

Ix of TPGA

A

CXR - Egg on side appearance

Echo

36
Q

Mx of TPGA`

A

Prostiglandin analogues to maintain ductus patency (E1 or E2)
Switch operation is definitive Sx.

37
Q

Levine Scale of Heart Murmurs

A
  1. Murmur only audible on careful listening for some time
  2. Murmur is fain but immediately audible on placing stethoscope on chest
  3. Loud murmur readily audible WITH NO palpable thrill
  4. Loud murmur with palpable thrill
  5. Loud murmur with thrill - so loud it is audible with only the rim of the stethoscope
  6. A loud murmur with Thrill - So loud you do not require stethoscope to hear.

Paediatrics (19 decks)

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