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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Physiological circulatory changes at birth

A

In fetus:
Ductus venosus passes blood from umbilical vein to IVC, by-passing liver
Lungs are fluid-filled and non-functioning -> High RA pressure
Blood pass through Foramen ovale to LA, by passing lungs
Blood pass through Ductus Arteriosus from PA to Aorta, by passing lungs

After birth: 
With first breath, pulmonary pressure drops and increased blood flow to lungs and blood return to LA
LA pressure rises > RA 
Foramen ovale closes 
Ductus arteriosus closes
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2
Q

Prevalence of CHD

A

0.8%

Most common birth defect

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3
Q

Classification of CHD

A

Left-to-Right shunts/Acyanotic
Right-to-Left shunts/Cyanotic
Obstructive valvular and non-valvular lesions

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4
Q

Types of presentation of CHD

A 
Antenatal diagnosis 
Murmur 
Cyanosis - RtoL shunts 
Heart failure - LtoR shunts, obstructive 
Shock - obstructive
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5
Q

Clinical features of innocent murmur

A

aSymptomatic
Soft blowing murmur
Systolic murmur only
left Sternal edge

Normal heart sounds with no added sounds
No parasternal thrill
No radiation

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6
Q

Clinical features of heart failure

A

Breathlessness
Sweating
Poor feeding
Recurrent chest infections

Poor weight gain
Tachypnoea
Tachycardia
Murmur, gallop rhythm 
Enlarged heart
Hepatomegaly
Cool peripheries
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7
Q

Causes of heart failure

A

Neonates:
Obstructed systemic circulation
If severe have duct-dependent circulation - Sudden deterioration on day 1-2 when duct closes

Infants:
Left-to-Right shunts - left sided HF

Older children:
Eisenmenger Syndrome - right sided HF, due to development of irreversibly raised pulmonary vascular resistance from chronically raised pulmonary blood flow, causing shunt shift from R to Left

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8
Q

Types of Left-to-Right shunts

A

Atrial septal defect
Ventricular septal defect
Persistent ductus arteriosus

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9
Q

Types of ASD

A

Secundum ASD

Atrioventricular septal defect

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10
Q

Pathophysiology of each type of ASD

A

Secundum ASD:
defect in atrial septum involving Foramen ovale

AVSD:
Defect in atrioventricular septum
Interatrial communication bw bottom end of atrial septum and AV valves (primum ASD)
WithMitral regurgitation

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11
Q

Clinical features of ASD

A

Asymptomatic
Recurrent chest infections/wheeze
Arrhythmias (in 40s)

Ejection systolic murmur at upper left sternal edge (increased flow in pulmonary valve)
Pansystolic murmur at apex - AVSD

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12
Q

Investigations for ASD

A

CXR: cardiomegaly, enlarged pulmonary arteries

ECG:
Secundum ASD - RBBB, RAD
AVSD - ‘superior’ QRS axis,

Echo with Doppler uss

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13
Q

Management of ASD

A 
Severe secundum (R Ventricle dilatation): cardiac catheterisation with insertion of occlusion device at 3-5 years 
AVSD: surgical correction af 3 years
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14
Q

Prevalence of VSD

A

30% of CHD

Most common type

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15
Q

Classification of VSD

A

Small: defect smaller than aortic valve diameter
Large: defect same of larger than aortic valve diameter

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16
Q

Clinical features of small VSD

A

Asymptomatic

Loud pansystolic murmur at LLSE

17
Q

Management of small VSD

A

None - Closes spontaneously

18
Q

Clinical features of large VSD

A 
Heart failure: breathlessness, faltering growth, recurrent chest infections
Tachypnoea, tachycardia, hepatomegaly
Active precordium
Loud P2
Soft pansystolic murmur LLSE
19
Q

Management of Large VSD

A

Diuretics
Captopril
Additional calorie input
Surgery at 3-6 months

20
Q

Define patent ductus arteriosus

A

Ductus arteriosus failed to close by 1 month after expected date of delivery

21
Q

Clinical features of PDA

A

Continuous murmur ULSE

Bounding pulse

22
Q

Management of PDA

A

Closure with coil or occlusion device by cardiac catheterisation
Surgical ligation

23
Q

Types of right-to-left shunts

A

Tetralogy of fallot

Transposition of great arteries

24
Q

Causes of cyanosis of newborn

A

Cyanotic CHD
Respiratory: RDS, meconium aspiration, pulmonary hypoplasia
Persistent pulmonary hypertension of newborn
Infection
Inborn error of metabolism

25
Q

Diagnostic test for Cyanotic CHD

A

Hyperoxia test:
Infant placed in 100% oxygen for 10 minutes
If right radial arterial PaO2 <15 kPa = cyanosis due to CHD once lung disease excluded

26
Q

Management of cyanosed neonate

A

Resuscitation and stabilisation

Prostaglandin infusion: maintain ductal patency because duct dependent circulation

27
Q

What is tetralogy of fallot

A

Overriding aorta over ventricular septum
Large VSD
Sub-pulmonary stenosis
RVH

28
Q

Clinical features of tetralogy of fallot

A

Antenatal diagnosis
Murmur
Hypercyanotic spells
Squatting on excercise

Clubbing (older)
Loud ejection systolic murmur ULSE

29
Q

What are hypercyanotic spells

A

Rapid increase in cyanosis
Associated with irritability, inconsolable crying
Breathlessness
Pallor (tissue acidosis)

30
Q

CXR of tetralogy of fallot

A

Boot shaped heart - uptilted apex w rvh

Pulmonary artery ‘bay’ - concavity on left border

31
Q

Management of tetralogy of fallot

A

Surgery at 6 months: closure of VSD and relieving right ventricular outflow obstruction
Cyanosis in Neonatal period: artificial shunt bw subclavian artery and pulmonary artery

32
Q

Management of hypercyanotic spells

A

Self-limiting

If prolonged (>15min): 
Morphine (sedation, analgesia) 
IV propanolol
IV fluids 
Bicarbonate (acidosis) 
Muscle paralysis and ventilation (Reduce metabolic oxygen demand)
33
Q

What is transposition of great arteries

A

Aorta is connected to right ventricle and pulmonary artery connected to left ventricle, resulting in two parallel circulations
Incompatible with life unless mixing of blood by congenital or artificial shunts

34
Q

Clinical features of transposition of great arteries

A 
Neonatal cyanosis (at day 2 w closure of ductus arteriosus) 
No murmur
35
Q

CXR of transposition of great arteries

A

Narrow upper mediastinum

‘Egg on side’ cardiac contour

36
Q

Management of transposition of great arteries

A

Prostaglandin infusion
Balloon atrial septostomy - balloon inserted by catheter, passed through atrial septum from LA to RA to increase size of ASD
Arterial switch operation in neonatal period

Paediatrics (15 decks)

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