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Cardiology Flashcards

1
Q

What two broad categories is congenitial heart disease divided into

A

Acyanotic (not blue)

Cyanotic (blue)

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2
Q

What is Acyanotic Congenital heart disease characterised by

A

Left to Right Shunt - increase flow into R heart and lungs

Outflow Obstruction

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3
Q

What are the main acyanotic congenital heart disease

A 
Left to right Shunts:
VSD - Ventricular Septal Defect 
ASD - Atrial Septal Defect
PDA - Patent Ductus Arteriosis 
AVSD - Atrioventricular Septal Defect

Outflow Obstruction:
Coarctation of the aorta
Aortic Stenosis
Pulmonary Stenosis

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4
Q

What is Cyanotic Heart disease characterised by

A

Right to Left Shunt

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5
Q

What are the main types of cyanotic heart disease

A

The 5 Ts

  1. Transportation of the Great Arteries
  2. Tetralogy of Fallot
  3. Truncus Arteriosus
  4. Tricuspid Atresia
  5. Total Anomalous pulmonary vascular return
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6
Q

What are the types of ASD and which is most common

A

Ostium Secundum - most common
Ostium Primidum
Sinus Venous ASD

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7
Q

What is Ostium Secundum

A

Defects high in septum - asymptomatic usually until adulthood

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8
Q

What ids Ostium Primidum

A

Defects opposing endocardial cushions associated with AV valve anomalies - usually present earlier

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9
Q

Why do small/ moderate sized defects not usually present until adulthood

A

Shunts increase with age

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10
Q

How may an ASD present and who is it common in

A 
Asymptomatic when younger
- Alcohol fetal syndrome 
- Downs Syndrome 
Older children and adults get symptoms of: 
- fixed splitting
- ejection systolic murmur 
- palpitations 
- SOBOE
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11
Q

What is the ASD murmur

A

Fixed widely Split S2

Ejection Systolic Murmur in pulmonary area

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12
Q

What tests would you perform for ASD

A

ECG
CXR: progressive right atrial enlargement
ECHO is diagnostic

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13
Q

How would you manage ASD

A

Closure of the defect

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14
Q

What is Patent Ductus Arteriosis and who is it most common in

A

Aorta and pulmonary artery still connected

Common in pre-term babies

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15
Q

What symptoms do you get in PDA

A

Poor feeding
Failure to thrive
Tachypnoea
Breathlessness

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16
Q

What is a complication of PDA

A

PDA related eisenmengers syndrome (PHTN):

  • cyanosis
  • Clubbed and blue toes but normal fingers
  • Heart Failure: Hepatomegaly and Oedema
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17
Q

What is the PDA murmur

A

Classic continuous machinery murmur

Large L to R shunt/ HF then gallop rhythm, thrill and active precordium

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18
Q

How does a ventricular septal defect present

A
  • May be asymptomatic
  • Even large ones may be asymptomatic until PVR has fallen (PVR is high at birth and falls over the weeks following birth)
  • Poor feeding
  • Failure to thrive
  • Tachypnoea
  • Breathlessness
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19
Q

What murmur is heard in VSD

A
  • Pan Systolic Murmur

- Active precordium, Thrill, Gallop Rhythm

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20
Q

What does a louder murmur usually mean

A

Smaller defect

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21
Q

What complications may you get in VSD

A

Hepatomegaly
Oedema
Eismengers Syndrome

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22
Q

What investigations may you perform in VSD

A

ECG

CXR - may see cardiomegaly, large pulmonary arteries and marked pulmonary plethora

23
Q

What is Atrioventricular Septal Defect

A

Basically a hole in the centre of the heart

24
Q

What is AVSD associated with

A

Downs Syndrome

25
Q

Why is it important to screen all Downs Syndrome children for AVSD and how is it screened

A
  • Can lead to more rapidly developing Pulmonary Vascular Resistance
  • Echocardiogram
26
Q

How does AVSD present

A

Poor feeding
Failure to thrive
Tachypnoea
Breathlessness

27
Q

What murmur is present in AVSD

A
  • Murmur arises from valvular regurgitation rather than septal defect - may get ejection systolic, mid diastolic, pansystolic
  • Active precordium, Thrill, Gallop Rhythm
28
Q

What complications may you get in AVSD

A

Eishmengers Syndrome

HF: Hepatomegaly, Oedema

29
Q

What is coarctation of the aorta

A

Narrowing of Descending Aorta

30
Q

Who is COA common in

A

More common in boys
Bicuspid Aortic Valve
Turners Syndrome

31
Q

How does COA usually present

A

Asymptomatic unless severe:

- Complete/ Almost complete obstruction will present collapsed and acidotic with HF - Urgent Repair!!!!

32
Q

What are the clinical signs of COA

A
  • HTN
  • Weak femoral pulses (always compare to brachials)
  • Radio-femoral delay
  • 4 limb BP: discrepancy between upper and lower limb BP
  • Ejection Systolic murmur (can be heard over back in older children after collaterals develop
33
Q

How may aortic stenosis present

A

May be asymptomatic unless severe:

  • Chest pain
  • Syncope
  • Failure to thrive
  • Child may present collapsed and acidotic
34
Q

What signs will be observed in aortic stenosis

A

Weak pulses
Ejection systolic murmur in aortic area
Thrill palpable in suprasternal and carotid region

35
Q

What causes pulmonary stenosis

A

congenital

Acquired: rheumatic heart disease

36
Q

How does Pulmonary stenosis usually present

A

Asymptomatic

37
Q

What are the signs of pulmonary stenosis

A

Ejection systolic murmur at LUSE
Murmur can radiate to round back if branches also stenosed
Right Ventricular heave if significant stenosis

38
Q

What are the features of Tetralogy of Fallot

A
  • Ventricular Septal Defect
  • Pulmonary Stenosis
  • Hypertrophy of R ventricle
  • Overiding Aorta
39
Q

How do tetralogy of Fallot patients present

A

Depends on lesion, severity and age

  • Cyanosis: patients are blue, restless, agitated and cry, worsening short severe exacerbations causing distress
  • Toddlers squat to increase peripheral resistance
  • Difficulty feeding, failure to thrive and clubbing
  • Acidosis
  • Collapse/Death (increased risk of MI, Stroke)
40
Q

How is tetralogy of fallot diagnosed

A

murmur: harsh ejection systolic murmur LLSE
CXR: classic boot shaped heart

41
Q

How is tetralogy of fallot treated

A

O2,
Morphine
IV propanol b-blockers
Corrective Surgery at 6 months

42
Q

What is Eisenmengers Syndrome

A

High pressure pulmonary flow damages pulmonary vasculature - causing increased pulmonary vascular resistance and RV pressure - therefore shunt reverses and patients turn blue

43
Q

What two groups can heart failure be classed into

A
  • Over circulation failure volume overload in cardiac chambers
  • Pump failure from congenital/acquired conditions
44
Q

What are examples of over circulation failure

A
  • conditions associated with increased pulmonary blood flow

- L to R shunts

45
Q

What are examples of pump failure

A

Congenital: Aortic stenosis, COA, pulmonary stenosis
Inflammatory: Viral myocarditis, HIV
dilated cardiomyopathies
rhythmicdisturbances: tachycardiomyopathy

46
Q

What are the signs and symptoms of HF

A 
tachypnoea and dyspnoea 
Poor feeding and failure to thrive 
irritability
Fatigue 
Oedema 
Weight loss, passing out, chest pain (older children)
47
Q

What investigations for suspected HF

A
  • CXR - cardiomegaly
  • ECG - tachycardia, LV hypertrophy, conduction blocks
  • Echo - structural disease
  • Biomarkers and bloods
48
Q

How do you treat HF

A

Treat the cause!!!
Drug management: digoxin (rhythm), diuretics (cogestion)
Pacemaker, Cardioverter Defibrillator
Heart Transplant

49
Q

What is the transportation of the great arteries

A

When the aorta and pulmonary artery have been swapped round

50
Q

What should you screen for in TOGA and what would be seen on X-ray

A

22q deletion

Egg on the side

51
Q

How does TOGA present

A

Cyanosis
Collapse
Acidosis

52
Q

How do you manage TOGA and TOF acutely

A

Prostaglandin to keep the ASD or VSD open until surgery

53
Q

How do you close PDA

A

Ibuprofen

Surgery to close it

54
Q

When does the forum ovale close and where is it

A

First breath

Between the two atria

Paediatrics (13 decks)

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