Cardiology Flashcards
What is the main type of condition in paeds cardiology?
Congenital heart defects
What are acquired CVS diseases in kids?
Kawasaki disease
Rheumatic fever
Bacterial endocarditis
What are inherited CVS syndromes?
Cardiomyopathy
Long QT syndrome
Marfan syndrome
What is the most common arrhythmia in kids?
Supraventricular tachycardia
What are commonest congenital defects?
Ventricular septal defect Patent ductus arteriosus Atrial septal defect Pulmonary stenosis Aortic stenosis Coarctation of the aorta Transposition of great arteries Tetralogy of Fallot
What is aetiology of congenital heart disease?
Genetic susceptibility
Environmental factors
Teratogenic insult - 18-60 days
What drugs can cause defects?
Alcohol Amphetamine Cocaine Ecstasy Phenytoin Lithium
What infections can cause defects of the heart?
TORCH: TOxoplasma Rubella Cytomegalovirus Herpes
What maternal conditions can cause heart defects?
Diabetes mellitus
SLE
What are risks of ventricular septal defect with trisomy 13, 18, and 21?
13 - 90%
18 - 80%
21 - 40%
What genetic syndromes are associated with defects?
Turner - coarctation of aorta
Noonan - Pulmonary stenosis
Williams - Supravalvular aortic stenosis
22q11 deletion syndrome
What should be asked about in history of heart problems?
Feeding/weight and development Tachypnoea/dyspnoea Exercise tolerance Syncope Palpitation Joint problems Chest pain - usually MSK
What are features of heart failure in children?
Dyspnoea
Tachycardia
Hepatomegaly
What should be done on examination of children with heart problems?
Weight and height Dysmorphic features Cyanosis Clubbing Tachy/dyspnoea Pulses/apex beat - femoral pulse Heart sounds Murmurs
What is a child with cyanosis likely to have wrong with them in their heart?
Interventricular septal defect causing shunt
What investigations are done in children?
Blood pressure O2 sats ABG - very rare as painful 12 lead ECG CXR ECHO Catheter Angiography MRI Exercise testing
What are principles of treatment in cardiology?
If you can fix it - fix it
If you cant fix it - improve situation
If you can do neither - replace it
How can you improve cardio situations?
Medication
Palliative measures
What are features of innocent murmurs?
Systolic No other signs of cardiac disease Soft murmur Vibratory Localised Varies with position, respiration, exercise
What is Still’s murmur?
Age 2-7 years
Soft systolic; vibratory
Apex and left sternal border
Loudest on supine position
What are features of pulmonary outflow murmur?
Age 8-10 years
Soft systolic - vibratory
Upper left sternal border, well localised, not radiating to back
Increase in supine position and with exercise
Often children with narrow chest
What are features of carotid brachiocephalic arterial bruits?
Age 2-10
Systolic - harsh
Supraclavicular - radiates to neck
Increases with exercise, decrease on turning head or extending neck
What are features of venous hum?
Age 3-8 Soft indistinct Continous murmur Supraclavicular Only in upright position
What are 3 types of ventricular septal defect?
Subaortic
Perimembranous
Muscular
What type of shunt happens in ventricular septal defect?
L to R shunt
How does ventricular septal defect present?
Pansystolic murmur on lower left sternal edge
Very small VSD has early systolic murmur
Very large VSD has diastolic rumble due to relative mitral stenosis
Signs of cardiac failure in large VSDs
What is Eisenmenger syndrome?
Untreated ventricular septal defect results in pulmonary hypertension leading to increased pulmonary vascular resistance, which leads to reversal of shunt to R to L leading to cyanosis
How is Eisenmenger syndrome treated?
Heart and lung transplant
What is used to close ventricular septal defect?
Amplatzer device trans catheter - femoral vein to right ventricle
Patch closure through open heart surgery
What is atrial septal defect?
Gap in atrial septum
What are features of atrial septal defect?
Few clinical signs in childhood, high chance of spontaneous closure
Sometimes detected in adulthood with AF, heart failure, pulmonary HTN
Wide fixed splitting of 2nd heart sound, pulmonary flow murmur
What are features of atrioventricular septal defect
Associated with trisomy 21
Singular AV valve - mitral and tricuspid fuse
What are features of pulmonary stenosis?
Asymptomatic in mild stenosis, in moderate and severe exertional dyspnoea and fatigue
Ejection systolic murmur upper left sternal border with radiation to back
How is pulmonary stenosis treated?
Balloon valvoplasty through catheter - femoral vein
What causes ejection systolic murmur?
More pressure is required to open stenosed valve leading to murmur slightly after S1 that crescendos
What are features of aortic stenosis?
Mostly asymptomatic - if severe reduced exercise tolerance, exertional chest pain, syncope
Ejection systolic murmur upper right sternal border - radiates to carotids
How is aortic stenosis treated?
Balloon aortic valvoplasty through catheter - femoral artery
What vessel takes blood from mother to foetus?
Umbilical vein
How does blood flow through the heart in the foetus?
Umblical vein to IVC IVC to right atrium Right atrium to left atrium through foramen ovale Left atrium to left ventricle Left ventricle to systemic
What is the function of ductus arteriosus?
Causes right to left shunt to allow more oxygenated blood for systemic circulation in foetus
What changes in foetal circulation at birth?
Pulmonary vascular resistance Pulmonary flow rises Increased systemic vascular resistance Ductus arteriosus closes Foramen ovale closes Ductus venosus closes
What are features of patent ductus arteriosus?
Very common in preterm infants
In term babies have goodchance of spontaneous closure
How is patent ductus arteriosus managed?
Fluid restriction/diuretics
Prostaglanding inhibitors
Surgical ligation if no spontaneous closure
What is a coarcatation of aorta?
Kink in aortic wall - typically in arch?
How is coarctation of aorta managed?
Re-open ductus arteriosus with prostaglandin E1 or E2
Resection with end to end anastomosis
Subclavian patch repair
Balloon aortoplasty
What is transposition of the great arteries?
Aorta connects to RV instead of LV and pulmonary trunk connects to LV instead of RV
Why is transposition of the great arteries so terrible?
There is no connection between systemic and pulmonary circulation - systemic circulation isn’t oxygenated
What is required for survival in transposition of the great arteries?
Shunt to allow pulmonary circulation into systemic circulation
What is Rashkinds septostomy?
Via a catheter open up atrial septum through foramen ovale
What is fallot’s tetralogy?
Right ventricular outflow obstruction
Right ventricular hypertrophy
Ventricular septal defect
Overriding aorta
What feature of fallot’s tetralogy is most determinant of cyanosis and why?
Pulmonary outflow obstruction - decreases blood in pulmonary circulation and leads to increased RV pressure pushing more deoxygenated blood into the aorta
How is tetralogy of fallot treated?
Create artificial shunt
When is tetralogy of fallot fixed?
6 months
What is done at 6 monoths in tetralogy of fallot?
Pulmonary valvoplasty
Ventricular septal defect closure
