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Cardiology Flashcards

1
Q

What is the main type of condition in paeds cardiology?

A

Congenital heart defects

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2
Q

What are acquired CVS diseases in kids?

A

Kawasaki disease
Rheumatic fever
Bacterial endocarditis

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3
Q

What are inherited CVS syndromes?

A

Cardiomyopathy
Long QT syndrome
Marfan syndrome

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4
Q

What is the most common arrhythmia in kids?

A

Supraventricular tachycardia

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5
Q

What are commonest congenital defects?

A 
Ventricular septal defect
Patent ductus arteriosus
Atrial septal defect
Pulmonary stenosis
Aortic stenosis
Coarctation of the aorta
Transposition of great arteries
Tetralogy of Fallot
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6
Q

What is aetiology of congenital heart disease?

A

Genetic susceptibility
Environmental factors
Teratogenic insult - 18-60 days

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7
Q

What drugs can cause defects?

A 
Alcohol
Amphetamine
Cocaine
Ecstasy
Phenytoin
Lithium
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8
Q

What infections can cause defects of the heart?

A 
TORCH:
TOxoplasma
Rubella
Cytomegalovirus
Herpes
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9
Q

What maternal conditions can cause heart defects?

A

Diabetes mellitus

SLE

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10
Q

What are risks of ventricular septal defect with trisomy 13, 18, and 21?

A

13 - 90%
18 - 80%
21 - 40%

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11
Q

What genetic syndromes are associated with defects?

A

Turner - coarctation of aorta
Noonan - Pulmonary stenosis
Williams - Supravalvular aortic stenosis
22q11 deletion syndrome

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12
Q

What should be asked about in history of heart problems?

A 
Feeding/weight and development
Tachypnoea/dyspnoea
Exercise tolerance
Syncope 
Palpitation
Joint problems
Chest pain - usually MSK
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13
Q

What are features of heart failure in children?

A

Dyspnoea
Tachycardia
Hepatomegaly

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14
Q

What should be done on examination of children with heart problems?

A 
Weight and height
Dysmorphic features
Cyanosis
Clubbing
Tachy/dyspnoea
Pulses/apex beat - femoral pulse
Heart sounds
Murmurs
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15
Q

What is a child with cyanosis likely to have wrong with them in their heart?

A

Interventricular septal defect causing shunt

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16
Q

What investigations are done in children?

A 
Blood pressure
O2 sats
ABG - very rare as painful
12 lead ECG
CXR
ECHO
Catheter
Angiography
MRI
Exercise testing
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17
Q

What are principles of treatment in cardiology?

A

If you can fix it - fix it
If you cant fix it - improve situation
If you can do neither - replace it

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18
Q

How can you improve cardio situations?

A

Medication

Palliative measures

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19
Q

What are features of innocent murmurs?

A 
Systolic
No other signs of cardiac disease
Soft murmur
Vibratory
Localised
Varies with position, respiration, exercise
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20
Q

What is Still’s murmur?

A

Age 2-7 years
Soft systolic; vibratory
Apex and left sternal border
Loudest on supine position

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21
Q

What are features of pulmonary outflow murmur?

A

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

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22
Q

What are features of carotid brachiocephalic arterial bruits?

A

Age 2-10
Systolic - harsh
Supraclavicular - radiates to neck
Increases with exercise, decrease on turning head or extending neck

23
Q

What are features of venous hum?

A 
Age 3-8
Soft indistinct
Continous murmur
Supraclavicular
Only in upright position
24
Q

What are 3 types of ventricular septal defect?

A

Subaortic
Perimembranous
Muscular

25
What type of shunt happens in ventricular septal defect?
L to R shunt
26
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
27
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
28
How is Eisenmenger syndrome treated?
Heart and lung transplant
29
What is used to close ventricular septal defect?
Amplatzer device trans catheter - femoral vein to right ventricle Patch closure through open heart surgery
30
What is atrial septal defect?
Gap in atrial septum
31
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
32
What are features of atrioventricular septal defect
Associated with trisomy 21 | Singular AV valve - mitral and tricuspid fuse
33
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
34
How is pulmonary stenosis treated?
Balloon valvoplasty through catheter - femoral vein
35
What causes ejection systolic murmur?
More pressure is required to open stenosed valve leading to murmur slightly after S1 that crescendos
36
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
37
How is aortic stenosis treated?
Balloon aortic valvoplasty through catheter - femoral artery
38
What vessel takes blood from mother to foetus?
Umbilical vein
39
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 ```
40
What is the function of ductus arteriosus?
Causes right to left shunt to allow more oxygenated blood for systemic circulation in foetus
41
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 ```
42
What are features of patent ductus arteriosus?
Very common in preterm infants | In term babies have goodchance of spontaneous closure
43
How is patent ductus arteriosus managed?
Fluid restriction/diuretics Prostaglanding inhibitors Surgical ligation if no spontaneous closure
44
What is a coarcatation of aorta?
Kink in aortic wall - typically in arch?
45
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
46
What is transposition of the great arteries?
Aorta connects to RV instead of LV and pulmonary trunk connects to LV instead of RV
47
Why is transposition of the great arteries so terrible?
There is no connection between systemic and pulmonary circulation - systemic circulation isn't oxygenated
48
What is required for survival in transposition of the great arteries?
Shunt to allow pulmonary circulation into systemic circulation
49
What is Rashkinds septostomy?
Via a catheter open up atrial septum through foramen ovale
50
What is fallot's tetralogy?
Right ventricular outflow obstruction Right ventricular hypertrophy Ventricular septal defect Overriding aorta
51
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
52
How is tetralogy of fallot treated?
Create artificial shunt
53
When is tetralogy of fallot fixed?
6 months
54
What is done at 6 monoths in tetralogy of fallot?
Pulmonary valvoplasty | Ventricular septal defect closure

Paediatrics (25 decks)

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