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Paediatrics > Cardiology > Flashcards

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
Q

What type of shunt happens in ventricular septal defect?

A

L to R shunt

26
Q

How does ventricular septal defect present?

A

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
Q

What is Eisenmenger syndrome?

A

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
Q

How is Eisenmenger syndrome treated?

A

Heart and lung transplant

29
Q

What is used to close ventricular septal defect?

A

Amplatzer device trans catheter - femoral vein to right ventricle
Patch closure through open heart surgery

30
Q

What is atrial septal defect?

A

Gap in atrial septum

31
Q

What are features of atrial septal defect?

A

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
Q

What are features of atrioventricular septal defect

A

Associated with trisomy 21

Singular AV valve - mitral and tricuspid fuse

33
Q

What are features of pulmonary stenosis?

A

Asymptomatic in mild stenosis, in moderate and severe exertional dyspnoea and fatigue
Ejection systolic murmur upper left sternal border with radiation to back

34
Q

How is pulmonary stenosis treated?

A

Balloon valvoplasty through catheter - femoral vein

35
Q

What causes ejection systolic murmur?

A

More pressure is required to open stenosed valve leading to murmur slightly after S1 that crescendos

36
Q

What are features of aortic stenosis?

A

Mostly asymptomatic - if severe reduced exercise tolerance, exertional chest pain, syncope
Ejection systolic murmur upper right sternal border - radiates to carotids

37
Q

How is aortic stenosis treated?

A

Balloon aortic valvoplasty through catheter - femoral artery

38
Q

What vessel takes blood from mother to foetus?

A

Umbilical vein

39
Q

How does blood flow through the heart in the foetus?

A 
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
Q

What is the function of ductus arteriosus?

A

Causes right to left shunt to allow more oxygenated blood for systemic circulation in foetus

41
Q

What changes in foetal circulation at birth?

A 
Pulmonary vascular resistance
Pulmonary flow rises
Increased systemic vascular resistance
Ductus arteriosus closes
Foramen ovale closes
Ductus venosus closes
42
Q

What are features of patent ductus arteriosus?

A

Very common in preterm infants

In term babies have goodchance of spontaneous closure

43
Q

How is patent ductus arteriosus managed?

A

Fluid restriction/diuretics
Prostaglanding inhibitors
Surgical ligation if no spontaneous closure

44
Q

What is a coarcatation of aorta?

A

Kink in aortic wall - typically in arch?

45
Q

How is coarctation of aorta managed?

A

Re-open ductus arteriosus with prostaglandin E1 or E2
Resection with end to end anastomosis
Subclavian patch repair
Balloon aortoplasty

46
Q

What is transposition of the great arteries?

A

Aorta connects to RV instead of LV and pulmonary trunk connects to LV instead of RV

47
Q

Why is transposition of the great arteries so terrible?

A

There is no connection between systemic and pulmonary circulation - systemic circulation isn’t oxygenated

48
Q

What is required for survival in transposition of the great arteries?

A

Shunt to allow pulmonary circulation into systemic circulation

49
Q

What is Rashkinds septostomy?

A

Via a catheter open up atrial septum through foramen ovale

50
Q

What is fallot’s tetralogy?

A

Right ventricular outflow obstruction
Right ventricular hypertrophy
Ventricular septal defect
Overriding aorta

51
Q

What feature of fallot’s tetralogy is most determinant of cyanosis and why?

A

Pulmonary outflow obstruction - decreases blood in pulmonary circulation and leads to increased RV pressure pushing more deoxygenated blood into the aorta

52
Q

How is tetralogy of fallot treated?

A

Create artificial shunt

53
Q

When is tetralogy of fallot fixed?

A

6 months

54
Q

What is done at 6 monoths in tetralogy of fallot?

A

Pulmonary valvoplasty

Ventricular septal defect closure

Paediatrics (25 decks)

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