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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what are the presenting features of heart failure in a baby/child?

A

failure to thrive / poor feeding / weight and development delay

tachypnoea, dyspnoea 
syncope 
palpitations  
decreased exercise tolerance 
(chest pain)
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2
Q

what are the 3 main clinical signs of heart failure found in babies/children?

A

tachypnoea
tachycardia
hepatomegaly

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3
Q

where type of murmur is still’s murmur and where is it heard ?

A

apex - left sternal border

LV outflow murmur

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4
Q

what causes a stills murmur/ LV outflow murmur to be increased?

A

supine position and with exercise

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5
Q

what type of murmur is pulmonary outflow murmur?

A

soft systolic, vibrator

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6
Q

at what point during conception can a tetralogy insult affect the heart?

A

18-60 days post conception

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7
Q

what are some of the aetiologies of congenital heart disease?

A

genetic susceptibility

teratogenic insult

environmental;

  • infections: toxoplasmosis, rubella, CMV, herpes
  • drugs: phenytoin, lithium, amphetamines, alcohol, ecstasy
  • maternal: diabetes, SLE

chromosomal

  • trisomy 13, 18, 21
  • turners
  • williams
  • noonans
  • 22q11 deletion
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8
Q

what heart defect is most commonly associated with downs syndrome?

A

atrioventricular septal defect (AVSD)

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9
Q

what drugs can cause congenital heart defects if taken during?

A 
phenytoin 
lithium 
alcohol 
amphetamines
ecstasy
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10
Q

what maternal health conditions can increase risk of congenital heart defects?

A

SLE

diabetes mellitus

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11
Q

what is a risk factor for transposition of the great arteries?

A

diabetic mother

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12
Q

how does transposition of the great arteries present?

A

usually picked up antenatally

baby is cyanosed at birth or within a few days after birth

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13
Q

what is the treatment for transposition of the great arteries?

A

prostaglandin infusion to maintain shunt (i.e. PDA, ASD, VSD)

balloon septostomy to create ASD

definitive traetment = switch procedure

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14
Q

what are the pathologies in tetralogy of fallot?

A

overriding aorta
pulmonary stenosis
right ventricular hypertrophy
ventricular septal defect

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15
Q

how does tetralogy of fallot present?

A

presents around 1-3 months
cyanosis
clubbing
poor feeding
ejection systolic murmur (pulmonary area - upper left sternal border)
tet spells (precipitated by crying etc causing them to become cyanotic and dyspneic)

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16
Q

what feature on x-ray is suggestive of tetralogy of fallot?

A

boot shaped

- right ventricular hypertrophy lifts up the apex

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17
Q

what is the management for tetralogy of fallot?

A
  • prostaglandin infusion to maintain PDA
  • palliative shunt formation

6 months - 1 yr later - total surgical repair

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18
Q

what treatment would you give to manage test spells in tetralogy of fallot?

A

IV fluids - improve preload
02 - cyanosis
betablockers - relax r. ventricle to improve pulmonary blood flow
sodium bicarbonate - combat metabolic acidosis
phenylephrine infusion - increase systemic vascular resistance
morphine - reduce resp drive

19
Q

what is the presentation of pulmonary stenosis?

A

mild - asymptomatic

moderate/severe - exertion dyspnoea + fatigue

20
Q

what clinical sign would you observe on examination of a child with pulmonary stenosis?

A

ejection systolic murmur
heard loudest over upper left sternal border (pulmonary area)

  • murmur radiates tot he back
  • made worse on exercise
  • worsens with age

palpable thrill in pulmonary area
right ventricular heave (due to RV hypertrophy)
raised JVP

21
Q

what is the treatment for pulmonary stenosis?

A

if mild - watch and wait

if moderate/severe - balloon valvuloplasty or valve replacement

22
Q

what 3 underlying pathologies can cause Eisenmenger syndrome?

A

ASD
VSD
patent ductus arterioles

23
Q

what are the signs of eisenmenger syndrome?

A 
pulmonary hypertension
arrythmias
murmurs (ASD, VSD, PDA)
chronic hypoxia
- dyspnoea
- cyanosis 
- clubbing 
- plethoric complexion (red appearance due to polycythaemia)
24
Q

what drug can be used to treat hypertension?

A

sildenafil

25
Q

what are the complications of Eisenmenger syndrome?

A

heart failure
infection
thromboembolism (due to polycythaemia triggered by hypoxia)
haemorrhage

26
Q

give 3 differentials of cyanotic heart disease in children.

A

tetralogy of fallot
transportation of the great arteries
Eisenmenger syndrome

27
Q

give 4 examples of innocent murmurs in children.

A

LV outflow murmur
pulmonary outflow murmur
carotid/brachiocephalic bruit
venous hum

28
Q

what are the general features of an innocent murmur in a child?

A

soft systolic murmur
vibrant, localised
no other cardiac signs
increases with exercise, portion, respiration

29
Q

what are the features of a carotid/brachiocephalic bruit?

A

systolic harsh murmur head in suprclavicular area
radiates to the back
increased with exercise
decreased with rotating the head or extending neck

30
Q

what are the features of a venous hum?

A

soft indistinct systolic murmur
continuous murmur with diastolic accentuation sometimes
heard in suprclavicular area
disappears when lying down or turning head

31
Q

what are the symptoms of aortic stenosis?

A

syncope
chest pain
dyspnoea

32
Q

what are the clinical features of aortic stenosis?

A

ejection systolic murmur heard in the upper right sternal border
radiates to the carotids

33
Q

what is the treatment for aortic stenosis?

A

ball valvulotomy

valve replacement

34
Q

what increases a babies risk of patent ductus arteriosus?

A

pre maturity

35
Q

what is the treatment for PDA in pre-terms?

A

fluid restriction
diuretics
prostaglandin inhibitors

36
Q

what is the presentation of co-arctation of the aorta?

A 
presents a few weeks after birth with reduced/weak femoral pulses 
radio-femoral delay (late stage)
systolic murmur 
tachypnoea 
poor feeding 
grey and floppy 
(may look like sepsis)
37
Q

what is the treatment for co-arctation of the aorta?

A

prostaglandins E1 or E2
subclavian patch repair
balloon aortoplasty

38
Q

give differentials of non-cyanotic heart disease in children.

A 
patent ductus arteriosus 
co-arctation of the aorta
pulmonary stenosis 
aortic stenosis 
VSD
ASD
39
Q

what features of a murmur in a child require further investigations?

A

diastolic murmur
louder on standing
other symptoms i.e. failure to thrive, cyanosis, tachypnoea
loud murmur

40
Q

you examine the precordium of a boy of 4 years old. you hear a soft systolic murmur in the apex at the left sternal border, and radiates to the back.
the murmur gets worse when he stands.
the patient is otherwise healthy.
what is the most likely diagnosis?

A

LV outflow murmur (Still’s)

not pulmonary outflow because it radiates - pulmonary doesn’t)

41
Q

you examine the precordium of a thin 9 year old girl. you hear a soft systolic murmur in the left sternal border that doesn’t radiate. it is made worse when she stands up.

A

pulmonary outflow murmur

clues;

  • thin
  • doesn’t radiate
  • left sternal border (LV outflow also LSB but radiates to the back)
42
Q

a diabetic mother attends the GP with her baby of 2 months old. she complains he hasn’t been feeding well and has become increasing short of breath to the point he has become slightly blue at the lips.

on examination you hear an ejection systolic murmur.

what is the most likely diagnosis?

A

tetralogy of fallot

risk factors - diabetes
ejection systolic murmur
presents 1-2 months of birth
symptoms - cyanosis, tachypnoea, dyspnoea, poor feeding, clubbing, tet spells

43
Q

where would you hear a VSD murmur?

A

lower left sternal border

Paediatrics (26 decks)

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