Cardiology Flashcards
what are the presenting features of heart failure in a baby/child?
failure to thrive / poor feeding / weight and development delay
tachypnoea, dyspnoea syncope palpitations decreased exercise tolerance (chest pain)
what are the 3 main clinical signs of heart failure found in babies/children?
tachypnoea
tachycardia
hepatomegaly
where type of murmur is still’s murmur and where is it heard ?
apex - left sternal border
LV outflow murmur
what causes a stills murmur/ LV outflow murmur to be increased?
supine position and with exercise
what type of murmur is pulmonary outflow murmur?
soft systolic, vibrator
at what point during conception can a tetralogy insult affect the heart?
18-60 days post conception
what are some of the aetiologies of congenital heart disease?
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
what heart defect is most commonly associated with downs syndrome?
atrioventricular septal defect (AVSD)
what drugs can cause congenital heart defects if taken during?
phenytoin lithium alcohol amphetamines ecstasy
what maternal health conditions can increase risk of congenital heart defects?
SLE
diabetes mellitus
what is a risk factor for transposition of the great arteries?
diabetic mother
how does transposition of the great arteries present?
usually picked up antenatally
baby is cyanosed at birth or within a few days after birth
what is the treatment for transposition of the great arteries?
prostaglandin infusion to maintain shunt (i.e. PDA, ASD, VSD)
balloon septostomy to create ASD
definitive traetment = switch procedure
what are the pathologies in tetralogy of fallot?
overriding aorta
pulmonary stenosis
right ventricular hypertrophy
ventricular septal defect
how does tetralogy of fallot present?
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)
what feature on x-ray is suggestive of tetralogy of fallot?
boot shaped
- right ventricular hypertrophy lifts up the apex
what is the management for tetralogy of fallot?
- prostaglandin infusion to maintain PDA
- palliative shunt formation
6 months - 1 yr later - total surgical repair
what treatment would you give to manage test spells in tetralogy of fallot?
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
what is the presentation of pulmonary stenosis?
mild - asymptomatic
moderate/severe - exertion dyspnoea + fatigue
what clinical sign would you observe on examination of a child with pulmonary stenosis?
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
what is the treatment for pulmonary stenosis?
if mild - watch and wait
if moderate/severe - balloon valvuloplasty or valve replacement
what 3 underlying pathologies can cause Eisenmenger syndrome?
ASD
VSD
patent ductus arterioles
what are the signs of eisenmenger syndrome?
pulmonary hypertension arrythmias murmurs (ASD, VSD, PDA) chronic hypoxia - dyspnoea - cyanosis - clubbing - plethoric complexion (red appearance due to polycythaemia)
what drug can be used to treat hypertension?
sildenafil
what are the complications of Eisenmenger syndrome?
heart failure
infection
thromboembolism (due to polycythaemia triggered by hypoxia)
haemorrhage
give 3 differentials of cyanotic heart disease in children.
tetralogy of fallot
transportation of the great arteries
Eisenmenger syndrome
give 4 examples of innocent murmurs in children.
LV outflow murmur
pulmonary outflow murmur
carotid/brachiocephalic bruit
venous hum
what are the general features of an innocent murmur in a child?
soft systolic murmur
vibrant, localised
no other cardiac signs
increases with exercise, portion, respiration
what are the features of a carotid/brachiocephalic bruit?
systolic harsh murmur head in suprclavicular area
radiates to the back
increased with exercise
decreased with rotating the head or extending neck
what are the features of a venous hum?
soft indistinct systolic murmur
continuous murmur with diastolic accentuation sometimes
heard in suprclavicular area
disappears when lying down or turning head
what are the symptoms of aortic stenosis?
syncope
chest pain
dyspnoea
what are the clinical features of aortic stenosis?
ejection systolic murmur heard in the upper right sternal border
radiates to the carotids
what is the treatment for aortic stenosis?
ball valvulotomy
valve replacement
what increases a babies risk of patent ductus arteriosus?
pre maturity
what is the treatment for PDA in pre-terms?
fluid restriction
diuretics
prostaglandin inhibitors
what is the presentation of co-arctation of the aorta?
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)
what is the treatment for co-arctation of the aorta?
prostaglandins E1 or E2
subclavian patch repair
balloon aortoplasty
give differentials of non-cyanotic heart disease in children.
patent ductus arteriosus co-arctation of the aorta pulmonary stenosis aortic stenosis VSD ASD
what features of a murmur in a child require further investigations?
diastolic murmur
louder on standing
other symptoms i.e. failure to thrive, cyanosis, tachypnoea
loud murmur
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?
LV outflow murmur (Still’s)
not pulmonary outflow because it radiates - pulmonary doesn’t)
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.
pulmonary outflow murmur
clues;
- thin
- doesn’t radiate
- left sternal border (LV outflow also LSB but radiates to the back)
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?
tetralogy of fallot
risk factors - diabetes
ejection systolic murmur
presents 1-2 months of birth
symptoms - cyanosis, tachypnoea, dyspnoea, poor feeding, clubbing, tet spells
where would you hear a VSD murmur?
lower left sternal border
