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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Cyanotic Heart Diseases:

A
  • tetrology of fallot
  • ebsteins anomaly
  • truncus arteriosus
  • TGA
  • tricuspid atresia
  • TAPVC
  • hypoplastic L heart
  • pulmonary atresia
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2
Q

Ebsteins Anomaly

A

Big R atrium with small ventricle + malfunctioning tricuspid. Sometimes ASD or PFO too.

Causes early cyanosis. Can also be asymptomatic if mild. May have arrhythmia (WPW).

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3
Q

Defects causing cyanosis in first few hours of life

A
  • ebsteins anomaly
  • TGA
  • pulmonary atresia
  • PHTN
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4
Q

Defects causing shock / catastrophy

A
  • hypoplastic L heart
  • coarctation of aorta (if severe)
  • aortic stenosis (if severe)
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5
Q

Acyanotic Congenital Defects

A

L to R shunt:

  • ASD
  • VSD
  • PDA
  • AVSD

Obstructive:

  • coarctation of aorta
  • aortic stenosis
  • pulmonic stenosis
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6
Q

Heart Defects Causing CHF

A

VSD
PDA
AVSD

lead to excessive pulmonary flow

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7
Q

Tetralogy of Fallot

A

VSD, over-riding aorta (above VSD), PA stenosis, RVH

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8
Q

Truncus Arteriosus

A

Single trunk from both ventricles

aorta, PA, coronaries

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9
Q

Tricuspid Atresia

A

No tricuspid valve (need ASD, VSD, PDA)

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10
Q

Transposition of great arteries

A

Aorta starts in RV

pulmonary artery starts in LV (left + right side totally separate, reliant on ASD + PDA)

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11
Q

Total anomalous pulmonary venous connections

A

Pulmonary veins not connected to LA, go to SVC instead (reliant on an ASD/PDA/PFO)

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12
Q

Most common cyanotic heart defects

may present with other things, but CAN be cyanotic

A
  • tetralogy of fallot
  • tricuspid atresia
  • transposition of great arteries
  • TAPVC
  • truncus arteriosus
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13
Q

DDx for cyanosis

A

Resp: RDS, TTN, MAS, pneumonia, CLD

Cardiac: cyanotic heart defect

Heme: Sepsis, polycythemia, methaemoglobinemia

neurometabolic: meningitis, ICH, drugs, hypothermia, hypoglycemia

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14
Q

Differentiating Resp vs Cardiac Cyanosis

A

Resp: increased WOB, sepsis RFs, meconium, difficult labour, high CO2, abnormal CXR, improve with O2

Cardiac: famHx, normal L+D, no or mild tachypnea, N CO2, CXR with pulm blood flow or cardiac silhoutette, min response to O2

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15
Q

Persistent Pulmonary Hypertension Description

A

Failure of post-natal adaptation: RVF, R–>L shunting through PFO + DA

primary: soon after birth, normal lungs on xray
secondary: diseased lungs, pulmonary vasoconstriction from hypoxia/acidosis

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16
Q

Work-up for Congenital Heart Disease

A
  • CXR
  • ECG, Echo
  • Pre (R arm) and post ductal (leg) saturation
  • four limb BP (systolic >10 higher in upper body = coarctation)
  • hyperoxic test (if cyanosis): 100% O2, repeat ABG after 10-15m, fail if <150
  • cyanosis: ABG, lactate, Hb, WBC, glucose
17
Q

Interpretation of Pre + Post ductal saturations

A

pre-ductal sat >3% above post = bad

Shunting through DA (R–>L)
PPHTN (sometimes), severe coarctation/AS, HLHS

higher post-ductal TGA

18
Q

Transposition of Great Vessels Management

A
  • intubation + O2
  • IV fluids
  • Amp + Gent
  • PGE1 (prostaglandin)
  • transport –> balloon atrial septostomy
  • switch operation at 7 days old
19
Q

Ventricular Septal Defect: Presentation

A
  • murmur starts about 1wk when PVR declines enough for L->R shunt
  • Murmur: holosystolic, loudest LLSB
  • loss of S2 split, loud P2 (PTHN)
  • very large may have no murmur
  • CHF symptoms (at 3-4wks): resp distress, feeding difficulty/diaphoresis, FTT, hepatomegally
  • if small will be asymptomatic or just murmur
20
Q

VSD treatment

A
  • CHF symptoms: diuretics, nutrition support
  • if closing spont (many do): monitor for signs of PHTN
  • surgery if sx no managed and to avoid PHTN (eisenmengers syndrome, shunt reverses R -> L, cyanosis)
21
Q

Atrial Septal Defect Presentation

A
  • shunt L –> R, low pressure, no sound
  • murmur at pulm valve = systolic ejection murmur (from extra flow)
  • wide fixed split S2
  • CHF symptoms rare
  • CHF + PHTN in 3rd or 4th decade possible
22
Q

ASD managment

A
  • most close spontaneously

- if large or CHF not responding to meds, surgical closure

23
Q

Patent Ductus Arteriosus Presentation

A

Aorta –> PA

  • more common in premies
  • murmur: cont at L infraclav or LUSB
  • bounding peripheral pulses
  • hyperactive precordium
  • tachycardia, +/- gallop, wide pulse pressure
24
Q

Patent DA complications and management

A

small - no intervention
large –> PHTN

premies: indomethacin (prostaglandin synthase inhib)

surgery if unsuccessful or in child/adult

25
Q

CHF pathophys/etiologies

A
  • low O2 (severe anemia)
  • hypermetabolic state ( hyperthyroid)
  • High output (overflow)
  • cardiomyopathy
26
Q

CHF Ddx - Premies

A

Anemia
PDA or large VSD (L->R)
severely preterm
lung disease

27
Q

CHF ddx - infants

A

VSD/AVSD
AS or CoA
myocarditis
AVM

28
Q

CHF ddx - child

A

L side obstruction
cardiomyopathy
myocarditis

younger:
Kawasaki’s
L –> R shunt
AVM

older:
rheumatic heart disease
acute HTN
thyrotoxicosis
meds
29
Q

DDx for difficult feeding + resp distress in infant

A
  • CHD / CHF
  • resp infection
  • sepsis
  • metabolic disorder
30
Q

Innocent Murmur Characteristics

A 
Soft
blowing, vibratory
systolic
well localized
vary /w position
31
Q

Pathologic Murmur characterstics

A

loud
harsh
pansystolic, diastolic, late systolic, continuous
no change with position

32
Q

Pan-systolic Murmur

A

MR, TR, VSD

33
Q

Continuous Murmur

A

PDA (varies in intensity)

34
Q

Systolic Ejection Murmur

A

PS (/w ASD sometimes), AS,

Several innocent murmurs too

35
Q

early diastolic murmur

A

AR or PR

36
Q

mid diastolic

A

MS, TS

37
Q

Newborn with Loud S2 (not split)

A

pulmonary HTN

Paediatrics (23 decks)

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