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Year 4 Child Health > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what congenital heart condition is associated with trisomy 21

A

VSD and AVSD

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2
Q

what congenital heart condition is associated with trisomy 18 and 13

A

VSD

DORV = double outlet RV

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3
Q

what congenital heart condition is associated with Turner’s syndrome

A

coarctation of the aorta

bicuspid aortic valve - aortic stenosis

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4
Q

what congenital heart condition is associated with DiGeorges syndrome

A

truncus arteriosus
interrupted Aortic arch
tetralogy of fallot
VSD

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5
Q

structure to history taking for paed cardiology

A

baby well/unwell
symptoms of cardiac disease: breathlessness, difficulty feeding, sweating with feeding, cyanosis
additional RF: premature, other anomalies/syndrome, FH of CHD

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6
Q

approach to CVS exam

A

inspection: work of breathing, tachypnoea, cyanosis, scars
palpation: apex, heaves, thrills
auscultation: HS I+II, murmurs
additional: peripheral pulses, saturations, growth

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7
Q

what is acrocyanosis

A

acral = extremities
blue hands and feet
blue around your mouth, NOT in your mouth

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8
Q

perioral blueness is a sign of cardiac disease, true or false

A

false - may be acrocyanosis

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9
Q

intermittent central cyanosis is a feature of which congenital heart condition

A

tetralogy of fallot

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10
Q

what is the SCRIPT mnemonic for describing murmurs

A 
Site - ULSE/URSE/LLSE/apex
Character 
Radiation - carotids, axilla
Intensity - grade 1-6
Pitch 
Positional changes 
Timing - systolic/diastolic/continuous
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11
Q

features of innocent murmurs

A 
very common in children 
'flow murmur' - blood is whooshing from fast HR
physiological 
<3/6
short systolic - NEVER diastolic or associated with a thrill 
asymptomatic - baby is fine
variable with position 
loudest at LLSE
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12
Q

how can congenital heart disease present

A

antenatal detection
newborn baby check
neonatal collapse
6 week check

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13
Q

in newborns, right ventricular pressure is equal to LV pressure but what happens over the next few weeks

A

RV pressure falls and becomes less than LV pressure

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14
Q

types of congenital heart disease

A

acyanotic

cyanotic

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15
Q

what are examples of acyanotic congenital heart disease

A 
VSD 
ASD
pulmonary stenosis 
AVSD 
PDA 
aortic stenosis 
coarctation of the aorta
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16
Q

what are examples of cyanotic congenital heart disease

A

TOF

TGA

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17
Q

causes of collapsed neonate when their duct shuts

A

systemic and cyanotic duct dependent lesions

dependent on ductus arteriosus

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18
Q

examples of systemic duct dependent lesions

A

hypoplastic left heart syndrome
critical aortic stenosis
interrupted aortic arch

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19
Q

examples of cyanotic duct dependent lesions

A

TGA

pulmonary atresia with intact septum

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20
Q

what is meant by systemic duct dependent lesion

A

severe obstruction of blood out of left side of the heart

systemic circulation os dependent on the PDA and so needs to be kept open until further management

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21
Q

what is meant by cyanotic duct dependent lesion

A

there is obstruction to pulmonary blood flow (blood going to lungs) OR lack of oxygenation of systemic blood
reliant on PDA - keep open

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22
Q

what is ASD

A

atrial septal defect
oxygenated blood from LA is shunted through hole into RA
this causes enlargement of both atria, RV and pulmonary artery

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23
Q

what is VSD

A

ventricular septal defect
oxygenated blood from LV is shunted through hole into RV
this causes enlargement of both ventricles, pulmonary artery, exposing them to abnormally high pressures

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24
Q

what is AVSD

A

atrioventricular septal defect

complete lack of AV septum

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25
what is PDA
patent ductus arteriosus | blood from aorta is shunted through PDA into pulmonary artery resulting in L-R shunt and increased pulmonary blood flow
26
what is coarctation
severe narrowing of the aorta in the region of the ductus arteriosus
27
what are the features of Tetralogy of Fallot TOF
1. pulmonary stenosis 2. RVH 3. VSD 4. overriding aorta
28
what is transposition of the great arteries TGA
1. aorta arising from RV instead of LV unoxygenated blood is delivered to the body 2. pulmonary artery arising from LV instead of RV well oxygenated blood is delivered back to the lungs
29
what is hypoplastic left heart syndrome HLHS
1. hypoplastic ascending aorta and aortic arch 2. hypoplastic LV 3. large PDA (only source of blood to body with R=L shunt) 4. ASD - allows blood returning from lungs to LA into RA then RV
30
what is the most common congenital heart defect
VSD
31
outcome of VSD
if small, close without intervention | if large, present with heart failure and may need surgery
32
symptoms of cardiac disease in neonates
``` breathlessness difficulty feeding and gaining weight pee and poo less sweating with feeding cyanosis ```
33
signs of increased work of breathing
``` tracheal tug nasal flare grunting intercostal recession subcostal recession ```
34
what is grunting
breathing against closed glottis gives themselves CPAP breath out against pressure to prevent atelectasis
35
periodic breathing
breath fast then slow
36
what is a heave
palpable impulse
37
acrocyanosis is different from central cyanosis, true or false
true central cyanosis will have blueness IN the mouth as opposed to acrocyanosis which is a functional peripheral vascular disorder with mottled skin caused by vasospasm in response to the cold
38
what is a thrill
palpable murmur
39
vast majority of murmurs in kids >1 are likely to be innocent murmurs, true or false
true
40
what grade must a murmur be if you feel a thrill
grade 4 at least
41
cause of collapsed neonate when their duct shuts
duct dependent disease
42
What are the 5 'S' you can use to describe an innocent murmur
``` Soft Short Systolic Symptomless Situation dependent ```
43
Give examples of pan systolic murmurs
mitral regurgitation tricuspid regurgitation VSD
44
give examples of ejection systolic murmurs
aortic stenosis pulmonary stenosis hypertrophic obstructive cardiomyopathy
45
what is splitting of the SII and why does it happen
this is when the pulmonary valve closes straight after the aortic valve making SII appear 'split' during inspiration, more venous blood enters the right side of the heart, and so takes longer to empty resulting in the pul valve closing slightly later
46
what types of murmur do you hear in ASD
mid systolic murmur loudest at left upper sternal edge | with FIXED splitting of SII i.e. does not vary with breathing
47
what murmur do you hear in PDA
continuous machine like murmur
48
what murmurs can you hear in TOF
pulmonary stenosis - ejection systolic at 2nd ICS left sternal edge ? pansystolic - VSD
49
what is cyanosis
when deoxygenated blood enter systemic circulation
50
what is PDA
patent ductus arteriosis the DA fails to close after birth resulting in a L-R shunt as blood from the high pressure aorta goes into the pul artery this can lead to pul HTN and RVH
51
RF for PDA
prematurity | rubella infection
52
symptoms and signs of PDA
asymptomatic breathlessness difficulty feeding and poor weight gain continuous machine like murmur
53
ASD leads to which kind of shunt
L-R | may reverse and form R-L eventually (Eisenmengers)
54
what is Eisenmenger syndrome
can arise from ASD, VSD and PDA after initial L-R shunt. The pulmonary pressure becomes greater than the systemic pressure and the shunt reverses to R-L leading to cyanosis as blood bypasses the pul circulation and lungs.
55
complications of ASD
Eisenmengers syndrome RVH and pul HTN AF / atrial flutter stroke - paradoxical
56
how can you get a stroke from ASD
DVT develop in the venous circulation, if it comes off it becomes an embolus and travels to the right side of the heart. Instead of going through pul circulation to the lungs to form a PE, it can pass through the ASD to the left side of the heart and into the aorta to go to the brain
57
symptoms of ASD
asymptomatic if small breathlessness difficulty feeding and poor weight gain adulthood: dyspnoea, HF, stroke
58
risk factors/associations for VSD
Down's syndrome Turner's syndrome idiopathic TOF
59
symptoms and signs of VSD
asymptomatic breathlessness difficulty feeding and failure to thrive tachypnoea pan systolic murmur at 4th ICS left sternal edge +- systolic thrill on palpation
60
those with VSD are at increased risk of what
infective endocarditis
61
complications of Eisenmengers syndrome
^ RBC as a response to cyanosis --> polycythaemia | this can increase risk of clots
62
findings in Eisenmengers syndrome
``` RV parasternal heave loud P2 raised JVP peripheral oedema (RHF) murmur arrhythmia cyanosis clubbing dyspnoea plethoric - polycythaemia ```
63
What is coarctation of the aorta
congenital narrowing of the aorta typically at the arch near the ductus arteriosus
64
RF for coarctation of the aorta
Turner's syndrome
65
in coarctation of the aorta, there is increased/decreased pressure proximal to the narrowing and increased/decreased pressure distal to the narrowing
increased pressure proximally | decreased pressure distally
66
symptoms and signs of coarctation of the aorta
weak femoral pulses difference in blood pressure and SaO2 in upper and lower limbs systolic murmur beneath left clavicle and scapula tachypanoea poor feeding
67
what can be given to keep the ductus arteriosus open
prostaglandins
68
explain the pathology behind TOF
Pulmonary stenosis means it is harder to pump blood through to the pul artery and so you consequently get RVH. The VSD means that blood from the LV enters the RV further increasing that blood volume. The overriding aorta sits more to the right above the VSD, this means that blood from the RV will follow the path of least resistance and enter the aorta which means it bypasses the lungs creating a R-L shunt which leads to cyanosis
69
What are 'Tet' spells
intermittent cyanotic episodes where R-L shunt is temporarily worsened as pul pressure > systemic pressure triggers: crying, physical exertion, waking older children tend to squat to increase the SVR and help blood to enter the pul artery
70
what is Ebsteins anomaly
congenital heart defect where the tricuspid valve is set lower in the right side of the heart leading to a bigger RA and smaller RV causing poorer flow from RV --> pul artery
71
what is a RF for Ebsteins anomaly
maternal use of lithium antenatally
72
what is Ebsteins anomaly associated with
ASD | WPW syndrome
73
what is TGA
transposition of the great arteries attachments of the great vessels to the heart are swapped i.e. the RV connects to the aorta and LV connects to the pulmonary artery the two separate circulations do not mix and they loop around the same circuit - deoxygenated round the body and oxygenate around the lungs
74
what is an immediate sign of TGA at birth
cyanosis
75
what pulse abnormality is associated with PDA
large volume, bounding, collapsing pulse
76
symptoms of heart failure in infants
breathlessness difficulty feeding sweating while feeding recurrent chest infections

Year 4 Child Health (22 decks)

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