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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

4 common acquired heart disease in children?

A

Kawasaki, rheumatic, myocarditis, endocarditis

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2
Q

What type of infection is Kawasaki disease?

A

Mucocutaneous lymph node disease

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3
Q

What can myocarditis lead to?

A

Dilated cardiomyopathy

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4
Q

What does endocarditis usually cause damage to?

A

Native valves

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5
Q

Organism most likely to cause myocarditis vs endocarditis

A

Myocarditis = viral, Endocarditis = bacterial

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6
Q

Turner Syndrome are likely to suffer which 2 cardiac conditions?

A

Bicuspid aortic valve and aortic coarctation

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7
Q

Noonans Syndrome are likely to suffer which 3 cardiac conditions?

A

Atrial septal defects, hypertrophic cardiomyopathy, pulmonary valve stenosis

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8
Q

Usual heart rate of a child?

A

120-160bpm

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9
Q

What does ductus venosus allow?

A

Bypass through liver to IVC

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10
Q

What does ductus arteriosus allow?

A

Bypass the lungs from pulmonary artery to descending aorta

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11
Q

What happens in pulmonary circulation and systemic blood pressure when a baby is born and why?

A

Pulmonary circulation increases due to decreased resistance and the systemic blood pressure increases due to increase vascular resistance

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12
Q

Order of fetal valve closure?

A

Ductus arteriosus, foreman ovale (functional closure), ductus venosus

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13
Q

What replaces ductus venosus?

A

Ligamentum teres

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14
Q

What happens in persistent fetal circulation/persistent pulmonary hypertension?

A

patent ductus arteriosus, causes high lung arterial pressure, high resistance to flow, right ventricular hypertrophy, patent foreman ovale as right atrium pressure decrease

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15
Q

Treatment of patent ductus arteriosus in newborn?

A

Oxygen and NO

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16
Q

What happens with a ventricular septal defect? Type of murmur?

A

Increased blood flow to pulmonary artery, left ventricular hypertrophy, increased pulmonary return, cardiac decompensation, pan systolic murmur

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17
Q

What happens to the heart in patent foreman ovale? type of murmur?

A

Enlargement of the right atrium, right ventricle and pulmonary vessels, short ejection systolic murmur

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18
Q

Persistent ductus arteriosus has what murmur?

A

Continuous across systolic and diastolic

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19
Q

What is complete atrio-ventricular septal defect associated with?

A

Down’s Syndrome

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20
Q

Is pulmonary stenosis acyanotic or cyanotic HD?

A

acyanotic

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21
Q

Is aortic stenosis acyanotic or cyanotic HD?

A

Acyanotic

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22
Q

is Coarctation acyanotic or cyanotic HD?

A

Acyanotic

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23
Q

Is hypoplastic left heart syndrome acyanotic or cyanotic HD?

A

Acyanotic

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24
Q

3 main signs of heart failure in children?

A

Tachypnoea, tachycardia, hepatic enlargement

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25
Q

Late sign of heart failure in children?

A

peripheral oedema

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26
Q

Diruetics used in right to left shunts?

A

Furosemide, spironolactone

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27
Q

What ACE inhibitor is used in paediatric cardiac failure?

A

Captopril

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28
Q

What do you do with a child presenting a left to right shunt?

A

Diuretics - furosemide, sprironolactone.
ACE - captopril
Digoxin
CPAP

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29
Q

What happens in transposition of the great arteries?

A

Aorta attached to right ventricle and pulmonary artery attached to left ventricle. Deoxygenated blood pumped around body (right ventricular hypertrophy), oxygenated blood pumped to the lungs

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30
Q

is TGA acyanotic or cyanotic HD?

A

cyanotic

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31
Q

4 aspects of tetralogy of fallot?

A

VSD, aortic overdrive moving across VSD, obstruction to pulmonary outflow, right ventricular hypertrophy

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32
Q

Is tetralogy of fallot acyanotic or cyanotic HD?

A

cyanotic

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33
Q

How does tetralogy of fallot appear on x-ray? why?

A

Boot shaped, severe right ventricular hypertrophy

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34
Q

How does heart pump blood if tricuspid atresia is present?

A

Needs to pass through atrial septum and ventricular septum, lots of mixing

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35
Q

Is tricuspid atresia acyanotic or cyanotic HD?

A

cyanotic

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36
Q

What happens in truncus arteriosus?

A

Pulmonary artery and aorta dont separate, usually with VSD meaning mixed blood through both, enlarged left and right ventricle

37
Q

What is total anomalous pulmonary venous drainage

A

None of the 4 pulmonary veins drain to right atrium, all via accessory pathways

38
Q

Is TAPVD acyanotic or cyanotic HD?

A

cyanotic

39
Q

In duct dependant cyanotic HD what is it important not to give and what is it important to give?

A

Do not give oxygen, give prostaglandin E2 infusion (5-20ng/kg/min)

40
Q

In tetralogy of fallow how is it surgically managed?

A

Shunt/ septostomy

41
Q

What does a modified BT shunt connect? why is it used?

A

Blalock Taussig Shunt - right subclavian to the pulmonary artery, replace ductus arteriosus

42
Q

In hypoplastic left heart syndrome although it is duct dependant how is management slightly different?

A

Maintain a small respiratory acidosis

43
Q

If an ejection click is present what do you think of?

A

Pulmonary stenosis (or aortic)

44
Q

What happens if the ducts close after birth when a ductal depedant pulmonary blood flow is in place?

A

severe hypoxia, metabolic acidosis, early neonatal death

45
Q

Some conditions that are ductal dependant pulmonary blood flow?

A

Tetralogy of fallot, pulmonary atresia/stenosis, tricuspid atresia, transposition great arteries

46
Q

5 conditions that are duct dependant systemic blood flow?

A

Hypoplastic left heart syndrome, Coarctation of the aorta, critical aortic stenosis, aortic atresia, severe mitral stenosis

47
Q

What is a pneumopericardium? how can it occur?

A

Air in the pericardium around the heart. Needs urgent decompensation. complication of premature infant ventilation.

48
Q

What duct is patent in total anomylous pulmonary venous drainsge?

A

Foreman ovale

49
Q

In TGA, if the baby does not have a septal defect what happens?

A

Rapidly fatal, need emergency septostomy to create large ASD

50
Q

What is give away sign between a pericardial effusion and cardiac enlargement?

A

Effusion has a rapid increase heart size with little change to respiratory symptoms

51
Q

What gives the heart a water bottle appearance?

A

Pericardial effusion

52
Q

What is Epteins anomaly characterised by?

A

Anomaly of the tricuspid valve which is regurgitant

53
Q

Eisenmengers Syndrome?

A

high-flow, high pressure congential heart defect, shunt reversal, chronic pulmonary arterial hypertension

54
Q

Dextrocardia with situs inversus?

A

When the heart is on the opposite side and so are all the other visceral organs

55
Q

What type of shunt is formed from a right to left ventricular septal defect?

A

left to right shunt

56
Q

If a newborn presents with cyanosis, what questions do you initially need to ask?

A

Gestation, Mode of delivery, any issues at the time, how long have they been cyanosed, have they been feedin, RR, O2, BP, birth weight, well beside blue

57
Q

In a new born baby presenting with new onset cyanosis, what do you want to initially assess?

A

CV exam, respiratory exam, neuro exam, femoral pulses, hepatomegaly

58
Q

5Ts and 1P causing cyanotic heart failure

A 
T:
Tetralogy of fallot
Transposition of the great arteries
total anomylous pulmonary venous connections
truncus arteriosus
tricuspid atresia
P:
Pulmonary atresia
59
Q

Respiratory causes of cyanosis in newborn?

A

RDS (usually preterm), congenital pneumoniae, pneumothorax, diaphragmatic hernia, oesophageal atresia/fistula, persistent pulmonary hypertension

60
Q

What can cause persistent pulmonary hypertension in a newborn?

A

Aspriation

61
Q

What is a key sign in differentiating a respiratory and cardiac cause of cyanosis in new born?

A

Cardiac does not get better with oxygen, respiratory does

62
Q

Initial management plan of a cyanotic baby?

A

oxygen 100% for 10 minutes, no improvement probably cardiac, IV access, blood gas, bloods (FBC/u&E/blood cultures), admit to neonatal

63
Q

If you give oxygen 100% for 10 minutes and the sats do not improve what is the first thing you do?

A

Stop oxygen

64
Q

When do you see a snowman heart on CXR?

A

total anomylous pulmonary venous connections

65
Q

In TGA, what must be commenced to ensure viability?

A

Prostaglandin infusion

66
Q

What emergency procedure can initiated for TGA?

A

Balloon atrial septostomy

67
Q

What is the surgical procedure to cure TGA?

A

Atrial switch operation

68
Q

3 month old with 48 hour onset extreme tiredness and not feeding, what do you want to know? examine?

A

Were they well before, feeding? thriving?, any obstetric issues or issues at time of birth, infective symptoms, ingestion of toxins
Examine - RR, O2, HR, BP, colour, temperature, CVS, heart sounds, femoral pulses, hepatomegaly

69
Q

What HR classifies an SVT?

A

over 230

70
Q

Is a fluid bolus useful in SVT?

A

No

71
Q

What do you do with 3 month old child presenting with cardiogenic shock?

A

100% O2, call consultant

72
Q

Causes of SVT in baby?

A

infection, sepsis, congestive heart failure due to myocarditis or CHD, hypovolaemia, ventricular arrythmias

73
Q

What is given to babies suffering paroxysmal ventricular tachycardia? what dose?

A

100 mcg of adenosine IV stat

74
Q

What does adenosine do in paroxysmal ventricular tachycardia?

A

converts PSVT to sinus rhythm by blocking the AV node to prevent all the transmissions getting through

75
Q

What 2 types of SVT does adenosine differentiate between?

A

WPW re-entry SVT and atrial flutter

76
Q

initial presentation of cyanosis what clinical signs do you look for?

A

RR, BP, temperature, HR, oxygen sats, hepatomegaly, 4 limb BP, femoral pulses, CVS exam, CRT, sepsis signs

77
Q

Questions to ask mum on presentation of acutely cyanosed baby?

A

Rash? feeding? toxins? infection contacts? breathing? temperature?

78
Q

if a 6 day old baby presents with worsening tiredness and feeding what 3 categories are you thinking about?

A

Sepsis, cardiogenic cause, metabolic cause

79
Q

Initial investigations into shocked child?

A

FBP, U&E, blood glucose, blood gas, IV access, CRP, blood culture, potentially give antibiotics, CXR, ECG

80
Q

6 days old presenting with new onset tiredness, bad feeds and cyanosis, not better with oxygen or fluid bolus; what is primary differential?

A

Coarctation of the aorta

81
Q

How do you see left ventricular strain in paediatric ECG?

A

inverted T wave in V6

82
Q

How do you see right ventricular hypertrophy in paediatric ECG?

A

upright T wave in V1

83
Q

Symptoms of septal defects?

A

Recurrent infections, arrythmias

84
Q

If a child presents with a new heart murmur what PMH questions do you need to ask?

A 
Has she been thriving?
General well being?
Exertional dyspnoea
Syncope
energy levels
Palpitations
Chest pain
Frequent pneumoniae
85
Q

If a child presents with a new heart murmur what is it important to ask about in the FH?

A

Any FH of cardiac problems or more specifically surgery/catheterisation?
Any sudden death in the family of young people?

86
Q

On palpation how will innocent murmurs appear different to pathological ones?

A

Normal apex position
No heaves
No thrills

87
Q

Features of an innocent murmur?

A 
Systolic
Short
Soft
No radiation
Ejection or musical in character
changes with position or respiration
exacerbated by increase CO like when the child has a fever, exercising or anaemia
88
Q

5 types of systolic innocent murmurs?

A 
Vibratory Still's murmur
Pulmonary flow murmur
Aortic systolic murmur
Peripheral pulmonary artery turbulence
Supraclavicular systolic murmur
89
Q

2 types of continuous innocent murmurs in children?

A

Venous hum

Mammary arterial souffle

Paediatrics (20 decks)

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