Cardiology Flashcards
4 common acquired heart disease in children?
Kawasaki, rheumatic, myocarditis, endocarditis
What type of infection is Kawasaki disease?
Mucocutaneous lymph node disease
What can myocarditis lead to?
Dilated cardiomyopathy
What does endocarditis usually cause damage to?
Native valves
Organism most likely to cause myocarditis vs endocarditis
Myocarditis = viral, Endocarditis = bacterial
Turner Syndrome are likely to suffer which 2 cardiac conditions?
Bicuspid aortic valve and aortic coarctation
Noonans Syndrome are likely to suffer which 3 cardiac conditions?
Atrial septal defects, hypertrophic cardiomyopathy, pulmonary valve stenosis
Usual heart rate of a child?
120-160bpm
What does ductus venosus allow?
Bypass through liver to IVC
What does ductus arteriosus allow?
Bypass the lungs from pulmonary artery to descending aorta
What happens in pulmonary circulation and systemic blood pressure when a baby is born and why?
Pulmonary circulation increases due to decreased resistance and the systemic blood pressure increases due to increase vascular resistance
Order of fetal valve closure?
Ductus arteriosus, foreman ovale (functional closure), ductus venosus
What replaces ductus venosus?
Ligamentum teres
What happens in persistent fetal circulation/persistent pulmonary hypertension?
patent ductus arteriosus, causes high lung arterial pressure, high resistance to flow, right ventricular hypertrophy, patent foreman ovale as right atrium pressure decrease
Treatment of patent ductus arteriosus in newborn?
Oxygen and NO
What happens with a ventricular septal defect? Type of murmur?
Increased blood flow to pulmonary artery, left ventricular hypertrophy, increased pulmonary return, cardiac decompensation, pan systolic murmur
What happens to the heart in patent foreman ovale? type of murmur?
Enlargement of the right atrium, right ventricle and pulmonary vessels, short ejection systolic murmur
Persistent ductus arteriosus has what murmur?
Continuous across systolic and diastolic
What is complete atrio-ventricular septal defect associated with?
Down’s Syndrome
Is pulmonary stenosis acyanotic or cyanotic HD?
acyanotic
Is aortic stenosis acyanotic or cyanotic HD?
Acyanotic
is Coarctation acyanotic or cyanotic HD?
Acyanotic
Is hypoplastic left heart syndrome acyanotic or cyanotic HD?
Acyanotic
3 main signs of heart failure in children?
Tachypnoea, tachycardia, hepatic enlargement
Late sign of heart failure in children?
peripheral oedema
Diruetics used in right to left shunts?
Furosemide, spironolactone
What ACE inhibitor is used in paediatric cardiac failure?
Captopril
What do you do with a child presenting a left to right shunt?
Diuretics - furosemide, sprironolactone.
ACE - captopril
Digoxin
CPAP
What happens in transposition of the great arteries?
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
is TGA acyanotic or cyanotic HD?
cyanotic
4 aspects of tetralogy of fallot?
VSD, aortic overdrive moving across VSD, obstruction to pulmonary outflow, right ventricular hypertrophy
Is tetralogy of fallot acyanotic or cyanotic HD?
cyanotic
How does tetralogy of fallot appear on x-ray? why?
Boot shaped, severe right ventricular hypertrophy
How does heart pump blood if tricuspid atresia is present?
Needs to pass through atrial septum and ventricular septum, lots of mixing
Is tricuspid atresia acyanotic or cyanotic HD?
cyanotic
What happens in truncus arteriosus?
Pulmonary artery and aorta dont separate, usually with VSD meaning mixed blood through both, enlarged left and right ventricle
What is total anomalous pulmonary venous drainage
None of the 4 pulmonary veins drain to right atrium, all via accessory pathways
Is TAPVD acyanotic or cyanotic HD?
cyanotic
In duct dependant cyanotic HD what is it important not to give and what is it important to give?
Do not give oxygen, give prostaglandin E2 infusion (5-20ng/kg/min)
In tetralogy of fallow how is it surgically managed?
Shunt/ septostomy
What does a modified BT shunt connect? why is it used?
Blalock Taussig Shunt - right subclavian to the pulmonary artery, replace ductus arteriosus
In hypoplastic left heart syndrome although it is duct dependant how is management slightly different?
Maintain a small respiratory acidosis
If an ejection click is present what do you think of?
Pulmonary stenosis (or aortic)
What happens if the ducts close after birth when a ductal depedant pulmonary blood flow is in place?
severe hypoxia, metabolic acidosis, early neonatal death
Some conditions that are ductal dependant pulmonary blood flow?
Tetralogy of fallot, pulmonary atresia/stenosis, tricuspid atresia, transposition great arteries
5 conditions that are duct dependant systemic blood flow?
Hypoplastic left heart syndrome, Coarctation of the aorta, critical aortic stenosis, aortic atresia, severe mitral stenosis
What is a pneumopericardium? how can it occur?
Air in the pericardium around the heart. Needs urgent decompensation. complication of premature infant ventilation.
What duct is patent in total anomylous pulmonary venous drainsge?
Foreman ovale
In TGA, if the baby does not have a septal defect what happens?
Rapidly fatal, need emergency septostomy to create large ASD
What is give away sign between a pericardial effusion and cardiac enlargement?
Effusion has a rapid increase heart size with little change to respiratory symptoms
What gives the heart a water bottle appearance?
Pericardial effusion
What is Epteins anomaly characterised by?
Anomaly of the tricuspid valve which is regurgitant
Eisenmengers Syndrome?
high-flow, high pressure congential heart defect, shunt reversal, chronic pulmonary arterial hypertension
Dextrocardia with situs inversus?
When the heart is on the opposite side and so are all the other visceral organs
What type of shunt is formed from a right to left ventricular septal defect?
left to right shunt
If a newborn presents with cyanosis, what questions do you initially need to ask?
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
In a new born baby presenting with new onset cyanosis, what do you want to initially assess?
CV exam, respiratory exam, neuro exam, femoral pulses, hepatomegaly
5Ts and 1P causing cyanotic heart failure
T: Tetralogy of fallot Transposition of the great arteries total anomylous pulmonary venous connections truncus arteriosus tricuspid atresia P: Pulmonary atresia
Respiratory causes of cyanosis in newborn?
RDS (usually preterm), congenital pneumoniae, pneumothorax, diaphragmatic hernia, oesophageal atresia/fistula, persistent pulmonary hypertension
What can cause persistent pulmonary hypertension in a newborn?
Aspriation
What is a key sign in differentiating a respiratory and cardiac cause of cyanosis in new born?
Cardiac does not get better with oxygen, respiratory does
Initial management plan of a cyanotic baby?
oxygen 100% for 10 minutes, no improvement probably cardiac, IV access, blood gas, bloods (FBC/u&E/blood cultures), admit to neonatal
If you give oxygen 100% for 10 minutes and the sats do not improve what is the first thing you do?
Stop oxygen
When do you see a snowman heart on CXR?
total anomylous pulmonary venous connections
In TGA, what must be commenced to ensure viability?
Prostaglandin infusion
What emergency procedure can initiated for TGA?
Balloon atrial septostomy
What is the surgical procedure to cure TGA?
Atrial switch operation
3 month old with 48 hour onset extreme tiredness and not feeding, what do you want to know? examine?
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
What HR classifies an SVT?
over 230
Is a fluid bolus useful in SVT?
No
What do you do with 3 month old child presenting with cardiogenic shock?
100% O2, call consultant
Causes of SVT in baby?
infection, sepsis, congestive heart failure due to myocarditis or CHD, hypovolaemia, ventricular arrythmias
What is given to babies suffering paroxysmal ventricular tachycardia? what dose?
100 mcg of adenosine IV stat
What does adenosine do in paroxysmal ventricular tachycardia?
converts PSVT to sinus rhythm by blocking the AV node to prevent all the transmissions getting through
What 2 types of SVT does adenosine differentiate between?
WPW re-entry SVT and atrial flutter
initial presentation of cyanosis what clinical signs do you look for?
RR, BP, temperature, HR, oxygen sats, hepatomegaly, 4 limb BP, femoral pulses, CVS exam, CRT, sepsis signs
Questions to ask mum on presentation of acutely cyanosed baby?
Rash? feeding? toxins? infection contacts? breathing? temperature?
if a 6 day old baby presents with worsening tiredness and feeding what 3 categories are you thinking about?
Sepsis, cardiogenic cause, metabolic cause
Initial investigations into shocked child?
FBP, U&E, blood glucose, blood gas, IV access, CRP, blood culture, potentially give antibiotics, CXR, ECG
6 days old presenting with new onset tiredness, bad feeds and cyanosis, not better with oxygen or fluid bolus; what is primary differential?
Coarctation of the aorta
How do you see left ventricular strain in paediatric ECG?
inverted T wave in V6
How do you see right ventricular hypertrophy in paediatric ECG?
upright T wave in V1
Symptoms of septal defects?
Recurrent infections, arrythmias
If a child presents with a new heart murmur what PMH questions do you need to ask?
Has she been thriving? General well being? Exertional dyspnoea Syncope energy levels Palpitations Chest pain Frequent pneumoniae
If a child presents with a new heart murmur what is it important to ask about in the FH?
Any FH of cardiac problems or more specifically surgery/catheterisation?
Any sudden death in the family of young people?
On palpation how will innocent murmurs appear different to pathological ones?
Normal apex position
No heaves
No thrills
Features of an innocent murmur?
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
5 types of systolic innocent murmurs?
Vibratory Still's murmur Pulmonary flow murmur Aortic systolic murmur Peripheral pulmonary artery turbulence Supraclavicular systolic murmur
2 types of continuous innocent murmurs in children?
Venous hum
Mammary arterial souffle
