Cardiovascular Flashcards
Causes of paediatric HF?
Congenital heart defects
Myocarditis
Cardiomyopathies
Arrhythmias
HTN
Sx of HF by age:
* All age groups
* Infants
* Young children
* Adolescents
All age groups:
* Oedema
* Cyanosis
* Hepatomegaly
* Heart murmur
Infants:
* Difficulty feeding
* Faltering growth
Young children:
* Exercise intolerance
* Abdo pain and vomiting
* Fatigue
* Poor appetite
Adolescents:
* Exercise intolerance
* Fatigue
Ix for paediatric HF?
Blood tests: FBC, U&Es, LFTs, CRP, TFTs, BNP
Imaging: ECHO and CXR
ECG
Tx of paediatric HF?
Conservative: Fluid restriction
Medical:
* Furosemide (diuretic)
* Captopril (Ace-i)
* Carvedilol (beta-blocker)
* Digoxin
If severe - inotropic support (i.e. adrenaline)
Surgical: correction of anatomical defect causing HF
What is cyanotic heart disease?
A range of congenital heart defects resulting in a right-to-left shunt which leads to systemic arterial desaturation and subsequent cyanosis.
Causes of cyanotic heart disease?
Typically presents at birth due to congenital malformations yjay result in a right-to-left shunt such as:
* Transposition of the great arteries
* Pulmonary and tricuspid atresias
* Tetralogy of Fallot
- Transposition of the great arteries: aorta + pul. trunk have insertions swapped around
- Pulmonary and tricuspid atresias: causes right side of heart to be dead-end.
- Tetralogy of Fallot: pulmonary stenosis + large ventricular septal defect results in shunting at the ventricular level.
Sx of cyanotic heart disease?
Visible cyanosis
Additional sx based on specific congenital defect involved
Typically presents within first few weeks of life
Ix for cyanotic heart disease?
- Often found antenatally during USS
- Otherwise, ECHO
Mx of cyanotic heart disease?
- Surgical correction of defect
- Heart transplant
While awaiting surgery can give prostaglandin E to maintain patency of the ductus arteriosus + temp. Relief from cyanosis
In fetus, there are 3 shunts that allow blood to bypass into lungs as fetal lungs are not fully developed yet. What are the 3 shunts and what do they connect?
- Ductus venosus - connects umbilical vein from placenta to inferior VC (allows blood to bypass liver)
- Foramen ovale - connects right atrium to left atrium (allows blood to bypass right ventricle and pul. circulation)
- Ductus arteriosus - connects pul artery to aorta (allows blood to bypass pul. circulation)
Describe how the 3 fetal shunts close after birth?
- Ductus venosus: stops functioning when umbilical cord is clamped → becomes ligamentum venosum
- Foramen ovale: After first breath → alveoli expand → dec. pul. vascular resistance → R atrium pressure dec → L atrium pressure greater → squashes atrial septum and closes foramen ovale → becomes fossa ovalis
- Ductus arteriosus: Prostaglandins keeps it open → thus inc. blood oxygenation = dec circulating prostaglandins → closure of shunt → becomes ligamentum arteriosum
What are innocent murmurs in children and what are it’s typical feautures?
aka flow murmurs. Caused by fast blood flow through various areas of heart during systole.
Features:
* Soft
* Short
* Systolic
* Symptomless
* Situation dependent
- What is it called when ductus arteriosus fails to close?
- Describe the pathophysiology.
- What is the usual cause?
Name: Patent ductus arteriosus (PDA).
Pathophysiology: Pressure in aorta > pul vessels → patent duct = left to right shunt → inc. pressure in pul. vessels = pul. htn + R heart strain = R ventricular hypertrophy → leads to inc. blood from pul vessels to left side of heart = L ventricular hypertrophy
Cause:
* Genetic
* Maternal infx (i.e. rubella)
* Prematurity
Sx of patent ductus arteriosus?
- SOB
- Difficulty feeding
- Poor wgt gain
- Left subclavicular thrill
- Collapsing pulse
- Apex beat
- Machinery murmur
Ix and tx for patent ductus arteriosus?
Ix: ECHO
Tx:
* Medical - Indomethacin or ibuprofen (close connection)
* Trans-catheter or surgical closure (Give prostaglandin E1 i.e. Alprostadil post birth to keep it patent before surgery)
Transcatheter = inserting catheter (like coil or occluder) to close PDA and prevent abnormal blood flow.
What is atrial septal defect?
A defect (hole) in septum (wall) between the two atria. The pressure in L atrium > R atrium therefore inc. blood flow to pul. vessels and lungs + inc. right sided overload = right heart failure + pul. htn.
Causes of atrial septal defect?
- Maternal alcohol consumption
- Rubella infx during preggo
- Maternal diabetes
- Genetic
Sx of atrial septal defect?
Mostly asx
* Ejection systolic murmur on auscultation - loudest on lower-left sternal edge (due to flow of blood through pul. valve)
* Heart failure sx - SOB, fatigue, oedema, tachycardic
Ix for atrial septal defects?
ECHO - GS
Other: CXR, cardiac MRI
Mx of atrial septal defect?
Manage conservitavely
Surgical closure if larger defect
Complications of atrial septal defect?
- Inc. stroke risk if a pt has a DVT
- AF or A fib
- Pul HTN
- R HF
- Eisenmenger syndrome
Pul. htn = pul pressure > systemic pressure. Therefore, this causes shunt to reverse and forms a right to left shunt across atrial septal defect and the blood bypasses the lungs + becomes Cynotic = Eisenmenger syndrome
What is a ventricular septum defect?
Congenital hole in septum (wall) between two ventricles. Commonly associated with Down’s Syndrome and Turner’s Syndrome.
Due to inc. pressure in L ventricle than R ventricle blood flows from left to right = right sided overload = R HF and Pul. htn.
Sx of ventricular septal defect?
Initially asx but:
* Poor feeding
* Dyspnoea
* Tachypnoea
* Failure to thrive
* Pan-systolic murmur (heard at left lower sternal border in 3rd+4th IC space
* Systolic thrill on palpation
* Eisenmenger’s syndrome - cyanosis, clubbing
What are cdtns that cause pan systolic murmurs?
- Ventricular septal defect
- Mitral regurgitation
- Tricuspid regurgitation
Tx of ventricular septal defect?
Manage conservitavely
Surgically: transvenous catheter closure via the femoral vein or open heart surgery.
Give abx during procedures to reduce risk of infective endocarditis
What is Tetralogy of Fallot?
Describe pathopyhsiology.
Congenital cdtn where there are 4 coexisiting pathologies:
1. Ventricular septal defect (VSD)
2. Overriding aorta
3. Pulmonary valve stenosis
4. Right ventricular hypertrophy
Pathophysiology:
* VSD allows blood flow between 2 ventricles
* Aortic valve placed above VSD = overriding aorta → when R ventricle contracts → inc. dexoygenated blood enters aorta from R side of heart → leads to inc. cyanosis
* Pul. valve stenosis → inc resistance against blood flow from R ventricle → encourages inc. blood flow into aorta instead → leads to inc. cyanosis
* Inc. strain on R ventricle → as it attempts to pump blood against L ventricle resistance + pul. stenosis → R ventricular hypertrophy
RF for Tetralogy of Fallot?
Rubella infection
Increased age of the mother (over 40 years)
Alcohol consumption in pregnancy
Diabetic mother
Sx of Tetralogy of Fallot?
- Cyanosis
- Clubbing
- Poor feeding
- Poor weight gain
- Ejection systolic murmur heard loudest in the pul. area (2nd IC space, L sternal border)
- “Tet spells” = intermittent symptomatic periods where the right to left shunt becomes temporarily worsened, precipitating a cyanotic episode = irritable, cyanotic, SOB, LOC, seizures or even death in severe cases.
Tx of Tet spell and Tetarology of Fallot?
Tet spell:
* Knees to chest/squat = inc. blood flow to pul. vessels
* O2 = for hypoxia
* Beta blockers = relax R ventricle
* IV fluids = inc. blood to pul. vessels
* Morphine = help w/breathing
* Sodium bicarb = buffer metabolic acidosis
Tetarology of Fallot:
* Neonates - prostaglandin infusion = maintain ductus arteriosus =
What is rheumatic fever?
Autoimmune cdtn triggered by streptococcus bacteria. It is a multi-system disorder that affects joints, heart, skin and nervous system.
Which bacteria typically causes rheumatic fever?
Streptococcus pyogenes - group A beta-haemolytic streptococcal.
Sx of rheumatic fever + explain the involvement of each of the following:
1. Joint
2. Heart
3. Skin
4. Nervous system
Typically presents 2-4 wks post streptococcal infx i.e. tonsillitis and causes sx such as:
* Fever
* Joint pain and rash
* SOB
* Chorea
* Nodules
Joint involvement:
* Migratory arthritis
Heart involvement:
* Tachycardia or bradycardia
* Murmurs
* Pericardial rub on ausc.
* HF
Skin involvement:
* Subcutaneous nodules (firm, painless over extensor joints i.e. elbow)
* Erythema marginatum rash (pink rings affecting torso + proximal limb)
Nervous system involvement:
* Chorea (irregular, uncontrolled rapid movements)
Ix of rheumatic fever?
Throat swab for bacterial culture
ASO antibody titres (Anti-streptococcal antibodies (ASO) are antibodies against streptococcus)
Echocardiogram, ECG and chest xray
What criteria is used for diagnosing rheumatic fever?
Jones criteria
