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Phase 3a - Paediatrics > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Causes of paediatric HF?

A

Congenital heart defects
Myocarditis
Cardiomyopathies
Arrhythmias
HTN

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2
Q

Sx of HF by age:
* All age groups
* Infants
* Young children
* Adolescents

A

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

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3
Q

Ix for paediatric HF?

A

Blood tests: FBC, U&Es, LFTs, CRP, TFTs, BNP
Imaging: ECHO and CXR
ECG

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4
Q

Tx of paediatric HF?

A

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

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5
Q

What is cyanotic heart disease?

A

A range of congenital heart defects resulting in a right-to-left shunt which leads to systemic arterial desaturation and subsequent cyanosis.

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6
Q

Causes of cyanotic heart disease?

A

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.
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7
Q

Sx of cyanotic heart disease?

A

Visible cyanosis
Additional sx based on specific congenital defect involved

Typically presents within first few weeks of life

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8
Q

Ix for cyanotic heart disease?

A
  • Often found antenatally during USS
  • Otherwise, ECHO
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9
Q

Mx of cyanotic heart disease?

A
  • Surgical correction of defect
  • Heart transplant

While awaiting surgery can give prostaglandin E to maintain patency of the ductus arteriosus + temp. Relief from cyanosis

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10
Q

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?

A
  1. Ductus venosus - connects umbilical vein from placenta to inferior VC (allows blood to bypass liver)
  2. Foramen ovale - connects right atrium to left atrium (allows blood to bypass right ventricle and pul. circulation)
  3. Ductus arteriosus - connects pul artery to aorta (allows blood to bypass pul. circulation)
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11
Q

Describe how the 3 fetal shunts close after birth?

A
  1. Ductus venosus: stops functioning when umbilical cord is clamped → becomes ligamentum venosum
  2. 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
  3. Ductus arteriosus: Prostaglandins keeps it open → thus inc. blood oxygenation = dec circulating prostaglandins → closure of shunt → becomes ligamentum arteriosum
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12
Q

What are innocent murmurs in children and what are it’s typical feautures?

A

aka flow murmurs. Caused by fast blood flow through various areas of heart during systole.

Features:
* Soft
* Short
* Systolic
* Symptomless
* Situation dependent

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13
Q
  • What is it called when ductus arteriosus fails to close?
  • Describe the pathophysiology.
  • What is the usual cause?
A

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

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14
Q

Sx of patent ductus arteriosus?

A
  • SOB
  • Difficulty feeding
  • Poor wgt gain
  • Left subclavicular thrill
  • Collapsing pulse
  • Apex beat
  • Machinery murmur
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15
Q

Ix and tx for patent ductus arteriosus?

A

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.

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16
Q

What is atrial septal defect?

A

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.

17
Q

Causes of atrial septal defect?

A
  • Maternal alcohol consumption
  • Rubella infx during preggo
  • Maternal diabetes
  • Genetic
18
Q

Sx of atrial septal defect?

A

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

19
Q

Ix for atrial septal defects?

A

ECHO - GS
Other: CXR, cardiac MRI

20
Q

Mx of atrial septal defect?

A

Manage conservitavely
Surgical closure if larger defect

21
Q

Complications of atrial septal defect?

A
  • 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

22
Q

What is a ventricular septum defect?

A

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.

23
Q

Sx of ventricular septal defect?

A

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

24
Q

What are cdtns that cause pan systolic murmurs?

A
  • Ventricular septal defect
  • Mitral regurgitation
  • Tricuspid regurgitation
25
Q

Tx of ventricular septal defect?

A

Manage conservitavely
Surgically: transvenous catheter closure via the femoral vein or open heart surgery.
Give abx during procedures to reduce risk of infective endocarditis

26
Q

What is Tetralogy of Fallot?
Describe pathopyhsiology.

A

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

27
Q

RF for Tetralogy of Fallot?

A

Rubella infection
Increased age of the mother (over 40 years)
Alcohol consumption in pregnancy
Diabetic mother

28
Q

Sx of Tetralogy of Fallot?

A
  • 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.
29
Q

Tx of Tet spell and Tetarology of Fallot?

A

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 =

30
Q

What is rheumatic fever?

A

Autoimmune cdtn triggered by streptococcus bacteria. It is a multi-system disorder that affects joints, heart, skin and nervous system.

31
Q

Which bacteria typically causes rheumatic fever?

A

Streptococcus pyogenes - group A beta-haemolytic streptococcal.

32
Q

Sx of rheumatic fever + explain the involvement of each of the following:
1. Joint
2. Heart
3. Skin
4. Nervous system

A

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)

33
Q

Ix of rheumatic fever?

A

Throat swab for bacterial culture
ASO antibody titres (Anti-streptococcal antibodies (ASO) are antibodies against streptococcus)
Echocardiogram, ECG and chest xray

34
Q

What criteria is used for diagnosing rheumatic fever?

A

Jones criteria

35
Q
A

Phase 3a - Paediatrics (14 decks)

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