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Paediatrics > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the most common congenital heart lesions?

A 
Ventricular septal defect (30%)
Persistent arterial duct (12%)
Atrial septal defect (7%)
Pulmonary stenosis (7%)
Tetralogy of Fallot (5%)
Transposition of the great arteries (5%)
Aortic stenosis (5%)
Coarctation of the aorta (5%)
Atrioventricular septal defect (2%)
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2
Q

What are the circulatory changes at birth?

A

Cutting umbilical vessels -> increased systemic vascular resistance

Crying -> decreased pulmonary vascular resistance and increased pulmonary blood flow

Closure of ductus arteriosus, foramen ovale and ductus venosus

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3
Q

What affects the ductus arteriosus?

A

Closed by:

  • oxygen
  • bradykinin/indomethacin (COX inhibitor)

Opened by:

  • hypoxia
  • prematurity
  • prostaglandin E2
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4
Q

What are causes of heart disease?

A

Genetic

  • familial
  • chromosomal - Trisomy 21 -> AVSD
  • syndromes - CHARGE, DiGeorge, Marfans

Maternal factors

  • IU infections - rubella -> PDA
  • medication - lithium, valproate, isoretinoin
  • diseases - maternal diabetes, SLE -> heart block
  • drugs - FAS -> ASD or VSD

Metabolic diseases
- cardiomyopathies

Infections

Childhood diseases
- Kawasaki’s

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5
Q

How do children with heart defect present?

A 
Antenatal scans
Newborn period - when duct closes
Heart murmur on check
Heart failure
Palpitations
Collapsing
Fever and unwell
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6
Q

What are the duct dependent lesions?

A 
Coarctation of the aorta
Transposition of the great arteries
Pulmonary stenosis/atresia
Aortic stenosis/atresia
Hypoplastic left heart syndrome

KEEP THE DUCTUS ARTERIOSUS OPEN

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7
Q

How does heart failure present in children?

A 
Poor feeding
FTT
Lethargy
Sweating
Hepatomegaly
Tachypnoea without recession
Pallor/cyanosis
Poor perfusion
Tachycardia
Murmur
Thrill
Gallop rhythm
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8
Q

What is an innocent murmur?

A

Asymptomatic patient
Soft blowing sound
Systolic
Left sternal edge with no radiation

Heard during febrile illness or anaemia due to increased cardiac output

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9
Q

What are causes of congenital heart disease

A

3 holes (left->right) - BREATHLESS or ASYMPTOMATIC

  • VSD
  • PDA
  • ASD

3 blocked pipes

  • coarctation of the aorta
  • pulmonary stenosis
  • aortic stenosis

3 BLUE babies (right->left)

  • tetralogy of Fallot
  • transposition of the great arteries
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10
Q

What is ventricular septal defect?

A

Commonest CHD
Blood flows from left -> right ventricle
Pansystolic
Loudest over LLSE (tricuspid area)

If large, may have heart failure and recurrent chest infections

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11
Q

What are the two types of ASD?

A

Secundum ASD (most common) - involes FO

Partial atrioventricular septal defect (AVSD) (primum) - involves atrioventricular valves

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12
Q

How does ASD present?

A

Asymptomatic
Recurrent chest infections/wheeze

Ejection systolic murmur ULSE with split 2nd heart sound

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13
Q

What investigations are done for ASD?

A

CXR

  • cardiomegaly
  • enlarged PA

ECG

  • secundum ASD - partial right bundle branch block
  • AVSD - defect at AV node so abnormal axis
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14
Q

How is ASD managed?

A

Cardiac catherisation

Surgery at 3-5 years

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15
Q

How are large VSDs investigated and managed?

A

CXR

  • cardiomegaly
  • enlarged PA
  • pulmonary oedema

Diuretics and captopril
Surgery at 3-6 months - prevent permanent lung damage from pulmonary hypertension

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16
Q

What is PDA?

A

Failure of ductus arteriosis to close after 1 month

Blood flows from aorta to pulmonary artery

Normal in prems

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17
Q

How does a PDA present and how is it managed?

A

Continuous murmur beneath left clavicle
Collapsing pulse

Coil or occlusion device at 1 year to prevent bacterial endocarditis and pulmonary vascular disease

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18
Q

What is pulmonary stenosis?

A

Pulmonary valve leaflets are partly fused so exit from right ventricle is restricted

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19
Q

How does pulmonary stenosis present?

A

Most asymptomatic
If critical then duct dependent and cyanotic

Ejection systolic murmur at ULSE

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20
Q

What is aortic stenosis?

A

Aortic leaflets are partly fused so left ventricular exit is partly restricted

Associated with mitral valve stenosis and coarctation of the aorta

21
Q

How does aortic stenosis present?

A

Asymptomatic
If severe - reduced exercise tolerance, chest pain, syncope
In neonates with critical AS and duct dependent circulation - SHOCK

Carotid thrill
Ejection systolic murmur URSE -> neck

22
Q

How is aortic stenosis treated?

A

Balloon valvotomy

If severe, then aortic valve replacement

23
Q

How does coarctation of the aorta present?

A

Asymptomatic
Systemic hypertension in right arm
Ejection systolic murmur at USE
Radio-femoral delay

24
Q

What investigations are done for coarctation of the aorta?

A

CXR

  • rib notching - development of large collateral intercostal arteries
  • visible notch in aorta

ECG
- left ventricular hypertrophy

25
Q

How is coarctation of the aorta managed?

A

Stent inserted via cardiac catheter

26
Q

What causes outflow obstruction in the sick infant?

A

Coarctation of the aorta
Interruption of the aortic arch
Hypoplastic left heart syndrome

27
Q

How do outflow obstructions present?

A

Heart failure and shock in neonatal period

Commence prostaglandins

28
Q

How does coarctation of the aorta present in neonates?

A

Examination on first day is normal

Collapse on day 2 when ductus arteriosus closes (this constricts the aorta where it inserts)

29
Q

What is tetralogy of Fallot?

A

Large VSD
Overriding aorta
Pulmonary stenosis -> right ventricular outflow obstruction
Right ventricular hypertrophy

30
Q

How does tetralogy of Fallot present?

A

Most diagnosed antenatally or following identification of murmur within first 2 months

Severe CYANOSIS
Hypercyanotic spells -> MI, CV accidents or death
Squatting on exercise

Clubbing
Loud ejection systolic murmur

31
Q

How is tetralogy of Fallot investigated?

A

CXR
- small heart

ECG

  • normal at birth
  • right ventricular hypertrophy later
32
Q

How is tetralogy of Fallot managed?

A

Medical with surgery at 6 months

Shunt from subclavian to pulmonary artery to increase pulmonary blood flow

33
Q

What is transposition of the great arteries?

A

Aorta connected to right ventricle
Pulmonary artery connected to left ventricle

Blue blood goes to body and pink blood to lungs
Unless there is mixing of blood this is incompatible with life

Associated with VSD, ASD and PDA

34
Q

How does transposition of the arteries present?

A

CYANOSIS on day 2 when duct closes

No mumur

35
Q

How is transposition of the arteries investigated?

A

CXR

- narrow upper mediastinum

36
Q

How is transposition of the arteries managed?

A

Prostaglandin infusion maintains ductus arteriosus

Surgical tearing of the atrial wall to allow mixing of the blood

Surgery to reassign vessels done in neonatal period

37
Q

What is Eisenmenger syndrome?

A

Long standing L->R shunt (ASD, VSD, PDA) causes pulmonary arteries to become thick (pulmonary hypertension)

Shunt decreases with time until it reverses and teenager becomes blue
Die of right heart failure

38
Q

What is cyanosis?

A

> 5g/dl of deoxygenated Hb
Impossible in profound anaemia
Can be normal in polycythaemia

39
Q

Which cardiac abnormality is associated with trisomy 21?

A

AVSD

40
Q

What is coarctation of the aorta associated with?

A

Bicuspid valve
VSD
Turner’s

41
Q

What is bicuspid aortic valve?

A

Two aortic valvelets fuse

Often no problem but can become calcified in later life -> stenosis and murmur

42
Q

How does SVT present?

A

Most common childhood arrythmia and presents with heart beat 250-300/min

Poor cardiac output pulmonary oedema
Heart failure or hydrops fetalis

43
Q

How is SVT managed?

A

Vagal stimulation - carotid sinus massage or ice cold pack to face
IV adenosine blous - induces AV block
Electrical cardioversion with shock

Maintenance therapy - flecainide or sotalol

44
Q

What is Noonan’s sydrome associated with?

A

PS
Hypertrophic cardiomyopathy - breathlessness
Septal defects

45
Q

What is Marfan’s associated with?

A

Aortic aneurysm or dissection

Mitral and tricuspid valves can prolapse -> regurgitation

46
Q

What is myocarditis?

A 
Viral infection (influenza, coxsackie, adeno) reaches the heart
Can occur after or during polio, rubella, Lyme disease

Body tries to fight disease, resulting chemicals cause damage -> heart muscle becomes swollen and thick

47
Q

What is sub-acute bacterial endocarditis?

A

Most commonly a-haemolytic streptococcus

Can occur in children with any CHD except secundum ASD
Esp VSD, coarctation, PDA or with prosthetic material

Fever, malaise, raised ESR

48
Q

How is SBE investigated and treated?

A

Multiple blood cultures
High dose penicillin with aminoglycoside for 6 weeks

Prophylaxis is good dental health

Paediatrics (14 decks)

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