Cardiovascular Flashcards
What proportion of children have an innocent murmur detected?
50%
What are the characteristics of an innocent murmur?
- Normal heart sounds
- Early/ES – NEVER just diastole
- Varies with position and respiration
- No clicks or thrill
What clinical aspects of a murmur should prompt cardiology review?
- Child under 1y
- Additional AbN findings
- Loud murmur
- Murmur is diastolic or continuous
- No variation with respiration
What are common causes of generalised oedema in children?
- Renal disease
- Liver disease
- Allergy
- Cardiac disease
- Protein-losing enteropathy
What’s the first distinguishing feature for the different causes of generalised oedema?
Circulatory overload
Which causes of generalised oedema have a circulatory overload?
- Acute GN/nephritic syndrome
- Cardiac disease
What test will distinguish the circulatory overload causes of generalised oedema?
Urinalysis (proteinuria, haematuria)
Which causes of generalised oedema don’t have a circulatory overload?
- Nephrotic syndrome
- Chronic liver disease
- Protein losing enteropathy
What type of vasculitis is HSP?
Small vessel
What is the classic triad of HSP?
- Non-blanching purpura on buttocks and extensor surface of LLs
- Arthropathy
- Abdo pain
What Ix will you do in suspected HSP?
- Tests to exclude coagulopathy and sepsis
- Urinalysis for haematuria
- UEC
Why does suspected HSP require escalation to a consultant or registrar?
They have a purpuric rash
What would be cause for admission with HSP?
- Abdo complications requiring surgical review
- Renal complications
- Severe joint/abdo pain requiring inpatient analgesia
What are the possible abdominal complications of HSP?
- Intussusception
- Bloody stools
- Haematemesis
- Bowel perforation
- Pancreatitis
What follow up is required for HSP? Why?
Renal follow up as AbN related to HSP-nephropathy can develop up to 6m later
What type of vasculitis is Kawasaki’s disease
Medium vessel
What age group does Kawasaki’s disease normally affect
Those under 5
What are the requirements for diagnosis of Kawasaki’s disease
Fever for 5 or more days, PLUS 4 of:
- Bilat, non-purulent conjunctivitis
- Mucosal membrane changes
- Unilat cervical lymphadenopathy
- Polymorphous rash
- Peripheral changes like hand & foot erythema & oedema
AND exlusion of diseases with a similar presentation
What Ix are required for Kawasaki’s disease?
- FBE for neutrophilia, thrombocytosis, anaemia
- Echo at presentation & 6 weeks pater
What is the Mx for Kawasaki’s disease
- Admit
- Prompt IVIG
- Aspiring for 6/52 or more
Whats the most important potential complication of Kawasaki’s disease?
Aneurism of major arteries, especially coronary As
Define malignant HT
Symptomatic HT with nausea, headaches etc
Why is malignant HT a medical emergency?
Risk of CCF, APO, and encephalopathy
What percentage of children are born with a congenital heart disease?
Just under 1%
