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LS YEAR 4 Paediatrics > cardiovascular > Flashcards

cardiovascular Flashcards

1
Q

what is an innocent murmur?

A

an extra or unusual sound made by the heart
it is usually the sound of blood and resembles a whooshing or swishing sound
two most common types are flow murmur and venous hum

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2
Q

are they common?

A

They are very common and harmless

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3
Q

how are they managed

A

no treatment needed nor follow-up as they tend to disappear with age

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4
Q

key features of an innocent murmur?

A 
non-radiating
sensitive- disappear or change with position
short duration 
soft- low amplitude
single
systolic
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5
Q

what is infective endocarditis

A

infection of the endocardium

seen with vegetations on the valves commonly

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6
Q

symptoms of infective endocarditis

A 
from Jane
fever
roth spots
osler node
murmurs
janeway lesions
anaemia/pale
nail changes-splinter haemorrage
emboli
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7
Q

what is rheumatic fever

A

a fever known as an important cause of cardiac disease worldwide but low incidence in developed countries

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8
Q

why does it develop?

A

in response to group a beta haemolytic streptococcus infection

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9
Q

key features of rheum fever

A

occurs after a latent phase 2-6 weeks between symptoms and previous infection

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10
Q

what is used for rheum fever

A

jones criteria
2 major
or 1 major and two minor

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11
Q

examples of major and minor symptoms

A

major: polyarthritis, erythema, nodules, pericarditis , chorea
minor: fever, arthralgia, prolonged PR interval, increased ESR/CRP

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12
Q

how do you manage rheum fever

A

corticosteriods
anti-inflammatory meds
antibiotics
duietrics if signs of heart failure

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13
Q

what are the congenital heart diseases presenting with cyanosis

A

tetrology of fallots

transposition of the great arteries

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14
Q

what are the congenital heart diseases presenting with murmur

A

pul valve stenosis

asd

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15
Q

what are the congenital heart diseases presenting with heart failure

A

vsd
asvd
pda

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16
Q

what are the congenital heart diseases presenting with shock

A

coartaction of aorta

aortic stenosis

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17
Q

which four are cyanotic and which are not

A 
cyanotic:
TETRAOLOGY OF FALLOT
TRICUSPID ATRESIA
TRANSPOITION OF GREAT ARTERIES 
TOTAL ANOMALOUS PULM DRAINAGE
non-cyaotnic 
ASD
VSD
PDA
DEXTROCARDIA
aortic stenosis
coarctation of aorta
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18
Q

what is fallot tetralogy seen with

A

downs

di George syndrome

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19
Q

what are the four things seen with fallots?

A

overriding aorta
right ventricular hypertrophy
pulmonary stenosis
VSD

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20
Q

how can children present or overcome it?

A

squatting position with knee chest point either lying or over parents shoulder

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21
Q

symptoms with fallots

A

low birth weight
cyanosis
paraoxymal hypercynotic stells- unpredictable restlessness, tachypnoea, pale and floppy

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22
Q

investigations for fallots

A

xray
echo
ecg

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23
Q

treatment of fallots

A

prostaglandin E infusion and surgery-blalock tausing surgery

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24
Q

what is a VSD

A

septal defect between ventricles causing mixing of blood

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25
Q

stats regarding vsd

A

25% of chd

most common CHD

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26
Q

what is a physical sign with vsd

A

pansystolic murmur

can have palpable thrill

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27
Q

are there symptoms with vsd

A

mostly asymptomatic

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28
Q

management of vsd

A

most will spontaneously close and the murmur will disappear
manage heart failure
surgery if risk of heart failure

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29
Q

if vsd has symptoms what can it be

A

recurrent chest infections
breathlessness
heart failure if untreated

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30
Q

what can cyanosis be secondary to?

A

esienmenger syndrome

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31
Q

if large vsd what can be present on signs on X-ray and ecg

A

similar signs on X-ray to heart failure

ecg- biventricular hypertrophy and signs of pulmonary hypertension

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32
Q

what is an ASD?

A

atrial septal defect is a gap in the septum between the atria

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33
Q

how does it present

what type of shunt

A

LA to RA shunt 7% of CHD, increased blood flow on right side, usually presents with systolic murmur in upper left sternal edge and fixed split s2.

34
Q

what are the two types of ASD?

A

ostium secundum

and ostum primum (partial avsd)

35
Q

where is aostium secundum located

A

foramen ovale

36
Q

who is aostium secundum seen in

A

3x more common in girls

37
Q

symptoms of an asdostium secundum

A

often asymptomatic

rarely leads to heart failure

38
Q

management of asdostium secundum

A

and closure needed by surgery in childhood even if
asymptomatic as complications can present in 3rd decade of life
this is done by occlusion device catherization or open heart surgery

39
Q

discuss partial AVSD

whats it associated with

A

this is a more serious ASD
left to right shunt with valve incompetence

three leaflet MITRAL valve

40
Q

whats AVSD seen with?

A

DOWNS

41
Q

symptoms of partial AVSD

A

small defects- asymptomatic

large- recurrent chest infection ad to heart failure

42
Q

prognosis

A

dependent on left right shunt degree

and severity mitral regurg

43
Q

what is Turner syndrome associated with

A

coarctation of the aorta

44
Q

what is downs associated with

A

ASD
VSD
ASVD
tetralogy of fallots

45
Q

what is trisomy 13 associated with

A

asd
vsd
pda

46
Q

what is tromsy 18 associated with

A

same as previous and

ToF, coarctation of A

47
Q

what is di George seen with

A

ToF

48
Q

how common Is pda?

A

1-2 per 1000

seen with preterm babies

49
Q

how is PDA defined

A

patent duct present after 1 month after the date that the child should of been orn

50
Q

presentation of pda

A

low diastolic pressure due to blood flowing back into pul artery

breathlessness

51
Q

signs of PDA

A

wide pulse pressure
bounding peripheral pulses
continue or macherniery murmur in left infraclavicular area

52
Q

managemennt of pda

A

diuetrics
surgery ligation if doesn’t close itself-rare
device closure with cardiac catheter at 1 year

53
Q

prognosis of pda

A

most spontenously close

54
Q

what is dextrocardia

A

when heart is located on right side of body

55
Q

what is coarctation of the aorta

A

congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. The word “coarctation” means narrowing. Coarctations are most common in the aortic arch.

56
Q

where is common site of coA

A

distal to the origin of the left subclavian artery

at ductus arteriosus level

57
Q

what occurs

A

bp is elevated in vessel proximal to the obstruction and extensive collateral circulation develops

58
Q

when do most occur

A

In neonate period and presentation within first 48 hours when duct closes

59
Q

clinical features of coarctation of aorta

A

h poor feeding, lethargy, tachypnea or CCF and shock.

Baby will often become ill very quickly as the DA closes.

Pulses commonly reduced and there may be delay between upper and lower limbs as well as a difference in BP (radio-femoral delay).

Can see differential cyanosis with upper body pink but legs blue.

A systolic murmur in the left infraclavicular area but a range of murmurs can occur due to collateral circulation (thrills or hums).

Ejection click if associated with bicuspid aortic valve (85%). If presenting late then can cause headache, nosebleeds, neuro problems, cold feet, muscle weakness.

60
Q

what is COa ASSOCIATED WITH

A

berry aneurysms and subsequent SAH

61
Q

investigations

A

Antenatal US
 CXR: CCF, indentation of aortic shadow (aortic notch)
 Echocardiogram
 U&Es – renal impairment
 BP: HTN in upper limbs, hypotension in lower limbs.
 ECG: LVH

62
Q

management

A

prostaglandin e Infusion to keep DA openreat CCF with diuretics and inotropes. Anti-hypertensives for HTN.
 Treat post correction HTN with ACE-i
 Balloon angioplasty or surgery

63
Q

what is HOCM associated with>

A

sudden cardiac death in young people-esp males

64
Q

key rhing to remember with paediatric ecg

A

right ventricle is dominant

left becomes dominant as they get older

65
Q

PR interval in paeds vs adult

A

> 0.2 in adults is abnormal

in paeds its >0.16

66
Q

t wave in paeds

A

T-T: The T wave is upright for the first week of life, then is inverted until adolescence.

67
Q

rate for ecg in children

A

< 2yo max HR is 160
2-7yo max 140
7-15 yo max 130

68
Q

what is transposition of great arteries?

A

right ventricle connected to aorta
pulmonary artery connected to left ventricle
this is opposite of normal
medical emergency

69
Q

key thing in transpotison of great arteries

A

prevent acidosis
hypoxia
hypotthermia
and hypoglycemia

within first few days of life
prevent heart failure

70
Q

how is transposition of great arrteries resolves

A

surgery In first two weeks of life to switch
balloon atrial septostomy
prosgralandin e infusions

71
Q

describe features of pulmonary stenosis

A 
RVH on ECG
RV heave
thrill
loud systolic murmur 
backward MURMUR 
balloon dilaiton
72
Q

heart failure presents when in kids

A

first 3 months

73
Q

sx of hf

A 
hepatomegaly
sweating 
tachycardia dn tachypoenia
breathlessness 
poor feeding/FFT
oedema
74
Q

what is seen in ASD

A

systolic murmur
s2 split fixed
rv heave

75
Q

what does fixed mean

A

does not change with respiration

76
Q

what is seen with marfans

A

aortic ansuerym

mitral valve prolapse

77
Q

three things with turner

A

aortic root dilation
aortic bicuspid valve
coarctation of aorta

78
Q

which has left ventricular thrill

A

PDA

79
Q

where are each heard best
PDA
innocent murmur
VSD

A

PDA -left clavicle
under and above clavicle
VSD- left sternal Edge, 3-4th ICS

80
Q

what can diminish an innocent murmur

A

compression of IJV or lying down

81
Q

pulses bisferiens indicates what?

A

Pulsus bisferiens = biphasic pulse

- aortic valve - stenosis and regurgitation

LS YEAR 4 Paediatrics (24 decks)

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