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Year 4 PAEDS > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

When does the cardiovascular system begin to develop?

A

End of the 3rd week

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2
Q

When does the heart start to beat?

A

Beginning of the 4th week

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3
Q

What supplies the foetus with oxygen?

A

Umbilical vein which emerges from the placenta

This carries oxygen rich blood from the mother to the inferior vena cava via the ductus venosus to the fetal heart

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4
Q

What carries oxygen-depleted blood from fetus to the placenta?

A

Two umbilical arteries

There are remnants of the umbilical arteries in the adult

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5
Q

What are the three shunts in fetal circulation?

A

1) Foramen ovale
2) Ductus arteriosus
3) Ductus venosus

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6
Q

Which shunts are critical during fetal life when the lungs are compressed, filled with amniotic fluid and non functional, and gas exchange is provided by the placenta?

A

Foramen ovale
Ductus arteriosus

Close shortly after birth when the newborn begins to breathe

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7
Q

What is the foramen ovale? Which way is the shunt?

A

An opening in the interatrial septum that allows blood to flow from RA to LA, hence bypassing the pulmonary circulation

A valve associated with this opening prevents backflow of blood during the foetal period

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8
Q

When does the foramen ovale close?

A

When the newborn begins to breathe and blood pressure in the atria increases

There is an increase in pressure in left side because there is a decrease in pulmonary resistance when baby takes their first breath - also the cold and the clamping of the cord causes a decrease in systemic resistance leading to a reactionary increase in BP

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9
Q

What is the ductus arteriosus? Which way is the shunt?

A

A short, muscular vessel that connects the pulmonary artery to the aorta

Most of the blood pumped from RV to pulmonary trunk is thus diverted to the aorta

Therefore, only enough blood reaches the foetal lungs to maintain the developing lung tissue

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10
Q

What happens when the ductus arteriosus closes?

A

When the newborn takes the first breath, pressure within lungs drops dramatically, and both the lungs and pulmonary vessels expand

As the amount of oxygen increases, the smooth muscles in the wall of the ductus arteriosus constrct, sealing off the passage

Eventually the muscular and endothelial components of the ductus arteriosus degenerate, leaving only the connective tissue component of the ligamentum arteriosum

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11
Q

What is the ductus venosus?

A

A temporary blood vessel that branches from the umbilical vein allowing much of the freshly oxygenated blood to bypass the liver and go directly to the fetal heart

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12
Q

When does the ductus venosus close?

A

Closes slowly during the first few weeks of infancy and degenerates to become the ligamentum venosum

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13
Q

What are heart murmurs?

A

Caused by turbulence of blood flow and my be innocent or pathological

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14
Q

How are heart murmurs classified?

A

Graded 1-6

Grade 1:

  • Murmur barely audible
  • No thrill

Grade 2:

  • Murmur soft and variable in nature
  • No thrill

Grade 3:

  • Murmur easily heard
  • No thrill

Grade 4:

  • Loud murmur
  • Thrill present

Grade 5:

  • Very loud murmur
  • Thrill present

Grade 6:

  • Murmur heart without stethoscope
  • Thrill present
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15
Q

What should be included when examining the heart of a child with a suspected murmur?

A

Check for radiation over the axilla, carotid arteries and the back

Listen in inspiration and expiration

Listen with the child lying down and standing up

Turn the child on the left side

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16
Q

Which types of murmur (systolic or diastolic) are always pathological?

A

Diastolic

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17
Q

What causes a diastolic murmur? (3)

A

1) Increased blood flow through a normal atrioventricular valve
2) Stenosis of a AV valve
3) Incompetence of the pulmonary or aortic vessels

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18
Q

What can how can systolic murmurs be described? (2)

A

Ejection systolic - diamond shaped in intensity

Pansystolic

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19
Q

What characteristics should be used to describe a murmur (5)

A

1) Systolic or diastolic
2) Character = blowing or harsh
3) Grade
4) Site of maximum intensity
5) Radiation

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20
Q

What is an innocent murmur?

A

Has no clinical significance

May be more apparent at times of illness or fever

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21
Q

How does an innocent murmur sound?

A

Musical

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22
Q

When is an innocent murmur heard?

A

Systole

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23
Q

Is there radiation in an innocent murmur?

A

No

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24
Q

Is an innocent murmur variable?

A

Yes - varies with posture and position

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25
Q

When is a patholologic murmur heard?

A

Diastole

Pansystolic

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26
Q

Describe how a pathological murmur sounds

A

Harsh or long

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27
Q

Does a pathological murmur radiate or have a thrill?

A

Yes may do either

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28
Q

What else is often associated with pathological murmurs?

A

Cardiac signs / symptoms

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29
Q

In which direction are shunts more common?

A

Left to right shunt

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30
Q

What can occur if there is a large, considerable volume is shunted left to right?

A

Hypertrophy
Ventricular dilatation
Congestive cardiac failure

= child presents with breathlessness but is not cyanosed

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31
Q

What is the most common congenital heart defect?

A

VSD

32% of CHD

Can be membranous or muscular

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32
Q

How may a VSD present?

A

If small = child may be asymptomatic

If large = breathlessness on feeding and crying, poor growth and recurrent chest infections

May be signs of HF

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33
Q

What may be heard on auscultation of a heart with a VSD?

A

A harsh, rasping, pansystolic murmur

Heard over lower left sternal border

In large defects = thrill is present and murmur radiates over the whole of chest (parasternal thrill)

34
Q

Is the loudness of a murmur proportional to the size of the shunt?

A

No

35
Q

What can be seen in on a CXR and ECG of a large VSD?

A

CXR - cardiomegaly and large pulmonary arteries

ECG - biventricular hypertrophy

36
Q

What is the management of VSD?

A

Prevention of endocarditis is important - prophylactic abx

Small muscular defects usually close spontaneously

Large membranous defects with cardiac failure are initially managed medically, but surgical treatment may be required

37
Q

What can happen if VSD are not corrected?

A

Increased pulmonary blood flow can lead to pulmonary HTN which eventually leads to reversal of the shunt and intractable cyanosis. This is life-threatening

= Eisenmenger’s syndrome

38
Q

When may an ASD be detected?

A

Later in childhood - the murmur is soft

39
Q

Describe the murmur in an ASD and what causes it

A

Systolic murmur heard in the second left interspace

Due to the high flow across the normal pulmonary valve (not due to flow across the ASD itself)

Second heart sound is widely split and ‘fixed’ (does not wary with respiration)

40
Q

How may a child with an ASD present?

A

Breathlessness
Tiredness on exertion
Recurrent chest infections

41
Q

What is the management of an ASD?

A

If defect is moderate or large, closure is carried out either by open heart surgery or using a cardiac catheter

42
Q

What is the prognosis of an ASD?

A

Usually good

If untreated, can develop cardiac arrhythmias in early adulthood

43
Q

List 3 innocent murmurs

A

1) Systolic ejection murmur
2) Pulmonary flow murmur
3) Venous hum

44
Q

What is a systolic ejection murmur?

A

Short systolic murmur occurring during ejection and heard along the left sternal edge at the apex

45
Q

What does a systolic ejection murmur sound like? When is it heard?

A

Musical - sounds like a tuning fork

Varies in intensity when child changes from lying to sitting, and is intensified by fever, excitement or exercise

46
Q

What is a pulmonary flow murmur?

A

Caused by rapid blood flow across a normal pulmonary valve

47
Q

What does a pulmonary flow murmur sound like? How is it best heard?

A

A brief, high-pitched blowing murmur, best heard in the second left intercostal space with the child lying down

48
Q

What is a venous hum?

A

Caused by flow through the systemic great veins

49
Q

What does a venous hum sound like? When is it heard?

A

Blowing, continuous murmur heard at the base of the heart just below the clavicles

Sounds like a soft hum during both systole and diastole

Varies with positioning of the head and disappears when the child lies down

50
Q

What CHD is associated with down syndrome?

A

Atrioventricular septal defect (AVSD)

40% of those with Down’s syndrome

51
Q

Which CHD presents with a collapsing pulse and in is more common in premature infants?

A

Patent ductus arteriosus

52
Q

How does a PDA murmur sound?

A

Pansystolic murmur in neonates

Continuous after 3 months of age

53
Q

Where does coarctation of the aorta usually occur?

A

At the origin of the ductus ateriosus

54
Q

Describe blood flow in coarctation of the aorta

A

Arteral blood flow bypasses the obstruction, reaching the lower half of the body through collateral vessels which enlarge

= LV hypertrophy - can lead to HF

55
Q

How may severe coarctation of the aorta present?

A

Severe cases = baby may collapse at the end of the 1st week of life when ductus ateriosus (through which systemic BF has been maintained) closes

56
Q

How does coarctation of aorta present?

A

Systolic murmur heard over left side of chest (esp back)

Disparity in pulses and blood pressure of arms and legs:

  • Right brachial and radial pulses are normal, but femoral pulses are absent or weak and delaued
  • HTN in right arm but not in legs
57
Q

What investigations are done for coarctation of aorta?

A

CXR - LV may be prominent, and rib notching may be seen where enlarged intercostal arteries have eroded underside of rubs

ECG - LV hypertophy

58
Q

What is the management of coarctation of the aorta?

A

Surgery to resect narrowed section of the aorta

59
Q

What is transposition of the great vessels?

A

Aorta arises from the RV and the pulmonary artery from the LV

60
Q

What happens to blood flow in transposition of the great vessels?

A

Mixing of venous and arterial blood occurs through the ductus arterosus and often through a septal defect which accompanies the condition

The less mixing of blood occurs between the two circulations, the more intense cyanosed the baby is

61
Q

How does transposition of the great vessels present?

A

Cyanosis (may be hard to spot)

Difficulty establishing feeds

62
Q

What investigations are done for transposition of the great vessels?

A

Pulse oximetry = cyanosis

CXR = narrow cardiac pedicle

ECG

63
Q

What is the long term management of transposition of the great vessels?

A

Surgery to switch origins of pulmonary artery and aorta

64
Q

What is the emergency management of a severely cyanosed child with poor systemic circulation in transposition of the great vessels?

A

Infusion of prostaglandin to maintain ductus arteriosus open

Emergency balloon septostomy to improve mixing of blood in the heart

65
Q

What is Fallot’s tetralogy?

A

1) VSD
2) Overriding of the aorta
3) Pulmonary stenosis
4) RV hypertrophy

66
Q

When does Fallot’s tetralogy present?

A

Rarely diagnosed in newborn

Presents with cyanosis at 3 months

67
Q

What is the prognosis of Fallot’s tetralogy?

A

Good

Treated with surgery

68
Q

What is a normal resting heart rate for:

1) Newborn
2) 2yrs
3) 4yrs
4) 6yrs+

A

1) Newborn: 110-150bpm
2) 2yrs: 85-125bpm
3) 4yrs: 75-115bpm
4) 6yrs+: 60-100bpm

69
Q

What do P waves represent?

A

Atrial depolarisation

70
Q

What does a P wave preceding a QRS complex represent?

A

Sinus rhythm

71
Q

What does the PR interval represent?

A

Time taken for the electrical activity to move between the atria and ventricles

72
Q

What does the QRS complex represent?

A

Depolarisation of the ventricles

73
Q

What does the ST segment represent?

A

Isoelectric lines that represents the time between depolarisation and repolarisation of the ventricles (contraction)

74
Q

What does the T wave represent?

A

Ventricular repolarisation

75
Q

What does the QT interval represent?

A

Time taken for the ventricles to depolarise and then repolarise

76
Q

Which chest leads give:

1) Septal view
2) Anterior view
3) Lateral view
4) Inferior

A

1) Septal view - V1, V2
2) Anterior view - V3, V4
3) Lateral view - I, aVL, V5, V6
4) Inferior view - II, III, aVF

77
Q

What are some common indications for paediatric ECGs?

A

1) Syncope, seizures, funny turns
2) Cyanotic episodes
3) Chest pain / exertion symptoms
4) Diagnosis of rheumatic fever, Kawasaki’s disease, pericarditis, myocarditis
5) Arrhythmias
6) CHD

78
Q

What may happen to the QRS axis in neonates?

A

Right axis deviation due to relative RVH in neonate

This regresses in first few months of life

Normal QRS varies with ages:

79
Q

What may happen to T waves in children?

A

T wave inversion in V1-3 = Juvenile T wave pattern

80
Q

What happens to the QRS axis with age?

A

Varies with age

1 week – 1 month: + 110°
1 month – 3 months: + 70° 
3 months – 3 years: + 60° 
Over 3 years: + 60° 
Adult: + 50°
81
Q

What ECG features may be normal in children?

A

1) Faster HR
2) Rightwards QRS axis
3) Marked sinus arrhythmia
4) Short PR and QRS
5) Slightly peaked P waves
6) Slightly long QTc
7) Q waves

Also:

  • Dominant R wave in V1
  • RSR pattern in V1

Year 4 PAEDS (23 decks)

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