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Paediatrics > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the two types of atrial septal defects?

Which is more common?

A

Secundum or Primium

Secundum - involves foramen ovale

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2
Q

What are they symptoms of an atrial septal defect?

A

can be none
recurrent chest infections/wheeze
arrthymias from 4th decade onwards

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3
Q

What are the signs of an ASD?

What are signs specific to ostium primum?

A
  1. Ejection systolic murmur - due to increased blood flow, best heard in upper sternal edge
  2. Fixed splitting of second heart sound (s2)
    - Ostium primum: due to AV valve abnormalities causing regurg - pansystolic murmur
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4
Q

What is the investigations for SD and what do you expect to see?

A

Echocardiography - Gold standard

CXR- cardiomegaly, enlarged pulmonary arteries

ECG:
Secuncum: RBBB and RAD
primium: RBBB and LAD

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5
Q

What are risk factors for ASD?

A
  1. down syndrome

2. feotal alcohol syndrome

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6
Q

What is the management?

A
  1. small - can resolve on its own
  2. secudnum - cardiac cath and insertion of occlusion device
  3. primium - surgical
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7
Q

What is the presentation of a small VSD?

A
  • Likely asymptomatic, will
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8
Q

What is the presentation of a large VSD?

A
  • tachychardia
  • tachypnoae
  • failure to thrive
  • recurrent chest infections
  • can have enlarged liver due to HF
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9
Q

What sort of murmur can you hear in VSD?

A
  • Pansystolic murmur, louder the smaller the defect
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10
Q

What investigations would you do and what do you expect to see in small and large VSD?

A
  • echo
  • CXE
  • ECG

normal in small VSD

Large VSD

  • CXR: cardiomegal, enlarged pulmonary arteries, pulmonary oedema
  • ECG: biventricular hypertrophy
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11
Q

What is the management of VSD?

A
  • drug therapy for HF - diuretics and captopril
  • additional calorie intake
  • surgery 3-6 months to avoid eisenmenger syndrome
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12
Q

What are complications of VSD?

A
  1. Eismenger syndrome - pressure in right becomes higher - reversal of blood flow R–>L causing deoxygenated blood to enter circulation = cynaosis (blue peripharies, pallor mouth)
  2. aortic regurg
  3. infective endocarditis
  4. RHF
  5. pulmonary HTN (pregnancy contraindicated)
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13
Q

Which conditions carry greater risk of VSD?

A
  1. Downs
  2. Patau
  3. Edwards
  4. fetal alcohol syndrome
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14
Q

What is a major risk with ASD?

A
  • paradoxical embolism

- can reach brain and cause stroke

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15
Q

What causes Eisenmenger syndrome?

A

reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.

This occurs when an uncorrected left-to-right leads to remodeling of the pulmonary microvasculature,

eventually causing obstruction to pulmonary blood and pulmonary hypertension.

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16
Q

What is Eusengmenger syndrome associated with?

A

ventricular septal defect
atrial septal defect
patent ductus arteriosus

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17
Q

What are the features of Eisengmenger syndrome?

A

original murmur may disappear

cyanosis
clubbing
right ventricular failure
haemoptysis, 
embolism
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18
Q

What is the management of eisengmenger syndrome?

A
  • early intervention

- heart lung transplant

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19
Q

Who is Atrioventricular septal defect common in?

A

downs syndrome

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20
Q

What does a largeAVSD result in?

A
  • pulmonary htn

- pulmonary vascular disease

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21
Q

What is the presentation of AVSD?

A
  • presents on antenatal scan
  • cyanosis at birth, HF at 2/3 weeks
  • no murmur heard. detected on echo
  • superior axis on ECG
  • hepatomegaly, oedema, poor feeding, failure to thrive, tachypnoea
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22
Q

How is VSD managed?

A
  • HF managed medically: diuretics + captopril
23
Q

What pathogen causes rheumatic fever?

Which age range?

A

Group A beta haemolytic streptococcus
- streptococcus pyogenes

5-15 yrs. proceeds to chronic in 80%

24
Q

What is the presentation?

A
  • latent interval of 2-6 weeks
  • followed by:
    pharyngeal/skin infections, polyarthritis,
    mild fever and malaise
25
Q

What is the Jones diagnostic criteria for rheumatic fever?

A

2 major

or

1 major and 2 minor

26
Q

What are major signs in Jones diagnostic criteria for rheumatic fever?

A
  1. Migratory Arthritis
  2. Carditis (endocarditis, myocarditis etc)
  3. Erythema marginatum
  4. Sydenham Chorea (2-6 months post infection, involuntary movements and emotional lability)
  5. subcutaneous nodules - rare
27
Q

What are the minor signs of RF?

A
  1. fever
  2. polyarthralgia
  3. raised CRP, ESR, Leucocytes
  4. ECG PR interval increased
  5. previous episode of RF
28
Q

What is the management of RF?

A
  1. bed rest, anti-inflammatory agents
  2. mycoarditis on echo - limit exercise and bed rest
  3. High dose aspirin
  4. Prednisolone if severe
  5. Infection: Benzylpenicillin
  6. HF: ACE-I (captopril) + diuretics
  7. Prophylaxis: Phenoxymethlpenicillin
29
Q

What is the most common cause of Infective endocarditis?

A
  • streptococcus aeurus
30
Q

What are RFs for infective endocarditis?

A
  • previous episode
  • congential Heart defects
  • prosthetic valves
31
Q

What are the signs of infective endocarditis

A
  1. Fever
  2. clubbing
  3. splinter haemorrhages
  4. anaemia
  5. splenomegaly
    6 HF, new murmur
  6. microscopic haematuria
32
Q

What investigations should you do for Infective Endocarditis

What is the management?

Prophylaxis?

A
  1. multiple blood cultures and multiple sites
  2. Echocardiogram

Management
Benzylpeniccilin + IV gentamicin

Prophylaxis - good dental hygiene, Abx not recommended

33
Q

How common is tetralogy of fallot? What is a possible cause?

A
  • most common cyanotic congenital heart disease

- chromosome 22 deletion

34
Q

What are the 4 components of tetralogy of fallot?

A
  1. right ventricular outflow obstruction
  2. Right ventricular hypertrophy
  3. Large ventricular septal defect
  4. overarching aorta
35
Q

What are the signs and symptoms of TOF?

How is it mostly diagnosed

A

Symptoms

  1. severe cyanosis
  2. hypercyanotic spells - squat
  3. feeding less
  4. failure to thrive

Signs

  1. clubbing
  2. loud harsh ejection systloc murmur - becomes shorter as cyanosis increases
36
Q

What investgations would you do for TOF and what do you expect to see?

A

CXR- RVH (boot shape), small eart, right sided aortic arch

ECG - normal at birth, RVH after

Echo

37
Q

What is the management of TOF?

A
  1. initial - medical, surgery at 6 months to close VSD and relieve ventricular outflow obstruction
  2. cyanosied in neonates - shunt to increase pulmonary outflow obstruction
  3. prolonged cyanotic spells
    - sedation and pain relief (morphine)
    - IV PROPANALOL - B-Blockers
    - IV FLUIDS
    - Bicarbonate to correct acidosis
    - muscle paralysis and artifical ventilation
38
Q

What occurs in transposition of great arteries?

What are possible risk factors

A
  • when great arteries are switched so aorta is connected to the right ventricle and pulmonary artery is connected to the left
  • maternal diabetes and rubella infection, alcohol, aged over40
39
Q

When is TGA detected and why?

What are the symptoms?

What are the signs?

A
  • on ductal closure around 2nd day of life

symptoms

  • cyanosis, profound and lfie threatening
  • acidosis
  • if ASD present - less severe symptoms

signs
- lound and single heart beat

40
Q

What investigations are done? for TGA

A
  • CXR
  • ECG
  • Echo
41
Q

What is the management of TGA?

A
  • maintain patency of ducts - Prostoglandin E - short term

- surgery

42
Q

What is tricuspid atresia

A
  • when the tricuspid valve (between right atrium and ventricle) has not developed
43
Q

What is the presentation of tricuspid atresia?

A
  • may be well at birth but will quickly become cyanosed as a newborn, breathless
  • mixing of systemic and pulmonary circulation in left atrium due to ASD
44
Q

What is the management of tricuspid atresia?

A
  • shunt insertion

- pulmonary artery banding to reduce pulmonary blood flow if breathless

45
Q

What is persistent ductus arteriosis?

What does it result in?

A

when the connection between the pulmonary artery and the descending aorta does not close up as it should 1 month after birth

  • results in left to right shunt - acyanotic
46
Q

How does ductus arteriosis present?

A
  1. machinar constant murmur (through systolic and diastolic)
  2. left subclavicular thrill
  3. large volume collapsing/bounding pulse
  4. can be heart failure if the gap is large - hepatomegaly and splenomegaly
47
Q

What is the management?

A
  1. Indomethacin - PE2 inhibitor

2. Surgery

48
Q

What are causes of HF in neonates?

A
  • obstructed systemic circulation (hypoplastic left heart syndrome, critical aortic valve stenosis, severe coarction of aorta)
49
Q

What causes HF in infants?

A
  • high pulmonary blood flow - VSD, AVSD, large persistant ductus arteriosis
50
Q

What causes HF in older children and adolescents

A
  • Eisenenmenger syndrome (RHF only)
  • rheumatic heart disease
  • cardiomyopathy
51
Q

What are the symptoms of HF

A
  • breathelessness
  • sweating
  • poor feeding
  • recurrent chest infections
52
Q

What are signs of HF

A
  • failure to thrive
  • tachypnoea
  • tachycardia
  • heart murmur - gallop rhythm
  • enlarged heart
  • hepatomgely
  • cold peripheries
53
Q

Management HF

A
  • ACE-i

- Diuretics

Paediatrics (9 decks)

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