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Phase 3A - Paediatrics > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the hallmarks of an innocent murmur?

A

7’s inoSSents

  1. Soft
  2. S1 and S2 normal (heart sounds normal)
  3. Symptomless
  4. Systolic
  5. Short
  6. Standing/ sitting may vary
  7. Special tests normal (ECG/CXR/ECHO normal) also comma only left sternal edge (no radiation)
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2
Q

What are the hallmarks of pathological murmurs?

A
  1. Diastolic
  2. Holosystolic
  3. Harsh
  4. Grade > 3/6
  5. Abnormal split S2
  6. Extra sounds “click”
  7. Louder with standing
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3
Q

Types of acyanotic murmurs

A

VSD (ventricular septal defect) > PDA (patent ductus arteriosus) > ASD (atrial septal defect)

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4
Q

What are acyanotic murmurs

A

They are left to right shunts there is no cyanosis because it’s oxygenated blood being shunted

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5
Q

What can acyanotic murmurs cause

A

They can cause pulmonary hypertension leading to Eisenmenger’s syndrome

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6
Q

How does an acyanotic murmur lead to Eisenmenger’s syndrome

A

Prolonged pulmonary hypertension due to a left-to-right shunt causes reactive constriction with permanent remodeling of pulmonary vessels → irreversible pulmonary hypertension
Right ventricle hypertrophies to compensate for pulmonary hypertension → right ventricular pressure increasing and eventually exceeding left ventricular pressure → reversal of blood flow → onset of cyanosis (either at rest or during exercise), digital clubbing, and polycythemia

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7
Q

What is the most common type of coronary heart disease

A

VSD

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8
Q

What is the presentation of VSD?

A

Small: asymptomatic, thrill over the lower sternal edge, quiet 2nd heart sound
Large: HF, failure to thrive, chest infections after 1 week of age, soft pansystolic or no murmur. Loud second heart sound

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9
Q

What are the tests for VSD?

A

Small: ECHO
Large: CXR, ECG, ECHO

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10
Q

What is the management of VSD?

A

Small: most close spontaneously
Large: HF with diuretics and captopril, surgical closure

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11
Q

What is PDA?

A

Failure of the ductus arteriosus to completely close postnatally

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12
Q

What is the presentation of PDA?

A

Continuous machinery murmur beneath the left clavicle = burrrr durrrr

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13
Q

What tests do you do for PDA?

A

ECHO

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14
Q

What is the management of PDA?

A

Asymptomatic just close to reduce endocarditis risk via catheter
Symptomatic close immediately

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15
Q

How do you close PDA?

A

Pharmacologically using indomethecin inhibits the prostaglandin synthesis with indomethacin or ibuprofen induces the closure of the ductus in preterm infants.

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16
Q

Why would you keep the PDA open

A

If needed for survival in transposition of the great vessels, tetralogy of Fallot, hypoplastic left heart

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17
Q

Symptoms of ASD

A

Can be asymptomatic

If severe HF, recurrent chest infection

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18
Q

What are the signs of ASD?

A

Wide fixed splitting 2nd heart sound

Ejection systolic murmur

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19
Q

What are the investigations of ASD?

A

CXR, ECG, ECHO

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20
Q

What is the management of ASD?

A

Surgery

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21
Q

What are the complications of ASD?

A

Risk of arrhythmia as as adults (AF/SVT)

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22
Q

What are examples of outflow obstructions

A

Aortic stenosis (ejection systolic murmur), pulmonary stenosis (ejection systolic murmur), coarctation (radiofemoral delay)

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23
Q

What condition presents with coarctation of the aorta

A

Turner’s syndrome

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24
Q

How does coarctation present

A

Ejection systolic murmur at the L upper sternal edge
High BP in the right arm
Rib notching on CXR -3 sign

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25
Q

What is the management of coarctation

A

Stent if severe

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26
Q

Murmur of wide fixed splitting of S2 “lub splat”

A

ASD

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27
Q

Pansystolic murmur “burrrr”

A

VSD and mitral regurgitation

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28
Q

Ejection systolic murmur “burrrr de”

A

Aortic stenosis

Pulmonary stenosis

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29
Q

Continuous machinery murmur “burrrrdurrrr”

A

Patent ductus arteriosus

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30
Q

What are cyanotic murmurs?

A

Truncus arteriosus, pulmonary atresia, hypoplastic left heart, tetralogy of fallot, atrioventricular septal defect, transposition of great arteries
They are right to left shunts
Cyanosis (deoxygenated blood being shunted)

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31
Q

What are the cardinal symptoms of tetralogy of fallots

A 
Pulmonary stenosis (causing large VSD) 
Right ventricular hypertrophy (RVH)
Overriding aorta 
VSD 
Ejection systolic murmur - left sternal edge
32
Q

Presentation of tetralogy of fallots

A

Cyanosis on exercise
Clubbing
Right parasternal heave
Cyanotic spells when upset

33
Q

Investigations for tetralogy of fallot

A

CXR - boot shaped heart

ECHO - increased right ventricular size

34
Q

Management of tetralogy of fallot

A

Bets blockers for hypoxic spell

Palliative surgery = blalock taussig shunt

35
Q

Presentation of transposition great arteries

A

Cyanosis from birth

36
Q

What is transposition of the great arteries

A

In transposition of the great arteries, the positions of the pulmonary artery and the aorta are switched. The pulmonary artery is connected to the left ventricle, and the aorta is connected to the right ventricle.
Oxygen-poor blood circulates through the right side of the heart and back to the body without passing through the lungs. Oxygen-rich blood circulates through the left side of the heart and directly back into the lungs without being circulated to the rest of the body.

37
Q

Tests for transposition of the great arteries

A

CXR - egg on side appearance

ECHO

38
Q

What is the management of transposition of great arteries

A

Prostaglandin infusion to maintain PDA
Balloon atrioseptostomy tears atrial septum to make ASD
Graft surgery

39
Q

What congenital murmurs do you get with Downs

A

AVSD, VSD, ASD

40
Q

What congenital murmurs do you get with Turners

A

Atrial stenosis and coarctation

41
Q

What congenital murmurs do you get with trisomy 13 + 18

A

Complex septal defects

42
Q

What congenital murmurs do you get with Williams

A

Elfin features

Supravalvular aortic stenosis

43
Q

What congenital murmurs do you get with noonans

A

Tricuspid stenosis and septal defects

44
Q

Down’s syndrome increases the risk of

A 
Duodenal atresias
Squint 
Hypothyroidism 
Leukaemia 
Hirschprung’s disease 
Deafness
45
Q

Features of Down’s syndrome

A 
Squint 
Epicanthic fold 
Flat bridge of nose 
Brushfield spots on iris
Open mouth
Protruding tongue 
Hands - single transverse palmar crease, short fingers, curved little finger
Feet - sandal gap between big toe and other digits
46
Q

What is Kawasaki disease

A

acute, necrotizing vasculitis of unknown etiology -small and medium vessels

47
Q

When does Kawasaki disease present

A

6 months to 4 years

48
Q

What are the clinical features of Kawasaki disease

A 
Fever for >5 days 
Four of
Conjunctivitis 
Red mucous membranes 
Strawberry tongue 
Cervical LNs
Rash 
Palm changes
49
Q

Complicates of Kawasaki disease

A

Follow up echos - risk of coronary artery aneurysms

50
Q

Treatment of Kawasaki disease

A

Prompt treatment with IVIG and aspirin for 6 months

51
Q

Fetal circulation

A

In utero oxygenated blood is provided by the placenta
Fetal lung is bypassed by most circulating blood
High pulmonary blood pressure means blood follows alternate path via:
Foramen ovale (from RA to LA)
Ductus arteriosus (from PA to aorta)

52
Q

When does rheumatic fever occur

A

2-6 weeks after strep pyogenes infection (group a beta haemolytic strep)

53
Q

Rheumatic fever can lead to

A

Mitral stenosis or aortic regurgitation

54
Q

How is rheumatic fever diagnosed

A

Strep positive throat swab
ASO titre
Duckett Jones major/minor criteria

55
Q

What is the major Jones criteria

A 
Pancarditis (pericarditis, endocarditis, myocarditis)
Polyarthritis
Sydenham chorea
Subcutaneous nodules 
Erythema marginatum
56
Q

What is the minor Jones criteria

A 
Fever
Arthralgia
Prolonged PR interval
Increased ESR of CRP
leukocytosis
57
Q

Jones diagnosis criteria

A

2 major criteria or 1 major and 2 minor criteria

58
Q

What is Eisenmenger’s syndrome

A 
Shunt reversal 
Initially large left to right shunt 
Due to blood shunted right, develop pulmonary artery hypertension to the point of right pressure exceeding left = shunt reversal = cyanosis 
Acquired cyanotic heart disease 
Poor prognosis
59
Q

Cyanotic from birth

A

Transposition of the great arteries

60
Q

Cyanotic without murmur

A

Transposition of the great arteries

61
Q

Cyanotic on crying/day 2-3 of life

A

Tetralogy of fallot

62
Q

Cyanosis with Down’s syndrome

A

AVSD

63
Q

Acquired cyanotic heart disease

A

Eisenmenger’s syndrome

64
Q

How would serious heart disease present in children?

A

Poor growth, breathlessness, pallor, cyanosis

65
Q

How does serious heart disease present in babies?

A

Feeding problems
Breaking off in mid-feed
Panting respiration
Sweating

66
Q

How does heart disease present in older children?

A

Lack energy and tire easily

67
Q

What character of pulse in aortic stenosis

A

Low volume

68
Q

What can a chest X-ray show?

A

Cardiac size and pulmonary vasculature

69
Q

What can an ECG show?

A

Info on the relative size of the cardiac chambers and on cardiac stain

70
Q

What are the changes in the circulation at birth?

A

Umbilical cord is clamped and cut cutting off flow to and from the placenta
Lungs become aerated and pressure in the pulmonary circulation drops
Extra blood pours into the lungs as a result of this dropping pressure and returns via the pulmonary veins to the left atrium
This changes the relative pressures In the left and right atria and encloses the foreman ovale by a flap valve effect
Normal lung function produces a marked rising oxygenation of neonatal blood
Muscles in the wall of the ductus arteriosus contract and lead to a physical and later anatomical closure of the doctor
The pulmonary pressure continues to drop over the first 1 to 2 months of life

71
Q

Causes of left ventricular outflow tract obstruction

A

Hypoplastic left heart syndrome, critical aortic stenosis or coarctation of the aorta

72
Q

What is hypoplastic left heart syndrome

A

the left side of the heart is critically underdeveloped
Children are born without an affective that’s ventricle and rely on the right ventricle to perfuse both lungs and systemic systems

73
Q

What do you use prostaglandin E2 for?

A

To keep the ductus arteriosus open, to sustain life until positive surgery in coarctation of the aorta

74
Q

What do you conditions account for 90% of cases of cyanotic congenital heart disease

A

Transposition of the great vessels and tetralogy of fallot

75
Q

What condition is the commonest cause of cyanotic congenital heart disease at birth

A

Transposition of the great vessels

76
Q

What happened in transposition of the great vessels

A

The left ventricle is connected to the pulmonary artery feeding oxygenated blood back through the pulmonary artery to the lungs. The right ventricle returns Deoxygenated blood to the aorta

Phase 3A - Paediatrics (11 decks)

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