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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
What is the management of coarctation
Stent if severe
26
Murmur of wide fixed splitting of S2 “lub splat”
ASD
27
Pansystolic murmur “burrrr”
VSD and mitral regurgitation
28
Ejection systolic murmur “burrrr de”
Aortic stenosis | Pulmonary stenosis
29
Continuous machinery murmur “burrrrdurrrr”
Patent ductus arteriosus
30
What are cyanotic murmurs?
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)
31
What are the cardinal symptoms of tetralogy of fallots
``` Pulmonary stenosis (causing large VSD) Right ventricular hypertrophy (RVH) Overriding aorta VSD Ejection systolic murmur - left sternal edge ```
32
Presentation of tetralogy of fallots
Cyanosis on exercise Clubbing Right parasternal heave Cyanotic spells when upset
33
Investigations for tetralogy of fallot
CXR - boot shaped heart | ECHO - increased right ventricular size
34
Management of tetralogy of fallot
Bets blockers for hypoxic spell | Palliative surgery = blalock taussig shunt
35
Presentation of transposition great arteries
Cyanosis from birth
36
What is transposition of the great arteries
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
Tests for transposition of the great arteries
CXR - egg on side appearance | ECHO
38
What is the management of transposition of great arteries
Prostaglandin infusion to maintain PDA Balloon atrioseptostomy tears atrial septum to make ASD Graft surgery
39
What congenital murmurs do you get with Downs
AVSD, VSD, ASD
40
What congenital murmurs do you get with Turners
Atrial stenosis and coarctation
41
What congenital murmurs do you get with trisomy 13 + 18
Complex septal defects
42
What congenital murmurs do you get with Williams
Elfin features | Supravalvular aortic stenosis
43
What congenital murmurs do you get with noonans
Tricuspid stenosis and septal defects
44
Down’s syndrome increases the risk of
``` Duodenal atresias Squint Hypothyroidism Leukaemia Hirschprung’s disease Deafness ```
45
Features of Down’s syndrome
``` 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
What is Kawasaki disease
acute, necrotizing vasculitis of unknown etiology -small and medium vessels
47
When does Kawasaki disease present
6 months to 4 years
48
What are the clinical features of Kawasaki disease
``` Fever for >5 days Four of Conjunctivitis Red mucous membranes Strawberry tongue Cervical LNs Rash Palm changes ```
49
Complicates of Kawasaki disease
Follow up echos - risk of coronary artery aneurysms
50
Treatment of Kawasaki disease
Prompt treatment with IVIG and aspirin for 6 months
51
Fetal circulation
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
When does rheumatic fever occur
2-6 weeks after strep pyogenes infection (group a beta haemolytic strep)
53
Rheumatic fever can lead to
Mitral stenosis or aortic regurgitation
54
How is rheumatic fever diagnosed
Strep positive throat swab ASO titre Duckett Jones major/minor criteria
55
What is the major Jones criteria
``` Pancarditis (pericarditis, endocarditis, myocarditis) Polyarthritis Sydenham chorea Subcutaneous nodules Erythema marginatum ```
56
What is the minor Jones criteria
``` Fever Arthralgia Prolonged PR interval Increased ESR of CRP leukocytosis ```
57
Jones diagnosis criteria
2 major criteria or 1 major and 2 minor criteria
58
What is Eisenmenger’s syndrome
``` 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
Cyanotic from birth
Transposition of the great arteries
60
Cyanotic without murmur
Transposition of the great arteries
61
Cyanotic on crying/day 2-3 of life
Tetralogy of fallot
62
Cyanosis with Down’s syndrome
AVSD
63
Acquired cyanotic heart disease
Eisenmenger’s syndrome
64
How would serious heart disease present in children?
Poor growth, breathlessness, pallor, cyanosis
65
How does serious heart disease present in babies?
Feeding problems Breaking off in mid-feed Panting respiration Sweating
66
How does heart disease present in older children?
Lack energy and tire easily
67
What character of pulse in aortic stenosis
Low volume
68
What can a chest X-ray show?
Cardiac size and pulmonary vasculature
69
What can an ECG show?
Info on the relative size of the cardiac chambers and on cardiac stain
70
What are the changes in the circulation at birth?
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
Causes of left ventricular outflow tract obstruction
Hypoplastic left heart syndrome, critical aortic stenosis or coarctation of the aorta
72
What is hypoplastic left heart syndrome
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
What do you use prostaglandin E2 for?
To keep the ductus arteriosus open, to sustain life until positive surgery in coarctation of the aorta
74
What do you conditions account for 90% of cases of cyanotic congenital heart disease
Transposition of the great vessels and tetralogy of fallot
75
What condition is the commonest cause of cyanotic congenital heart disease at birth
Transposition of the great vessels
76
What happened in transposition of the great vessels
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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