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Coovadias Paediatrics > Cardiovascular disorders > Flashcards

Cardiovascular disorders Flashcards

1
Q

Name signs and symptoms suggestive of cardiac disease in children

A 
Central cyanosis unresponsive to oxygen
Pallor
Sweatiness
Failure to feed
SOB when feeding
Sweating when feeding
Tachypnoea
Tachycardia
Palpable spleen
Recurrent LRTI
FTT
Puffy eyes
Sudden weight gain
Sudden oedema
Hepatomegaly
Heart murmurs
Abnormal pulse rate/rhythm 
Apnoea
Syncope
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2
Q

Which children is idioipathic congestive cardiomyopathy more common in?

A

Black children

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3
Q

Why is cor pulmonale common in children?

A

Enlarged adenoids and tonsils -> upper airway obstruction

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4
Q

Although less likely than in adults, what is the arrythmia in children almost certainly?

A

Supraventricular tachyarrythmia

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5
Q

Why does a VSD take time to become audible in neonates and how long can it take?

A

High pulmonary pressure at birth -> fall in pulmonary pressure and vascular resistance
6-8 weeks

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6
Q

Give a differential diagnosis for cyanosis

A 
Cyanotic congenital heart defect
Pulmonary conditions
CNS issue
Metabolic issue 
- hypoglycemia
- hypocalcemia
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7
Q

Why should you stop giving oxygen if a cyanosis is of cardiac origin?

A

Oxygen -> closure of ductus arteriosus -> aggravate situation

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8
Q

Discuss your short term management of a child with a cyanosis of cardiac origin?

A
  1. Maintain infant’s temperature
  2. Give 5% IV glucose
  3. Give IV sodium bicarbonate for acidosis if confirmed
  4. Give oral prostraglanding E2
    - - 30-60mcg/kg hourly
    - dissolve 500mcg tablet in 10ml sterile water
    - 1ml = 50mcg
    - alternative is IV
  5. Give IV prostaglandin E1 as continuous infusion
    - 0.05-0.1mcg/kg
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9
Q

What is stunted growth in a cardiac child a sign of?

A

Increased pulmonary blood flow

Cardiac failure

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10
Q

How can cyanosis affect the anterior fontanelle?

A

Delayed closure

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11
Q

What haematocrit do you expect in a severe cyanosis case?

A

Raised haematocrit

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12
Q

Why must we correct an iron deficiency in cardiac patients, especially in children below the age of 2?

A

May lead to cerebral thrombosis

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13
Q

Why is it a priority to treat septic lesions and dental caries in children with cyanotic heart defects?

A

Risk of paradoxical embolisation -> cerebral abscesses

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14
Q

Give signs of a brain abscess in children

A

Intractable headache
Unexplained fever
Neurological signs

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15
Q

Name the potential cardiac anomalies that are known as congenital cyanotic conditions

A
  1. Transposition
  2. Pulmonary atresia w/ intact ventricular septum
  3. ricuspid atresia
  4. Tetralogy of Fallot
  5. Ebstein’s anomaly
  6. Eisenmenger syndrome
  7. Crticical pulmonary stenosis
  8. Truncus arteriosus
  9. Total anomalous pulmonary venous connection
  10. Atrioventricular communis canal
  11. Hypoplastic left-heart syndrome
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16
Q

Concerning transposition of the great vessels

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis within 1st week of life
Normal pulse
Auscultation: usually without murmur but may be a precordial systolic murmur
Plethora on CXR
ECG
- right axis, RVH
- upright  wave in V4R, V1
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17
Q

Concerning pulmonary atresia with intact ventricular septum

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis from birth
Poor/normal pulse
Auscultation: pansystolic xiphisternum (T1) and single HS2
Oligaemia on CXR
ECG
- normal to left access
- poor RV forces
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18
Q

Concerning tricuspid atresia

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis from birth
Poor/normal pulse
Auscultation: no murmur/soft systolic over precordium and single HS2
Oligaemia on CXR
ECG
- left axis, poor RV forces
- P pulmonale
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19
Q

Concerning tetralogy of fallot

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis is variable 
Normal pulse
Auscultation: ejection systolic murmur at LSB and single HS2
Ologaemia on CXR
ECG
- right axis, RVH
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20
Q

Concerning ebstein’s anomaly

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A

Cyanosis from birth that tends to improve
Normal pulse
Auscultation: pansystolic murmur and diastolic scratch at xiphisternum
Oligaemia on CXR
ECG
- large RA, poor RV forces, RBBB

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21
Q

Concerning eisenmenger syndrome

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Initially not cyanosed -> progressive
Normal pulse
Auscultation: ejection systolic click at LSB + soft ejection systolic murmur + very loud pulmonary HS2
Oligaemia on CXR
ECG
- right axis, RVH
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22
Q

Concerning critical pulmonary stenosis

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis is mild to moderate
Normal pulse
Auscultation: ejection systemic murmur at 2nd LICS and soft pulmonary HS2
Oligaemia on CXR
ECG
- right axis
- RVH
- P pulmonale
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23
Q

Concerning truncus arteriosus

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis is moderate
Collapsing pulse
Auscultation: systolic ejection click and long systolic murmur at LSB w/wo early diastolic murmur
Plethora on CXR
ECG
- normal to right axis
- biventricular hypertrophy
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24
Q

Concerning total anomaly pulmonary venous connection

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis is mild to moderate
Small pulse
Auscultation: ejection systolic murmur 2nd LICS + wide split of HS2 + middiastolic murmur at xiphisternum
Plethora on CXR
ECG
- right axis
- RVH
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25
Q

Concerning atrioventricular communis canal

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis is variable
Normal pulse
Auscultation: precordial systolic murmur
Plethora on CXR
ECG
- left axis 
- biventricular hypertrophy
- prolonged PR
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26
Q

Concerning hypoplastic left-heart syndrome

  • when does cyanosis appear
  • what is the pulse
  • what would you hear on auscultation
  • what would you see on chest x ray
  • what would you see on ECG?
A 
Cyanosis is mild to moderate
Very poor pulse
Auscultation: precordial systolic murmur + ejection systolic click + gallop
Plethora on CXR
ECG
- right axis
- RVH
- poor LV forces
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27
Q

Name causes of heart failure in infancy

A 
Acyanotic CHD w/ increased PBF or severe ventricular outflow obstruction
Cyanotic CHD w/ increased PBF
Myocarditis
Cardiomyopathy
Tachyarrythmias
Bradyarrythmias
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28
Q

Name signs of cardiac failure in children

A 
Tachypnoea
Inspiratory crepitations at lung base
Elevated JVP
Hepatomegaly
Dependent oedema
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29
Q

Discuss your treatment of heart failure in a child

A
  1. Nurse baby at 60 degrees
  2. Give oxygen
  3. Restrict fluid intake
  4. Give inotropes
    - digoxin
  5. Diuretics
    - furosemide
    - spirinolactone
  6. Vasodilators
    - ACE-I
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30
Q

What formulations of digoxin are there?

A

Elixir 0.05mg/ml
Tablets 0.125mg/0.25mg
Injection 0.25mg/ml

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31
Q

What is the dose of digoxin used to treat heart failure in a child?

A

5-10mcg/kg/day in 2 divided doses

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32
Q

What precaution must you take when administering IV digoxin?

A

3/4 of oral/intramuscular dose under ECG control

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33
Q

What infusion can you add to the digoxin in severe cardiac failure?

A

Dobutamine 5-20mcg/kg/min
OR
Dopamine 3-20mcg/kg/min

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34
Q

What is the dose and administration of furosemide in acute heart failure?

A

IV initially then oral maintenance

1-6mg/kg/day in 2-4 divided doses

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35
Q

What is the dose of captopril in acute heart failure?

A

0.5-6mg/kg/day in 3-4 doses

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36
Q

What must you give if you are administering a diuretic that causes potassium loss?

A

Potassium supplement 1-2mmol/kg/day
OR
Spirinolactone 2-3mg/kd/day in 2-3 doses orally

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37
Q

What systolic murmurs in children should be considered significant?

A

Persists
Loud
Assoc w/ signs of cardiac disorder

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38
Q

Which murmurs in children are always significant?

A

Diastolic murmurs

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39
Q

Name common features of a functional systolic murmurs

A

Usually

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40
Q

What does a pectum carinatum with Harrison sulci in children suggest?

A

Intrathoracic ariway obstruction

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41
Q

What is pectum carinatum usually due to in the cardiac context?

A

Pulmonary arterial hypertension

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42
Q

How common is CHD?

A

7-10/1000 live births (1%)

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43
Q

What is the cause of CHD in the majority of instances?

A

Unknown 85-90% of the time

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44
Q

What is the top congenital cardiac anomaly?

A

VSD

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45
Q

List the top congenital cardiac anomalies from most common to least

A
  1. VSD
  2. PDA
  3. Coarctation
  4. TOF
  5. AS
  6. ASD
  7. PS
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46
Q

What is the pressure and oxygen saturation in the aorta

A

Pressure 105/75-85

Oxygen 98%

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47
Q

What is the pressure and oxygen saturation in the LA

A

Pressure 6-8

Oxygen 100%

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48
Q

What is the pressure and oxygen saturation in the LV

A

Pressure 105/0-5

Oxygen 98%

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49
Q

What is the pressure and oxygen saturation in the RA

A

Pressure 0-4

Oxygen 72%

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50
Q

What is the pressure and oxygen saturation in the RV

A

Pressure 20/0-4

Oxygen 72%

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51
Q

What is the pressure and oxygen saturation in the pulmonary trunk

A

Pressure 20/10-14

Oxygen 72%

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52
Q

Name signs of cyanotic CHD with increased PBF

A 
CYANOSIS
SOB
FTT
CCF
Sweating
Chest deformities
Tachycardia
Tachypnoea
Cardiomegaly
Plethora
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53
Q

Name causes of cyanotic CHD with increased PBF

A 
TGA
Truncus arteriosus
TAPV
HLHS
Single ventricle complex with no PS
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54
Q

Name signs of cyanotic CHD with decreased PBF

A 
CYANOSIS
No cardiomegaly
No CCF
Oligaemia
Stunting
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55
Q

Name causes of cyanotic CHD with decreased PBF

A 
TOF
PA
TA
Critical PS
Ebstein anomaly
Eisenmenger syndrome
Single ventricle complex with PS
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56
Q

Name signs of acyanotic CHD with increased PBF

A 
Acyanotic
SOB
FTT
Sweating
CCF
Recurrent LRTIs
Chest deformities
Tachycardia
Tachypnoea
Cardiomegaly
Plethora
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57
Q

Name causes of acyanotic CHD with increased PBF

A

VSD
PDA
ASD
AVSD

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58
Q

Name signs of acyanotic CHD with normal PBF

A

Asx unless severe
Ventricular hypertrophy
Low CO

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59
Q

Name causes of acyanotic CHD with normal PBF

A 
AS
PS
Coarctation
Tricuspid regurgitation
Mitral regurgitation
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60
Q

Name the potential cardiac anomalies that are known as congenital acyanotic conditions

A 
Coarctation
Aortic stenosis
VSD
Endocardial cushion defect (ASD+MI)
ASD
PDA
PS
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61
Q

Concerning coarctation of the aorta

  • comment on the pulse
  • comment on systolic murmur
  • comment on diastolic murmur
  • comment on 2nd heart sound
  • what do you see in CXR
  • what do you see in ECG
A 
Brachial bounding and delayed/absent femorals
Ejection systolic at back
Mid diastolic at apex
Normal 2nd heart sound
CXR
- large proximal aorta 
- 3 sign descending aorta (older children)
ECG
- normal
- LVH
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62
Q

Concerning aortic stenosis

  • comment on the pulse
  • comment on systolic murmur
  • comment on diastolic murmur
  • comment on 2nd heart sound
  • what do you see in CXR
  • what do you see in ECG
A 
Small volume pulse
Ejection systolic at 2RS radiates to neck and click if valvar (with thrill = severe)
Early diastolic
Normal 2nd heart sound
CXR
- large proximal aorta
ECG
- normal axis
- LVH if severe
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63
Q

Concerning VSD

  • comment on the pulse
  • comment on systolic murmur
  • comment on diastolic murmur
  • comment on 2nd heart sound
  • what do you see in CXR
  • what do you see in ECG
A 
Normal pulse
Pansystolic at 4LS grade 3-5 + can have thrill
Mid diastolic at apex
Loud P2
CXR
- cardiomegaly
- pulmonary plethora
ECG
- biventricular enlargement
64
Q

Concerning endocardial cushion defect

  • comment on the pulse
  • comment on systolic murmur
  • comment on diastolic murmur
  • comment on 2nd heart sound
  • what do you see in CXR
  • what do you see in ECG
A 
Normal pulse
Ejection systolic at 2LS
Mid diastolic at 4LS
Fixed split and loud P2
CXR
- cardiomegaly
- pulmonary plethora
ECG
- QRS axis -60
- RsR in V1
65
Q

Concerning ADS

  • comment on the pulse
  • comment on systolic murmur
  • comment on diastolic murmur
  • comment on 2nd heart sound
  • what do you see in CXR
  • what do you see in ECG
A 
Normal pulse
Ejection systolic at 2LS in infants
Continuous machinery sound
Mid diastolic at 4LS
Fixed split
CXR
- RA enlarged
- RV enlarged
- pulmonary plethora
ECG
- Rt axis RsR in V1
66
Q

Concerning PDA

  • comment on the pulse
  • comment on systolic murmur
  • comment on diastolic murmur
  • comment on 2nd heart sound
  • what do you see in CXR
  • what do you see in ECG
A 
Collapsing pulse
Ejection at 2LS with click (thrill = severe)
Mid diastolic at apex
Loud P2
CXR
- cardiomegaly
- asx pulmonary plethora
ECG
- normal
- biventricular enlargement
67
Q

Concerning pulmonary stenosis

  • comment on the pulse
  • comment on systolic murmur
  • comment on diastolic murmur
  • comment on 2nd heart sound
  • what do you see in CXR
  • what do you see in ECG
A 
Normal pulse
No diastolic
Soft P2 and wide split
CXR
- large MPA
- RV enlargement
- normal lung vascularity
ECG
- Right axis
- RVH
68
Q

Name the cardiovascular adaptations of the foetus

A 
Umbilical vein
Ductus venosus
Foramen ovale
Ductus arteriosus
Umbilical artery
69
Q

What is the physiological mechanism of clamping the umbilical vessels?

A

Wharton’s jelly exposed to air -> temperature falls -> contraction

70
Q

Which chemical is the ductus arteriosus sensitive to?

A

Prostaglandin E2

71
Q

What are the mechanisms by which the ductus arteriosus closes?

A
  1. Oxygen from aortic blood flowing into pulmonary artery causes smooth muscle to constrict
  2. Decrease in prostaglandins due to lack of placenta
  3. Lungs release bradykinin
72
Q

What are the mechanisms by which the umbilical arteries close?

A
  1. Oxygen from iliac veins causes smooth muscle to constrict

2. High pressure from lack of placenta

73
Q

What % of PDAs are isolated?

A

90% isolated

10% associated eg congenital rubella syndrome

74
Q

What is the continuous murmur of PDA also known as?

A

Gibson’s murmur

75
Q

How can a PDA become an Eisenmenger syndrome?

A

R to L shunt -> increased pulmonary volume -> pulmonary hypertension -> L to R shunt becomes R to L shunt

76
Q

Where is the continuous murmur of PDA found?

A

ULSB

77
Q

Why is the PDA murmur continuous?

A

Pressure in systole AO >PA

Pressure in diastole AO>PA

78
Q

Why is PDA Eisenmenger syndrome only cyanotic in the lower extremities?

A

Blood before the PDA is oxygenated and goes to the upper extremities and head

79
Q

Which infants does the ductus arteriosus often remain patent?

A

Preterm infants esp with respiratory distress

80
Q

How is a PDA treated?

A 
Preterm infant
-- NDAIDs eg indomethacin, ibuprofen
Term infant
- before 6 to 12 months of age EVEN if asx
- device closure in cath lab
- surgical ligation
81
Q

What defect are the majority of VSDs caused by?

A

Defect in membranous septum

82
Q

Which conditions are VSDs associated with?

A

FAS

Down syndrome

83
Q

Give another term for a pansystolic murmur

A

Holosystolic murmur

84
Q

What is the most common CHD?

A

VSD

85
Q

What heart sounds are heard in a VSD?

A

Pansystolic murmur LLSB
Smaller VSD= louder murmur
Mid-diastolic murmur at apex if VSD large enough
Loud P2 if pulmonary hypertension

86
Q

Name the changes with time in VSD

A

Left heart dilates -> PA pressure rises -> CCF better -> right heart hypertrophies -> PA pressure rises higher -> CCF better -> RH hypertrophies more -> CCF -> pressures balance -> shunt reverses

87
Q

How does VSD present clinically?

A 
Left heart dilates
- CCF
- tachypnoea
- dyspnoea
- failure to feed
PA pressure rises
- cyanosis 
RVH
- parasternal heave
- epigastric heave
88
Q

What is a left parasternal heave a sign of?

A

RVH

89
Q

How does the pansystolic murmur in VSD change?

A

As PA pressure rises, less pressure difference between LV and RV -> softer murmur

90
Q

Discuss management of VSD

A

Manage CCF
Prophylactic amoxicillin for IE 1hr before teeth extraction

Small defects -> spontaneous
Moderate defect -> smaller
Large defect -> CCF -> requires closure
- surgery
- device closure in cath lab
91
Q

If a child with a VSD fails to respond to anti-failure treatment, what should you expect?

A

A coexistent defect

92
Q

What is the most common CHD in ADULTS?

A

Ostium secundum ASD

93
Q

Why is ASD often missed until adulthood?

A

Low pressure shunt

94
Q

What is heart sounds are heard in ASD?

A

Ejection systolic at ULSB
Split S2
Can hear tricuspid diastolic at LLSB

95
Q

Discuss the changes with time in ASD

A

Right heart dilates -> RV dilates -> pulmonary hypertension -> CCF

96
Q

How can you differentiate a VSD using ECG?

A

Ostium primum = right axis deviation

Ostium secundum = left axis deviation

97
Q

Discuss management of ASD

A

Manage CCF
Monitor for arrythmias

Refer for closure:
Secundum
- before school going age
Primum
- large
98
Q

What is a complete AVSD?

A

Ostium primum ASD + inlet VSD with common AV valve

99
Q

What is a partial AVSD?

A

Ostium primum ASD

100
Q

What would you see on an ECG of AVSD?

A

Left anterior hemiblock with left QRS axis between 0 and -90 degrees and Rsr’ pattern in V1

101
Q

Name the signs of aortic stenosis

A

Displaced apex (LVH)
Suprasternal thrill
Carotid thrill

102
Q

What heart sounds are heard in aortic stenosis?

A

Ejection systolic 2nd RICS and into neck

25% early diastolic murmur

103
Q

Which gender predominates in congenital aortic stenosis?

A

Males 4:1

104
Q

What kind of aortic valve is often found in congenital AS?

A

Biscupid

105
Q

What sign of AS is seen on CXR?

A

Enlarged proximal aorta

Cardiomegaly if severe

106
Q

What does absence of a click in AS suggest?

A

Subvalvar stenosis

Supravalvar stenosis

107
Q

If the lower limb pulse are reduced or absent what do you suspect?

A

Coarctation of the aorta

108
Q

What heart sounds are heard in coarctation of the aorta?

A

Systolic betw L scapula and spine
1/3 apical mid-diastolic
Suprasternal thrill

109
Q

Why must the right arm always be used for BP recordings in suspect coarctation of the aorta?

A

L subclavian aa is occasionally involved

110
Q

What is the figure ‘3’ sign?

A

Indentation to in descending aorta to the L of vertebral column - coarctation of the aorta

111
Q

Why can notching of the inferior edges of the 3rd to 8th ribs in older children be seen in coarctation of the aorta

A

Formation of collaterals -> enlarged collateral intercostal arteries

112
Q

What age should elective surgical repair of an asymptomatic aortic coarctation take place?

A

Two years

113
Q

What should you suspect in a child >1year with signs of coarctation and CCF?

A

Aortic arteritis

114
Q

What is aortic arteritis also known as?

A

Takayasu’s arteritis

115
Q

Name the causes of mitral incompetence

A

Congenitally abnormal mitral valve
OR
2nd to L heart dilation

116
Q

What heart sound is heard in mitral incompetence?

A

Pansystolic murmur at the apex

117
Q

What is a sign of pulmonary stenosis?

A

Left parasternal heave

118
Q

What heart sound is heard in pulmonary stenosis?

A

Ejection systolic 2nd LICS and into lungs

119
Q

What is a sign of severe tricuspid incompetence?

A

Palpable liver

120
Q

What heart sound is heard in tricuspid incompetence?

A

Pansystolic murmur at LLSB

121
Q

Which test do you use to differentiate respiratory and cardiac cyanosis?

A

Hyperoxia test

122
Q

Name the causes of cyanosis in children

A 
ABCs
Airway obstruction
- choanal atresia
- laryngomalacia
- vocal cord paralysis
- tracheal stenosis
- vascular ring
- external mass

Breathing

  • pneumonia
  • bronchiolitis
  • congenital lung abnormality
  • congenital DH
  • hypoventilation

Circulation

  • methaemoglobinaemia
  • congenital cardiac lesions
  • persistent pulmonary hypertension
123
Q

Name the features of tricuspid atresia

A

Hypoplastic right ventricle
Pansystolic murmur LLSB -> VSD
Single heart sound
Left axis deviation on ecg

124
Q

What is wall-to-wall heart on CXR diagnostic of?

A

Ebstein’s anomaly
Pulmonary atresia
Critical pulmonary stenosis

125
Q

What syndrome is Ebstein’s anomaly associated with?

A

Wolff-Parkinson-White (WPW)

126
Q

What is a common cause of Ebstein’s anomaly?

A

Mother’s with bipolar -> lithium

127
Q

What word is associated with the right ventricle in Ebstein’s anomaly?

A

Atrialisation of the right ventricle

128
Q

How does a child fare with Ebstein’s as it gets older after birth?

A

Gets better after birth (less cyanotic)

129
Q

What heart sound can be heard in Ebstein’s anomaly?

A

Pansystolic LLSB (tricuspid regurgitation)

130
Q

What are the 4 abnormalities of TOF?

A

Right ventricular outflow tract obstruction
RVH
VSD
Overriding aorta

131
Q

What is the most common cyanotic CHD?

A

TOF

132
Q

What is TOF associated with?

A

Chromosome 22 deletion

DiGeorge Syndrome

133
Q

What are signs of TOF in a child?

A

Cyanosis
Clubbing
Polycythaemia

134
Q

What is a hypercyanotic spell in TOF also known as?

A

“Tet” spell

135
Q

Why do TOF children squat?

A

Squatting -> kinks femoral arteries -> incr SVR -> pressure L > right -> shunt reverses

136
Q

Discuss management of a hypercyanotic spell

A

Place child in knee-chest/squatting position
Administer morphine 0.1-0.2mg/kg
Administer fluid bolus 10-29ml/kg crystalloid/colloid
Administer esmolol 0.5mg/kg stat then 0.1mg/kg/min
Phenylephrine
Administer sodium bicarbonate 1mmol/kg IV
Check hct and treat

137
Q

What is a bootshaped heart on CXR diagnostic of?

A

TOF (RVH)

138
Q

What heart sound is heard in TOF?

A

Ejection systolic LUSB

139
Q

How will a pulmonary atresia with VSD appear on CXR?

A

Boot shaped heart

140
Q

How will a pulmonary atresia without VSD appear on CXR?

A

Wall-to-wall heart

141
Q

What are the trouble 3Ts?

A

Cyanotic heart lesions with increased PBF

  1. Transposition
  2. Truncus arteriosus
  3. TAPVD
  4. HLHS
142
Q

At what age do cyanotic heart lesions with increased PBF present?

A

Young age <6months

143
Q

What is complete TGA also known as?

A

Right TGA (aorta on right)

144
Q

What is supportive management of PDA-dependent lesions?

A

Prostaglandin E1 IVI

Oral prostaglandin E2 orally

145
Q

What TGA is acyanotic?

A

Levo-TGA

‘Congenitally corrected’

146
Q

What is egg-on-side/string cardiac silhoutte on CXR diagnostic of?

A

TGA

147
Q

What syndrome is truncus arteriosus associated with

A

DiGeorge Syndrome

148
Q

What is 22q11.2 deletion syndrome also known as?

A

DiGeorge Syndrome

149
Q

What are characteristics of a truncus arteriosus?

A 
To-and-fro murmur
- pansystolic LLSB
- mid-diastolic 
Bounding/collapsing peripheral pulses
Wide PP
Loud ejection click 
Single S2
Cardiomegaly w/ plethora
150
Q

What is TAPVD also known as?

A

TAPVC

Drainage vs connection

151
Q

Where are the 3 potential locations of TAPVD?

A

Supracardiac (SVC)
Infracardiac (IVC)
Infradiaphragmatic (hepatic vv)
Cardiac (RA/coronary sinus)

152
Q

What is a snowman CXR diagnostic of?

A

TAPVD

153
Q

What heart sounds can be heard in TAPVD?

A

Pulmonary stenosis = ejection systolic LUS

Tricuspid stenosis = mdm LLSB

154
Q

What is snowman CXR also called?

A

Figure of 8

155
Q

Name complications of right to left shunting

A 
Chronic hypoxia
Myocardial and somatic tissue dysfunction
Paradoxical emboli
Neurological sequelae
Hemiplegia/paresis
Cerebral abscess
Polycythaemia
Hyperuricacidaemia
Thrombocytopenia
Iron deficiency
Exercise intolerance
156
Q

What does HLHS usually comprise of?

A

Aortic valve atresia
Mitral atresia
Hypoplastic ascending aorta
Diminutive LV

157
Q

What does HLHS require for survivability?

A

ASD

PDA

Coovadias Paediatrics (10 decks)

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