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Paediatrics > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

Which natural septal defect closes in first breaths of life?

A

Foramen Ovale - Connects LA/RA. When baby takes first breath, pressure in RA decrease (as placental flow is cut) and pressure in LA increases as lungs receive more blood flow. These pressure differences cause the foramen ovale to close

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2
Q

Which congenital heart problems require a patent ductus arteriosis to keep baby alive?

A

Tetralogy of fallot
pulmonary atresia
Coarctation

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3
Q

What medication will keep the ductus arteriosus patent until the baby can be operated on?

And what could cause it to close, potentially fatally?

A

Prostin (prostaglandin)

high flow oxygen

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4
Q

How does congenital HD commonly present?

A

Heart mumur - most common
Any collapsed unwell baby
cyanosis

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5
Q

How common are heart murmurs in children?

A

Heard in 50-75% at some time

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6
Q

What are the features of an innocent murmur?

A 
Think 'S'!
aSymptomatic
Soft blowing murmur
Systolic only - no radiation
left Sternal edge
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7
Q

How is a murmur described?

A 
Intensity
Timing
Location
Transmission
Quality (musical? Harsh? Vibratory?)
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8
Q

Which murmurs are pathological?

A

Diastolic murmurs

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9
Q

What investigation should a child receive if unsure about murmur?

A

Echo

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10
Q

What can cause innocent murmurs in kids to change?

A

Change in position
Illness
Anaemia

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11
Q

What is Still’s murmur?

A

Innocent ejection murmur with characteristic low frequency ‘twanging/musical quality’. Usually on L sternal edge

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12
Q

What is venous hum?

A

Continuous murmur heard just beneath clavicles. Abolished by hyperextension of the back/neck

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13
Q

What are the differentials for a baby presenting with a murmur?

A

Innocent murmur
Pulmonary valve stenosis
Atrial septal defect

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14
Q

What are the differentials for a baby presenting with cyanosis?

A

Tetralogy of Fallot - but not immediately at birth!

Transpostition of great arteries - severe cyanosis

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15
Q

What are the differentials for a baby presenting with HF?

A

VSD
AVSD
Patent ductus arteriosus

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16
Q

What are the differentials for a baby presenting with shock?

A

Aortic valve stenosis

Coarctation of the aorta

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17
Q

What CHDs are associated with Down’s syndrome?

A

AVSD, VSD, ASD

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18
Q

What CHDs are associated with Turner’s syndrome (45 XO)

A

Aortic valve stenosis, coarctation of aorta

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19
Q

What are the 4 anatomical abnormalities of Tetralogy of Fallot?

A

VSD
Pulmonary Stenosis
Overarching aorta
R ventricular hypertrophy

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20
Q

What CHDs is TOF associated with?

A

Down’s syndrome

Digeorge (22q11 microdeletions)

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21
Q

Why does TOF present with cyanosis?

A

Shunting of deoxygenated blood through the VSD into the left side of the heart

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22
Q

What symptoms are common in TOF

A

Hypercyanotic spells (irritable, crying, cyanotic, pale, floppy
Loud, harsh ejection systolic murmur heard at day 1 at L sternal edge
clubbing

23
Q

How is TOF managed?

A

Definitive surgery within 6 months - if cyanosis is severe give prostin to keep ductus arteriosus patent before surgery

24
Q

What is the management in TOF during hypercyanotic spells that last over 15 mins?

A

Sedation, analgesia, fluids, muscle paralysis and ventilation (to decrease oxygen demand)

25
Q

What is the most common type of ASD?

A

Secundum ASD - defect in central atrial septum involving foramen ovale

26
Q

What is a primum ASD?

A

Defect in atrioventricular septum - associated with a common atrial and ventricular orifice

27
Q

What can you hear when listening to a heart with ASD?

A

Ejection systolic murmur heard at left upper sternal edge
Widely split second heart sounds - L to R shunting so RA increases in size compared to LA and pulmonary/aortic valves don’t close simultaneously

28
Q

What are the clinical signs of ASD?

A

Asymptomatic
Recurrent chest infections
Arrhythmias after age of 4

29
Q

Which is the commonest defect seen in CHD?

A

VSD - 25 %

Perimembranous VSDs are most common

30
Q

What is Eisenmenger syndrome?

A

Irreversibly raised pulmonary vascular resistance, resulting in R to L shunting and severe cyanosis
Only treatment is heart and lung transplant

31
Q

Symptoms of VSD?

A

HF
SOB
Failure to thrive after 1 week of age

32
Q

Signs seen with Large VSD?

A

Soft pansystolic murmur or no murmur
Tachypnoea
Tachycardia

33
Q

How is VSD managed?

A

First line: treat HF with diuretics
Can give ACE inhibitors to reduce afterload
Surgery 3-6 months (if small may resolve spontaneously)

34
Q

What is the ductus arteriosus?

A

Normal connection in infants that connects pulmonary artery to descending aorta - resolves shortly after birth

35
Q

When and how is persistent ductus arteriosus diagnosed?

A 
When = If not closed by 1 month
How = Echo, CXR likely to be normal
36
Q

What murmur can you hear with persistent ductus arteriosus?

A

Venous hum

37
Q

What is coarctation of the aorta?

A

Localised aortic constriction

38
Q

How does coarctation of the aorta present if severe?

A

Shock

39
Q

What symptoms might present with coarctation of the aorta in neonates?

A

HF

Absent femoral pulses

40
Q

Why can you hear a wide range of murmurs with coarctation of the aorta?

A

Collateral circulation

41
Q

What is associated with Coarctation of the aorta?

A

Berry aneurysms, can lead to SAH

42
Q

How is coarctation of the aorta managed?

A

Prostin to keep ductus arteriosus open

Surgical repair

43
Q

Whatis the life expectancy for a baby born with coarctation of the aorta?

A

40

44
Q

What is transposition of the great arteries?

A

The aorta arises from the right ventricle and pulmonary artery is connected to the left ventricle
Hypoxic blood is therefore circulated to the body

45
Q

How does transposition of the great arteries present?

A

Profound, life threatening cyanosis in the first few days of life (after the DA closes)

46
Q

Signs of transposition of the great arteries?

A

CYANOSIS - always present
Second HS loud
Medical emergency

47
Q

Subtypes of transposition of the great arteries

A

Intact ventricular septum
VSD
VSD + pulmonary stenosis

48
Q

Investigations for transposition of the great arteries?

A

Diagnosed antenatally by USS

Echo

49
Q

Management of transposition of the great arteries

A

Prostaglandin to keep DA open

Surgery immediately - arterial switch in first few days

50
Q

What is rheumatic fever?

A

a serious complication that can develop following an untreated throat infection (by a type of bacteria called group A streptococcus)

51
Q

What is the pathophysiology of rheumatic fever?

A

When your body senses the streptococcal infection, it sends antibodies (infection-fighting molecules) to fight it. However, the antibodies sometimes attack the tissues of parts of the body, such as the joints or heart instead

52
Q

What should always be suspected with a new murmur and fever?

A

Infective endocarditis

53
Q

What are the signs of rheumatic fever?

A

Polyarthritis
Endocarditis - heart murmur
Erythema marginatum - rash on trunk and limbs, pink macules spread outwards and fade in centre

54
Q

What is the commonest arrhythmia in children?

A

SVT

Paediatrics (2 decks)

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