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*Paediatrics CBL FALSHCARDS > CBL:cardiology > Flashcards

CBL:cardiology Flashcards

1
Q

Characteristic of the murmur: Ventricular Septal Defect

A
  • Pansystolic murmur
  • lower left sternal border
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2
Q

Characteristic of the murmur: Coarctation of the Aorta

A
  • Crescendo-decrescendo murmur
  • upper left sternal border
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3
Q

Characteristics of the murmur: Patent ductus arteriosus

A
  • continous
  • upper left sternal border
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4
Q

Characteristics of the murmur: Pulmonary stenosis

A
  • ejection systolic
  • upper left sternal border
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5
Q

Where do we check for the pulse in BLS of:

A. child under 1 year old

  1. child 1 year old and over
A

A. child under 1-year-old -> brachial and femoral

B. In a child 1 and over -> femoral and carotid

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6
Q

Antibiotics (2) given for a child <3 years old when meningitis is suspected

A

Meningitis in children < 3 months: give IV amoxicillin in addition to cefotaxime to cover for Listeria

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7
Q

What’s Trident hand deformity?

What is it suggestive of?

A

short, stubby fingers with separation between the middle and ring fingers -> achondroplasia (dwarfism)

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8
Q

History of palpitations. What questions to ask?

A

Questions to ask in history of palpitations:

  • onset (on rest , exercise)
  • any fainting/ collapse?
  • how long for do they last?
  • can you show me the rhythm (regular or not)
  • any changes in frequency recently
  • any pain/when (before the palpitation, with or after onset of palpitations)
  • any SOB with it
  • recent stressors (as possible trigger)
  • FHx (cardiac, syncope, unexpected death)
  • medication/ drugs
  • lifestyle
  • how does it affect you -> severity
  • does anything makes it worse/better (SOCRTES); previous treatments eg. Valsava manouver
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9
Q

How to do Valsalva Manoeuvre?

A

How to do Valsava:

  • take breath in, close your nose/mouth hold it and blow ou
  • OR Hold end of straw, pinch it and blow through a closed space as hard as you can – blow against an obstruction
  • blow into 10 ml syringe to move the plunger

​​Mechanism: increased intrathoracic pressure and improves venous return as it increases Vagus stimulus ->slows the HR down

*Vagus is linked with parasympathetic nervous system = induces bradycardia

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10
Q

Investigations to be considered in ‘on-off symptoms’ of an arrhythmia e.g. palpitations

A
  • ECG as baseline
  • Electrolytes level: Ca++ , Magnesium and K+ -> as may cause irregular HR (imbalance by e.g. vomiting, diarrhea, anorexia/ bulimia)
  • 24 hour ECG-> depends on history and ordered tests (e.g. if once every few months-> cannot really rule out anything as we may not ‘cupture’ the moment) -> useful if symptoms happen everyday
  • CarioMemo -> if symptomatic only occasionally, pt puts it on the chest and ECG is recorded *but some people may not be able to record e.g. due to collapse, then CardioMemo is not useful unless the carers would put it on; then we can implant
  • RevelDevice, that sends the information through WiFi; useful in e.g. unexplained fainting -> but can have interference from electrical devices (e.g. hairdryer)
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11
Q

Picture (on ECG) of hyperkalaemia

A

Possibly picture of hyperkalaemia

As K + rises (> 6.0 mmol/L):

  • Tall peaked T waves, best seen in precordial leads
  • Prolongation of QRS duration
  • Prolongation of PR interval
  • Disappearance of P waves
  • Wide bizarre biphasic QRS complexes (sine waves)
  • Eventual asystole
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12
Q

Common causes of hyperkalaemia in children

A

Common causes of hyperkalaemia in children:

  • kidney problems (acute or chronic)
  • adrenal insufficiency (eg. Addison’s) -> as Na+ will not be retained -> more K+ retained
  • dehydration
  • destruction of RBCs -> due to burns, injuries
  • type 1 diabetes
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13
Q

Supraventricular tachycardia in children - what are the considerations for management?

A
  • reassurance
  • safety netting (symptoms that may change/ come to A&E)
  • if we find that something is not right -> decide if to treat or not to treat

How do we decide if to treat or not -> depends on history (associated symptoms, duration, frequency, how does it affect their life)

If it happens e.g. every second moth -> then discuss with the patient how much it affects them, if they want to take anti-arrhythmic every day for something that is occasional BUT if bothering then go ahead with medication

  • if anything changes (symptoms/ frequency) then consider re-assessment and treatment (e.g. ablation, medication)

*ablation is useful but risky (it may do an ablation on the pathways we did not intend to and mess up with the conduction further)

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14
Q

What is a possible connection between a baby being SOB and not gaining weight?

A

In a case: Child is breathless, have a murmur, not gaining weight = failure to thrive

*child is has SOB -> difficult to feed if breathing so fast as there will be L->R shunt so more overload of the R side -> pulmonary oedema/congestion (ask how long does it take for a child to finish the feed – takes longer due to being breathless etc)

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15
Q

Case: Child is breathless, have a murmur, not gaining weight (failure to thrive)

What further investigations would you do?

A
  • ECHO
  • ECG
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16
Q

Case: Child is breathless, have a murmur, not gaining weight (failure to thrive)

Management

A

Management:

  • diuretics -> less congestion -> better feeding
  • NG feed -> feed goes directly into the tummy (but danger of overfeeding)
  • PEG
  • IV fluids (but electrolytes and all nutrition would not be enough to satisfy nutritional needs)

*surgery not always the best option, think how severe the hole is -> any other symptoms, can we wait a bit rather than putting a child through an invasive procedure *do cardiology review if in any doubts to make sure we can only ‘watch and wait

17
Q

S1 is a result of what?

S2 is a result of what?

A
  • S1 – result on M/T valve closing
  • S2 – aortic and pulmonary close
18
Q

S1 - S2 is what?

S2 - S1 is what?

In terms of cardiac cycle…

A

S1 and S2 = systolic

S2 – S1 = diastolic

19
Q

Why do we hear a murmur? Is it a result of what?

A

Why do we hear the murmurs -> pathopysiology:

  1. Increase flow across normal structure / flow murmurs -> e.g. increased output (exercise, pregnancy, fever, hyperthyroidism, anaemia, fistula)
  2. Normal flow across abnormal structure -> valvular problem (structure)
  3. Pressure gradient -> e.g. if stenosis gets worse -> more pressure needs to be generated -> lauder murmur (so the severity of the murmur may be dictated by a pressure gradient)
20
Q

Is a loud murmur always bad?

A

Murmur soft vs loud - is it good or bad?

  1. Example of VSD:

Loud murmur in VSD is good = hole is smaller (as more resistance more pressure is required)

Softer murmur in VSD = hole is bigger (so worse/more severe)

  1. Example of aortic stenosis:

Aortic stenosis: the louder them murmur = the bigger the gradient = the worse the stenosis is

21
Q

Possible causes of: Pansystolic murmur, L sternal age

A

Pansystolic murmur, L sternal age – possible causes:

  • Mitral regurgitation
  • Tricuspid regurgitation
  • VSD
22
Q

Characteristics of mitral regurgitation murmur and tricuspid murmur (compare)

A

*mitral regurgitation usually radiates to the axilla + does not increase with inspiration

*tricuspid murmur same as above (radiation to the axilla + pansystolic) but increase with resp

23
Q

How to approach an adult ECG (up to HR)

A

How to approach ECG (adult):

(In order)

  • Patient details
  • When it was done
  • Rhythm (irregular/regular)
  • HR: count big squares and /300 (you may do range)
24
Q

How to approach adult ECG: consider P wave

*what does bifid P wave imply?

A
  • P wave - is it normal, how big is it? (the bigger -> the bigger the R atrium is)
  • bifid P wave -> mitral stenosis
  • duration of PR (3-5 little squares) *in children we want shorter; it is rate dependant: if fast HR and long PR -> 1st degree heart block (longer for depolarization to spread between atria nad ventricly)
25
Q

Approach to ECG: QRS

  • size
  • dominance
A

QRS complexes:

  • Broad/narrow -> location
  • Dominance -> L vent hypertrophy V5 V6, tall; on the R -> deep/inverted
26
Q

Approach to ECG: axis

What are the deviations in adults and children?

A
  • Axis -> look at I and aVF

Calculate the voltage

*in children R axis deviation normal

* in adult L axis deviation possible

27
Q

ECG: T wave

  • how it should look like
  • hyperkalaemia appearance
  • hypokalaemia appearance
  • MI appearance
A
  • T wave - should be upright
    • Hyperkalaemia: T waves get taller and toller
    • Hypokalaemia: flat
    • MI: inverted T wave, pathological Q waves, ST elevated/depressed
28
Q

ECG: QT - how shall we calculate it

  • what does long Q-T may mean
A

*QTc -> Q-T corrected interval; e.g. long Q-T due to ion channel problems (usually Na+) -> to label someone as ‘long QT’, do genetic testing as well and other tests

* short QT also possible

Corrected Q-T used in Bazzett’s formula

29
Q

Delta wave

U wave

what do they imply?

A
  • Delta wave -> Wolf-Parkinson White (slurred upstroke due to faster conduction that went through vent)
  • U wave -> hypothermia/ hypocalcaemia
30
Q
A

*Paediatrics CBL FALSHCARDS (47 decks)

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