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*Paediatrics CBL FALSHCARDS > Congenital heart conditions > Flashcards

Congenital heart conditions Flashcards

1
Q

Small VSD murmur

A

Loud pan systolic murmur at the lower left sternal edge Radiates to whole precordium

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2
Q

Management of small VSD

A

Lesion will close spontaneously Maintain good oral hygiene to prevent bacterial endocarditis whilst defect is present

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3
Q

Large VSD

A

small size or bigger than the aortic valve

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4
Q

Large VSD mumur

A

Soft pan systolic murmur or no murmur

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5
Q

Clinical features of large VSD

A
  1. Heart failure with breathlessness - Increased pulmonary oedema, vascular markings + Pulmonary hypertension 2. Failure to thrive 3. Recurrent chest infections
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6
Q

Ix of VSD

A
  1. Chest radiograph; - Cardiomegaly - Enlarged pulmonary arteries and markings 2. ECG - Biventricular hypertrophy
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7
Q

Management of VSD

A
  1. Medication - Diuretics/Captopril 2. Pulmonary artery band - to reduce pulmonary hypertension
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8
Q

4 x Features of Tetralogy of Fallot

A
  • Large VSD
  • Overriding aorta over the ventricular septum
  • Pulmonary stenosis - RV obstruction
  • Right ventricular hypertrophy
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9
Q

How and when are patients with VSD likely to present?

A
  1. 6 months with a failure to thrive
  2. Breathing - Increased effort, low O2 sats and crackles
  3. Circulation - Pansystolic murmur
  4. Cardiomegaly and Plethoric lung fields
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10
Q

CXR of Tetralogy of Fallot

A

Boot shaped heart due to RV hypertrophy

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11
Q

How does the tetralogy of Fallot present?

A

5 days and with cyanosis

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12
Q

Clinical features of Tetralogy of Fallot

A
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13
Q

Hypercyanotic spells features

A

Tetralogy of Fallot

  • Behavior -

Limp & Lethargic

Inconsolable crying and irritabiity preceding recent D&V

Squating on exercise

  • Breathing -

Increased effort and O2 sats 58% (severe cyanosis)

  • Circulation -

Heart rate - 140

No mumur

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14
Q

Management of Hypercyanotic spells

A
  • Medical emergency as severe cyanosis can cause MI, Stroke or death
  • O2 sats
  • Blood pressure
  • Heart rate
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15
Q

Signs of Tetralogy of Fallot

A
  1. Harsh ejection systolic murmur at the left sternal edge from day 1
  2. Clubbing of fingers and toes will develop in older children
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16
Q

Patent ductus arteriosus

A

Persistent ductus arteriosus which connects the pulmonary artery to the descending aorta

Higher pressure in the orta, so oxygenated blood takes two turns round to the lungs

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17
Q

Mumur for PDA

A

Continous mumur below the left clavicle

  • Mumur continues through to diastole because the pulmonary artery pressure is lower than aorta through out the whole of the cardiac cycle
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18
Q

Two major features of a PDA

A
  1. Collapsing / Bounding pulse and wide pulse pressure
  2. Continous murmur below the left clavicle
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19
Q

Management of PDA

A
  1. Closure via surgical ligation/coil closure
    - closure is recommended to abolish lifetime risk of bacterial endocardiitis and pulmonary vascular disease
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20
Q

How does a patient with PDA present

A
  1. Tachypnoae
  2. Poor feeding and poor weight gain
  3. Reccurent LRTI
  4. Crackles on auscultation but normal O2 sats
  5. Chest X ray - Plethoric lung fields
  6. Echo - duct seen
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21
Q

Atrial septal defect

A
  1. Secumdum ASD - defect in the atrial septum involving the foramen ovale
  2. Partial AVSD - interatrial connection between the bottom end of the atrial septum and AV valves
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22
Q

Atrial septal defect murmur

A
  1. ejection systolic mumur in upper left sternal edge - due to increased flow across the pulmonary valve
  2. fixed and widely split second heart sound
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23
Q

Investigations of ASD

A
  1. Septum secumdum ASD -
    - Partial right bundle branch block (common in young children)
    - Right axis deviation due to right ventricular enlargement
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24
Q

Atrial septal defect presentation

A
  1. Commonly asysmptomatic
  2. Present at 5 years with incidental murmur
  3. Recuurent chest infections and arrythmias
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25
Q

Atrioventricular septal defect

A

non fusion of the endocardial cushion - abnormalities of the AV valves

Increased incidence in Trisomy 21

26
Q

Presentation of AVSD

A
  1. Cyanosis at birth or heart failure within 2 -3 weeks of life
  2. Recurremt lower respiratory tract infections
  3. Increased effort of breathing and crackles on auscultation
  4. Cardiomegaly, plethoric lung fields and heart failure
27
Q

Pulmonary stenosis clinical features

A
  1. Mainly assymptomatic unless critical stenosis
28
Q
A
29
Q

Physical signs of pulmonary stenosis

A
  1. Ejection systolic murmur at the left sternal edge
  2. Ejection click
  3. Clear on auscultation and low O2 sats
  4. Weak pulse
30
Q

Pulonary stenosis murmur

A

Ejection systolic murmur at the upper left sternal edge

Radiates to the back

31
Q
  1. Ix of Pulmonary stenosis
A
  1. Chest Xray - Oligaemic ( lacking blood because of stenosis in pulmonary valve )
  2. CBG - acidotic, hypoxic
  3. Echo - critical PS
  4. ECG - Right ventricular hypertrophy
32
Q

Pulmonary stenosis - how does it present

A

2 days with cyanosis

33
Q

Mx of pulmonary stenosis

A
  1. Most children are assymptomatic
  2. Transcatheter balloon dilatation
34
Q
A
35
Q

Transposition of the great arteries -

  • when does it present
  • signs on examination
A
  1. Presents within 12 hours with cyanosis as closure of duct leads to reduction of blood mixing and cyanosis
  2. Tachypnea
  3. Clear on auscultation
  4. Tachycardia
36
Q

Murmur in transposition of arteries

A

No murmur

37
Q

Ix in Transposition of Arteries

A

Chest radiograph

  • Increased pulmonary marking due to increased pulmonary vascular flow
  • Egg on side appearance of heart

CBG - acidotic + hypoxic

38
Q

Coarctation of the Aorta symptoms

A
  • constriction of the aorta, severe obstruction of the left ventricular outflow

Breathing -

increased effort and clear on auscultation

Circulation -

- Low blood pressure

  • Weak femorals
  • Brachiofemoral delay

* Severe heart failure*

39
Q

Ix of Coarctation of Aorta

A
  1. Chest Xray
    - Cardiomegaly and congestion
  2. CBG - acidotic
  3. 4 limb BP - lower limbs have sign weaker bp
  4. Echo - Coarctation
40
Q

Presentation of the coarctation of Aorta

A
  1. Presents at 6 weeks
  2. Increased work of breathing
  3. Heart failure
41
Q

Aortic stenosis - what are the symptoms and appearance

A

Def : restricts exit from the left ventricle

Breathing :

effort is increased and clear on auscultation

Sats unable to be read

Circulation :

  • Pulses thready and weak
  • Bp unrecordable

Appearance :

  • MOTTLED NOT BLUE
42
Q

Main clinical presentation of Aortic stenosis and when does it present

A
  1. Presents 4 hours
  2. Pulses thready and weak
  3. Blood pressure unrecordable
  4. MOTTLED NOT BLUE
43
Q

Ix of aortic stenosis

A

CXR - Cardiomegaly and congestion

CBG - severe acidosis

4 limb bp - unobtainable

Echo - Critical stenosis

44
Q

TOF murmur

A
  • systolic murmur
  • left sternal edge
45
Q

Atrial secumdum defect - murmur

A

upper left sternal edge

soft systolic mumur

splitting of S2 sound

46
Q
A
47
Q

Coarcatation of the aorta mumur

A

Ejection systolic

Left sternal edge

radiates to the back

48
Q

Aortic stenosis mumur

A
  1. Ejection systolic
  2. Maximum in aortic space radiating to the enck and carotids
49
Q

Mumurs causing mild cardimegaly and increased pulmonary markings

( Right ventricular hypertrophy)

A
  1. VSD
  2. ASD
50
Q

Mumur causing left ventricular hypertrophy

A

Aortic stenosis

51
Q

Mumur which causing rib notching

A

Coarctation of the aorta

52
Q

Small boot shaped heart and oligemic lung fields caused by

A

ToF

53
Q
  1. Narrow mediastinum and egg on side appearance and increased pulmonary markings
A

TGA

54
Q

Ft of innocent mumurs (6)

A
  1. Soft
  2. Single
  3. Small - no radiation
  4. Assymptomatic
  5. Systolic - early ejection systolic
  6. Left Sternal edge
55
Q

Assymptomatic mumurs

A
  1. small ASD
  2. small VSD
56
Q

Cyanotic mumurs

A

1 . TGA

  1. ToF
57
Q

Mumurs with potential to cause cardiac failure

A
  1. VSD
  2. PDA
58
Q

Difference in paediatric ecg vs adult

A
  1. HR much faster
  2. Marked sinus arrythmia due to variations in breathing
  3. Right axis deviation
  4. Partial bundle branch block
  5. T wave inversion in leads v1 - v4
59
Q

Mx of SVT

A
  1. Antiarrythmia medication - beta blcokers, digocix and amiadorone
  2. Catheter ablation
60
Q

Ix paediatric palpitations

A
  1. Holter monitor - 24 hour ECG
  2. Cardiacmemo - ECG during episode of fast heart rate
  3. Reveal implant device -loop recorder through the skin
61
Q

Main investigations to do in paediatric cardiology

A
  1. ECG
  2. CHEST XRAY
  3. ECHO

*Paediatrics CBL FALSHCARDS (47 decks)

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