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Peadiatric: cardiology > Congenital Heart dIsease > Flashcards

Congenital Heart dIsease Flashcards

1
Q

Cause of CHD?

A
  • most idiopathic (85 -90%)
  • teratogens:
    - alcohol,
    - medication (phenytoin),
    - infections ( rubella)
  • genetics (gene/ chromosomal)
    • marfan’s
    • trisomy 21
    • turners (45XO)
    • trisomy 13
    • trisomy 18
  • Diabetic mother
  • Fam Hx
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2
Q

Incidence of CHD?

A

1/1000 (1%)

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3
Q

Top 5 CHD in order?

A
  • VSD
  • PDA
  • Coarctation
  • TOF
  • Aortic stenosis
  • ASD
  • pulmonary valve stenosis
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4
Q

Classify acyanotic CHD?

A
  • acyanotic w/ increased pulmonary BF

- acyanotic w/ normal BF

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5
Q

Which acyanotic conditions allow for left to right shunting?

A
  • PDA
  • ASD
  • VSD
  • AVSD (or endocardium cushion defect)
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6
Q

How do infants w/ acyanotic (incr. pull BF) CHD present?

A
  • excessive sweating during feeds
  • interrupted feeds
  • failure to thrive
  • Recurrent LRTIs
  • SOB
  • plethora
  • if significant lesion: CCF

Signs

  • chest deformities: pectus carnatum, Harrison’s sulcus, precordial bulge, chest asymmetry
  • signs of CCF
  • plethora
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7
Q

Where does one hear a PDA? Characteristics?

A
  • just below the left clavicle
  • characteristics differ
    - preterm: systolic murmer
    - term infants: continuos (machinery) murmer
    - very large w/ incr. flow: mid diastolic murmer at apex
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8
Q

Who gets PDAs and how do they differ with these groups?

A
  • Pre-term: esp. Respiratory distress
    - left to right shunt develops towards end of first week of life
    - closes by expected term date
    - closure can be accelerated w/ NSAIDs ( ibuprofen/ indomethacin)
  • Term:
    - NSAIDs not effective
    - surgical ligation required / device closure before 6-12 months (even asymptomatic)
    -
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9
Q

How does PDA present?

A
  • preterm: tachypnoea and systolic murmur

- term: continuos murmur, bounding/ collapsing pulses, wide pulse pressure, easily palpable dorsal is pedis

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10
Q

When do large VSDs present?

A

-large defects between 2-6 weeks of life w/ decrease in plum. Vascular resistance

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11
Q

Murmur of VSD?

A
  • loud pan systolic murmur at left lower sternal border
    - small defects have louder murmer because high velocity but low volume shunt
  • mid diastolic murmur in large defect
  • loud P2 if associated plum. hypertension
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12
Q

What must you suspect if VSD fails to respond to anti- failure treatment?

A
  • coexisting defect: e.g. PDA/ coarctation
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13
Q

Natural hx of VSDs?

A
  • small defects: may close spontaneously in first 2 years
  • medium: get smaller
  • large: esp. W/ CCF will require intervention usually surgical
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14
Q

ASD presentation?

A

Symptoms:

  • usually asymptomatic
  • frequent LRTIs (flooded lungs)

Signs

  • right ventricular hypertrophy (heave)
  • murmur: pulmonary ejection systolic murmur w/ fixed splitting of S2
  • tricuspid diastolic murmur
  • CXR: large pulmonary artery, plethoric lungs
  • ECG: RSR pattern in V1
    • primum: left axis deviation
    • secundum: right axis deviation
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15
Q

ECG changes in AVSD?

A

ECG: RSR pattern in V1

 - primum: left axis deviation
 - secundum: right axis deviation
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16
Q

CXR changes in AVSD?

A

CXR: large pulmonary artery, plethoric lungs

17
Q

Mx of ASD?

A
  • secundum: surgical or device closure during childhood

- primum: only large defects need closure

18
Q

Classify AVSDs (w/ description)

A
  • complete: osmium primum ASD w/ inlet VSD w/a common atrioventricular valve.
  • partial: ostium primum only
19
Q

Name a common population group w/AVSDs.

A
  • trisomy 21
20
Q

Murmur of AVSD?

A
  • pansystolic murmur at apex secondary to mitral regurgitation
  • ejection systolic at pulmonary valve secondary to increased pulmonary flow
  • no murmur: balanced pressures due to large defect
21
Q

ECG in AVSD?

A
  • left anterior hemiblock
  • left QRS axis between 0 - minus 90 degrees
  • RSR in V1 (right ventricular hypertrophy)
22
Q

Top 5 cause of CHD in order?

A
  • VSD
  • PDA
  • Coarctation
  • TOF
  • Aortic stenosis
  • ASD
  • pulmonary valve stenosis
23
Q

Which gender predominates aortic stenosis

A

Males w/ 4:1 ratio

24
Q

Presentation of AS?

A

Symptoms:
-usually asymptomatic in infancy ( develops later in a congenitally bicuspid valve)

Signs:

  • Significant stenosis: palpable thrill, loud long ejection systolic murmur radiating to the neck in 2nd (right) intercostal space, ejection click (valvular)
  • very severe: left heart failure, poor volume pulses, narrow pulse pressure

Investigations:
-CXR: normal or enlarged proximal aorta, cardiomegaly (very severe)

25
Q

Classify AS?

A
  • valvular
  • supra valvular (rare)
  • sub valvular (rare)
26
Q

Is pulmonary stenosis an acyanotic or cyanotic CHD?

A

-primarily an acyanotic condition but if critical pressures in the right atrium can build up enough to cause a right to left shunt through a patent foramen ovale leading to mixing and cyanosis

27
Q

Aetiology of rheumatic fever?

A
  • susceptible person (HLA class II variant)

- pharyngeal infection with GAS

Peadiatric: cardiology (6 decks)

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