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Paediatrics > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

CHD accounts for what % of congenital anomalies?

A

30%

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2
Q

What are the big 8 that account for most of cardiac anomalies?

A

VSD, ASD, PDA, pulmonary and aortic stenosis, coarctaton of aorta, transposition of great arteries, tetralogy of fallot

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3
Q

What is the aetiology of CHD?

A

Genetic predisposition and environmental hazards

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4
Q

What environmental hazards contribute to CHD?

A

Drugs (alcohol, cocaine, amphetamines, ectasy, phenytoin, lithium)
Infection - ToRCH
Maternal DM, SLE

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5
Q

When is the teratogenic window for cardiac anomalies?

A

18-60 days post conception

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6
Q

What does maternal DM put the child at increased risk of?

A

Hypertrophic cardiomyopathy which resolves after birth

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7
Q

What does maternal SLE put the child at risk of?

A

Ab attach bundle of his –> heart block

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8
Q

What is trisomy 13 assoc with?

A

VSD and ASD

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9
Q

What is trisomy 18 assoc with?

A

VSD and PDA

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10
Q

What is trisomy 21 assoc with?

A

ASVD

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11
Q

What is turner’s syndrome assoc with?

A

Coarctation of aorta and biscupid aortic valve

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12
Q

What is Noonan syndrome assoc with?

A

Pulmonary stenosis

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13
Q

What are the symptoms of DiGeorge syndrome?

A

CATCH 22
Cardiac abnormalities, anomalous face, thymus aplasia, cleft palate, hypocalcaemia due to hypoparathyroidism
22nd chromosome (22q11)

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14
Q

What are the key areas of history you want to cover in suspected heart problems in a child?

A 
Feeding, wt, development 
Cyanosis
Dyspnoea/tacypnoea
Exercise tolerance
Chest pain - often mistaken for GO reflux, costochondritis 
Syncope
Palpitations
Joint problems - rheumatic fever
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15
Q

What is rheumatic fever?

A

Inflammatory sequela involving heart, joints, skin, CNS after untreated GAS infection

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16
Q

What should you check for in examination of a child you suspect to have cardiac problems?

A 
Weight, ehight
Dysmorphic features
Cyanosis
Clubbing
Tachy/dyspnoea
Pulses/apex - esp femoral 
Heart sounds
Murmurs
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17
Q

What investigations may be useful in identifying a cardiac condition?

A 
BP 
O2 sats, ABG
ECG
CXR
Echo 
Catheter to measure intracardial pressures/sats
Angiography
MRI/A
Exercise testing
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18
Q

What % of murmurs are innocent?

A

70-80%

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19
Q

What are consistent features of innocent murmurs?

A 
Systolic murmur/continuous in venous hum 
No signs of cardiac dx
Soft murmur (grade 1/2 of 6)
Vibratory/musical 
Localised
Varies w. position/exercise/respiration
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20
Q

What is the most common innocent murmur?

A

Still

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21
Q

What is a typical presentation of still murmur?

A

Age 2-7
Soft, systolic vibratory, twangy murmur at apex & L sternal border
Increases when supine/exercising

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22
Q

What is a typical presentation of pulmonary outflow murmur?

A

Age 8-10
Soft systolic, vibtatory murmur at upper L sternal border, well localised, not radiating to back and worse in supine position & with exercise

Often in children with narrow chest

23
Q

What is a typical presentation of carotid/brachiocephalic arterial bruit?

A

Age 2-10y
1-2/6 systolic, harsh
Supraclavicular, radiating to neck
Worse with exercise, decreased on turning head/extending neck

24
Q

What is a typical presentation of someone with venous hum?

A

Age 3-8y
Soft, continuous murmur, sometimes diastolic accentuation
Supraclavicular
ONLY in upright position

25
Q

Why are innocent murmurs more common in children?

A

As heart closer to chest wall

Heart smaller so low more turbulent and walls thinner

26
Q

What are the three types of VSD?

A

Subaortic, perimembranous, muscular

27
Q

What sort of shunt do you mostly get in VSD?

A

L to R

28
Q

What sort of murmur do you get in VSD?

A

Pansystolic at lower left sternal edge

Sometimes thrill

29
Q

If the hole in VSD is small what signs/symptoms will you see?

A

Asymptomatic + early systolic murmur

30
Q

In large VSD what murmur will you get?

A

Diastolic murmur due to relative mitral stenosis

31
Q

How can VSD lead to R –> L shunt, why is this a problem and what is the name of this syndrome?

A

RV doesn’t fill properly, jet goes up pulmonary artery –> extra fluid in pulmonary arteries –> irritation of pulmonary arteries –> fibroblast + smooth muscle deposition in pulmonary artery –> RV hypertrophy –> RV pressure increases –> more pulmonary HTN and switch to R to L shunt
–> cyanosis
Known as Eisenmenger syndrome

32
Q

What signs do you get in large VSD?

A

Cardiac failure: tachypnoea, tachycardia, hepatosplenomegaly

Stopping feeding as too out of breath

33
Q

How do you treat VSD?

A 
Amplatzer (closure) device
Patch closure (CP bypass w. autologous pericardium)
34
Q

How do ASDs tend to present?

A

Asymptomatic normally & spontaneously close

Can present in adulthood with AF, heart failure + pulmonary HTN

35
Q

What murmur do you get in ASD?

A

Wide, fixed splitting of 2nd heart sound, pulmonary flow murmur

36
Q

How do you treat ASD?

A

Occlusion device if big

37
Q

What is assoc with trisomy 21?

A

Single AV valve, ostium primum ASD and high VSD

38
Q

How does pulmonary stenosis tend to present?

A

Mild - asymptomatic

Mod/severe - severe, exertional dyspnoea, fatigue

39
Q

What murmur do you get with pulmonary stenosis?

A

Ejection, systolic murmur upper left sternal border w. radiation to back

40
Q

Do you treat pulmonary stenosis? If so, how?

A

Monitor as when heart grows stenosis narrower relative to heart
Rx with balloon valvoplasty (leads to regurg but kids tolerate this well)

41
Q

How does aortic stenosis present?

A

Usually asymptomatic
If severe –> reduced exercise tolerance, exertional chest pain, syncope
If coronary circulation impaired –> coronary heart disease symptoms

42
Q

What sort of murmur do you get in aortic stenosis?

A

Ejection, systolic murmur upper right sternal border, radiation to carotids

43
Q

What shunts are present in the foetal circulation?

A

Foramen ovale - RA, LA
Ductus arteriosus - pulmonary trunk and aorta
Ductus venosus - umbilical vein and vena cava (bypassing liver)

44
Q

What changes occur to the foetal circulation at birth?

A

Pulmonary vascular resistance falls, pulmonary BF rises, systemic vascular resistance increases
3 shunts close

45
Q

In which group are PDA most common?

A

Prems

46
Q

How do you treat PDA?

A

Fluid restriction, diuretics, prostaglandin inhibitors (ibrupofen, indomethacin), surgical ligation, closure umbrella device

47
Q

What is coarctation of the aorta?

A

Kink in aorta (usually below DA in descending aorta)

48
Q

How do you test for coarctation of aorta?

A

Absent femoral pulses/radial-femoral delay

Be aware this may not be reliable in first few weeks as DA compensates until it closes

49
Q

What must you think of in 2-3wk old child, acutely unwell and in shock?

A

Check femoral pulses for coarctation of aorta

50
Q

How do you treat coarctation of aorta?

A

Re-open ductus arteriosus with prostaglandin E1/2, resection with end to end anastomosis, subclavian patch repair, balloon arthroplasty

51
Q

What is transposition of the great arteries?

A

Cyanotic heart condition in which the aorta is coming out of the LV and pulmonary trunk is coming out of the RV

52
Q

What is the treatment for transposition of the great arteries?

A 
If know about it antenatally deliver and give prostaglandins to keep shunts open
Switch procedure (be aware of damaging coronary arteries --> MI)
53
Q

What four things are assoc with fallot tetralogy?

A

Pulmonary stenosis
RV hypertrophy
High VSD
Overriding aorta

54
Q

How does fallot tetralogy lead to cyanosis?

A

Less O2 going to lungs –> RV hypetrophy and inc. pressure in RV –> bigger R to L shunt

Paediatrics (35 decks)

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