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PaedsY5 Dev and Cardio > Further Cardiac Conditions > Flashcards

Further Cardiac Conditions Flashcards

1
Q

What is the most common childhood arrhythmia?

A

SVT

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2
Q

Why does SVT occur?

A

Tachyarrhythmia from above Bundle of His- localised re-entry circuit

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3
Q

What are clinical features of SVT?

A

Hydrops fetalis

IU death

Poor CO/ pulmonary oedema from HF features

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4
Q

What investigations are important in SVT?

A

ECG: Narrow complex 250-300 bpm, features of MI if severe HF

WPW syndrome (short PR, delta wave)

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5
Q

What is the management of SVT?

A

Restore sinus rhythm

Circulatory/ Respiratory support

Vagal maneouvres

IV adenosine

Electro cardioversion

Maintenance therapy: flecainide/ sotalol

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6
Q

What are the clinical features of congenital complete heart block?

A

Rare

Foetal hydrops, IU death, HF

Asymptomatic for years

syncope

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7
Q

What is CCHB associated with?

A

Anti-Ro/ Anti-La in maternal serum

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8
Q

What is the treatment for CCHB?

A

Endocardial pacemaker

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9
Q

Which arrhythmias are rare in infants?

A

Long QT

Afib/ Aflut/ectopic atrial tachycaardia/ VT/ VFib are rare

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10
Q

What are the clinical features of Long QT and what is associated with Long QT?

A

Long QT: sudden LOC, late childhood, sudden death- caused by erythromycicn, electrolyte disorders, head injury

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11
Q

What is suggested if a child has sinus arrhythmias?

A

Nothing.

Normal, cyclical with respiration

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12
Q

What is Rheumatic fever caused by?

A

AI reaction post Group A beta haemolytic streptococcus (GAS)/ Scarlet fever due to anti-M protein antibodies

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13
Q

What is evidence of preceding GAS infection?

A

Positive throat culture – but usually negative by the time symptoms occur

Rapid streptococcal antigen test +ve

Elevated/rising streptococcal antibody titre

Recent scarlet fever

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14
Q

What is the Major criteria in the Jones criteria?

A

Carditis: tachycardia, murmurs (mitral/aortic regurgitation), pericardial rub,
cardiomegaly, conduction defects

Arthritis: usually affects larger joints, lasting <1 week in a joint but migrating to other
joints over 1-2 months

Subcutaneous nodules: small firm painless nodules seen on extensor surfaces, joints
and tendons

Erythema marginatum: geographical-type rash with red, raised edges and clear centre
mainly on trunk and proximal limbs

Sydenham’s chorea: rapid, involuntary, irregular movements with flowing/dancing
quality

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15
Q

What does CASES stand for?

A

Carditis: tachycardia, murmurs (mitral/aortic regurgitation), pericardial rub,
cardiomegaly, conduction defects

Arthritis: usually affects larger joints, lasting <1 week in a joint but migrating to other
joints over 1-2 months

Subcutaneous nodules: small firm painless nodules seen on extensor surfaces, joints
and tendons

Erythema marginatum: geographical-type rash with red, raised edges and clear centre
mainly on trunk and proximal limbs

Sydenham’s chorea: rapid, involuntary, irregular movements with flowing/dancing
quality

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16
Q

What are the minor criteria in Jones criteria?

A

Pyrexia

Raised ESR/CRP

Arthralgia (only if arthritis not present as major criteria)

Prolonged PR interval (only if carditis not present as major criteria)

Previous rheumatic fever

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17
Q

What is PRAPP?

A

Pyrexia

Raised ESR/CRP

Arthralgia (only if arthritis not present as major criteria)

Prolonged PR interval (only if carditis not present as major criteria)

Previous rheumatic fever

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18
Q

How do you diagnose Rheumatic fever with the JONES criteria?

A

JONES Criteria: evidence of recent strep throat (Increased ISO titre, other streptococcal Abs, Group A strep on throat culture) +

2 majors or 1 major + 2 minors

19
Q

What investigations might you do for rheumatic fever?

A

Bloods: FBC (inc WCC), inc ESR/CRP, rising antistreptolysin O titre

Throat swab: culture for GAS, rapid streptococcal antigen test

ECG: saddle-shaped ST elevation and PR segment depression (features of pericarditis), arrhythmias

Echocardiogram: pericardial effusion, myocardial thickening or dysfunction, valvular dysfunction

20
Q

What is the initial management for Rheumatic fever?

A

bed rest and anti inflamamtory

High does aspirin, antibiotics (amoxicillin), corticosteroids if not rapid resolution

21
Q

What is the long term (prophylaxis) for rheumatic fever?

A

IM benzathine benzylpenicillin every 3-4 weeks until 10 years after last episode or until age 21 or lifelong if severe valve disease

(or
▪ Oral phenoxymethylpenicillin bd
▪ Oral sulfadiazine
▪ Oral azithromycin (penicillin allergy)

Valve replacement if necessary

22
Q

What is syncope and who gets it?

A

LOC due to transient brain oxygen drop (perfusion)

Common in adolescents and benign

23
Q

Discuss two main causes and presentations of syncope

A

Cardiac cause (arrhythmia/ structural)- Symptoms on exercise, FH of sudden unexpected death, palpitations

Neural (stressor e.g. postural, vasovagal, dizziness/ lightheaded/ abnormal vision/ pallor/ sweating) + Maladaptive drop in BP

24
Q

What investigations would you consider in syncope?

A

Check BP, signs of cardiac disease, ECG- corrected QT

25
Q

What is the management of syncope?

A

Treat cause

26
Q

What may cardiomyopathy be due to?

A

Dilated cardiomyopathy may be inherited, secondary to metabolic disease or may result from a direct viral infection

27
Q

How would you investigated cardiomyopathy?

A

Echo

28
Q

How would you treat cardiomyopathy?

A

Symptomatic: diuretics, ACEi, carvedilol

Myocarditis may improve sponataneously

29
Q

What are the 5 different types /causes of Pulmonary HTN (pHTN)?

A

Venous: Idiopathic, post tricuspid shunt, HIV, persistent pulmonary HTN of the newborn

Arterial: LH disease, pulmonary stenosis or compression

Resp disease: Chronic Obstructive Lung disease/ bronchopulm dysplasia, ILD, Obstructive sleep apnoea

Pulmonary thromboembolic disease

Pulmonary inflammatory or capillary disease

30
Q

How do you treat pHTN?

A

If left untreated and pulmonary vascular bed changes: transplant of heart/ lungs

Medication: NO, IV Magnesium sulphate, oral phosphodiesterase inh

31
Q

What increases your risk of IE?

A

Increased risk if turbulent flow/ defect

32
Q

What are the presenting features of IE?

A

Fever, anaemia, pallor

Necrotic skin lesions

Splinter haemorrhages/ clubbing

Cardiac signs

Cerebral infarct

Arthralgia/itis

Micro Haematuria

Retinal infarct

Splenomegaly

FROM JANE C

33
Q

What does FROM JANE C mean?

A 
Fever
Roth Spots
Osler’s nodes
Murmur
Janeway Lesions
Anaemia
Nail – splinter
hemorrhages
Emboli
Clubbing
34
Q

What investigations do you do for IE?

A

Multiple blood cultures (3 sets at 3 different sites and times) pre antibiotic

Echo (vegetation)

Dukes criteria for IE: 2 major or 1 major + 3 minor or 5 minor

35
Q

How do you treat IE?

A

MDT

Commonly: Streptococcus viridans

High dose penicillin + aminoglycoside (gentamicin) for 6w IV

Surgical removal and prosthesis

36
Q

What antibiotics are needed for the different IE organisms?

A

Aerobic cover
▪ Streptococci → penicillin + ceftriaxone (+/- gentamicin)
▪ Staphylococci → pencillin or vancomycin (if methicillin resistant)
▪ Enterococcus → penicillin + gentamicin
▪ HACEK → ceftriaxone + gentamicin

37
Q

What may cause HF in Neonates?

A

Neonate (duct dependent, obstructed systemic circulation) -> hypoplastic L-heart, aortic stenosis, severe coarctation of the aorta, interruption of aortic arch -> i.e. DO NOT CLOSE THE DUCTUS ARTERIOSUS

38
Q

What does HF present with?

A

SOB/ poor feeding, chest inf., fatigue

Poor weight gain, increased RR, HR, murmur, gallop rhythm, signs of venous congestion, cardiomegaly, hepatomegaly (common), respiratory distress. Low CO, pallor

39
Q

What investigations do you do for paeds HF (results similar to adult)?

A

Basic Obs

CXR

ECG

Echo

40
Q

What is the management of HF?

A

o Multiple faceted approach with specific aims:

  1. Reduce preload:
    · Diuretics (e.g. furosemide) or GTN
  2. Enhance cardiac contractility:
    · Dopamine; or
    · Digoxin, dobutamine, adrenaline, milrinone
  3. Reduce afterload:
    · Oral ACE inhibitors
    · Hydralazine, nitroprusside, alprostadil
  4. Improving oxygen delivery
    · Beta-blockers (e.g. carvedilol)
  5. Enhance nutrition

o If cyanotic -> prostaglandin infusion (alprostadil / prostaglandin E2)

41
Q

What may cause HF in Infants?

A

Infants (defect -> high pulmonary blood flow -> L-to-R shunt) -> persistent VSA, ASD, PDA

42
Q

What may cause HF in Older Children?

A

Older children (R- or L-HF)-> Eisenmenger (RHF), Rheumatic HD, cardiomyopathy

43
Q

What may cause HF in all children generically?

A

volume overload (anaemia or sepsis); pressure overload (HTN)

PaedsY5 Dev and Cardio (5 decks)

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