general Flashcards
examples of:
R>L shunt
L>R shunt
mixing CHD
3 each
R>L shunt - TOF, TGA, TA
L>R shunt - PDA, ASD, VSD
mixing CHD - truncus, TAPVR, HLH
symptoms / signs of HF (early and late)
tachypnoea, tachycardia
poor feeding
poor growth
hepatomegaly
diaphoresis
cyanosis
shock»_space; renal failure, seizures, NEC etc.
pulmonary oedema
when would CHF present?
2-6 weeks of age (i.e. later than the others) …kinda same time as VSD/ASD
which 4 conditions are more likely to present with shock for CHF?
those needing the PDA to keep systemic perfusion up i.e.
HLHS
coarct
critical AS
interrupted aortic arch
why does differential cyanosis occur and in what conditions does it occur?
occurs in CoA, AS, interrupted aortic arch
Results from a R to L shunt at the level of the PDA:
deox blood flows through the DA > lower half of body
ox blood from left heart prox to the obstruction will supply upper half of body
reversed differential cyanosis - when does this occur and why?
TGA with coarct / PHTN
most oxygenated blood flow is pumped by the left ventricle out to the pulmonary artery and thus across the PDA
why does VSD only classically become symptomatic at 4-6 weeks of age?
PVR falls further at that age
risk of CHD if family member has it
2%
10% if bicuspid valve
cyanotic baby and the following findings of CXR = ?
a. Oligaemic lung fields
b. Plethoric lung fields
c. Congestion
d. Massive cardiomegaly
a. Oligaemic lung fields = PS, pulmonary atresia etc
b. Plethoric lung fields = TGA
c. Congestion = TAPVR
d. Massive cardiomegaly = Ebstein’s
what is the biggest predictor of a duct dependent lesion?
presence of murmur
cyanosis is important but not as much
one contraindication and one relative contraindication to PGE
TAPVR – reduction in PVR may lead to increased PBF and exacerbate venous congestion due to obstruction
TGA – often will not change saturations in presence of intact or restrictive atrial septum
PGE is most effective in what time frame?
first 96h of life
broad types of duct dependent lesions
duct dependent PBF
duct dependent systemic circulation
examples of duct dependent PBF lesions
• Ebstein anomaly
• Pulmonary atresia (with intact ventricular septum)
• Critical pulmonary stenosis
• Tetralogy of Fallot*
• Tricuspid atresia*
* Only duct dependent if severe RVOT
examples of duct dependent systemic flow
• Critical AS
• Critical coarctation
• Hypoplastic left heart
• Interrupted aortic arch
what is heterotaxy
failure of differentiation into right and left sided organs
name 5 types of vascular rings - which is most common
double aortic arch (complete) - most common
Right aortic arch with left ligamentum arteriosum
anomalous inominate artery - anterior to trachea
vascular/pul artery sling - ONLY one going anterior to oes
aberrant right subclavian artery - posterior to oes
aberrant right subclavian artery - a/w what?
T21 and CHD
what kind of study is diagnostic for a vascular ring? what kind is it not diagnostic for?
barium swallow
not for inominate - will be normal with no indentations
what is the problem with an ALCAPA
left coronary arises from pulmonary artery
after birth, PVR falls so blood goes from LCA to pul artery ‘myocardial steal’
so LV becomes dilated, MV shitty
lateral infarct and heart failure
PHTN defined by what pressure
Pul artery pressure >25
S2 in PHTN
narrowly split or single loud S2 - bc the pul valve will shut earlier
some ddx/systems causes for secondary causes of systemic HTN
- renal
- cardiovascular
- endocrine: thyroid, adrenal, phaeochromocytoma
- other: NF1
- iatrogenic: steroids
BP goal for anti-hypertensive treatment in children
i. SBP and DBP <90th centile (if <13 years)
ii. BP < 130/80 (if >13 years)
thiazides CI with what disease
diabetes - increases glucose
most common organisms for IE
strep viridans - dental stuff
staph aureus - post op
enterococci - GI stuff
when do you need IE prophylaxis
dental /skin stuff for high risks only:
• Unrepaired cyanotic heart defects
• Previous endocarditis
• Prosthetics
most common causes of myocarditis
adenovirus, coxsackieviruses, echoviruses
exam cause of constrictive pericarditis
TB
what age group of KD more likely to get CAA
the extremes - <6mo, >5yo
most common cause of acquired heart disease in 1st world children
KD
CAA rates in KD
15-20% if not treated
5% in IVIG
rheumatic fever organism
GAS THROAT not skin
criteria to diagnose initial RF
Two major, OR
One major + two minor
PLUS evidence of preceding GAS infection
Major = ACHES
A = arthritis - migratory polyarthritis
C = chorea - disappears in sleep, adolescent females
H = heart carditis/valvulitis
E = erythema marginatum
S = subcutaneous nodules - painless, mobile
Minor = TAPE
T = temperature
A = arthralgia
P = PR prolongation
E = elevated acute phase reactants
prophylaxis post RF
Benzathine penicillin G (BPG) IM 4 weekly for ageeeesss
most common valves affected in rheumatic fever
mitral > aortic
exam answer: Intrapericardial tumour arising near the great arteries is most likely a … ?
teratoma
exam thoughts: rhabdomyoma, think of what condition
tuberous sclerosis
exam thoughts: hypertrophic cardiomyopathy with normal LV systolic function, and nystagmus/dysarthria
= freidrich’s ataxia
exam thoughts: marfan’s think of what 3 cardiac lesions
mitral - MR/MVP
AR
aortic dissection
exam thoughts: MPS think of what cardiac lesions
MR
AR
muscular dystrophy causes what kind of cardiomyopathy
DCM
Noonan vs Turner
noonan normal sexual maturity, often mentally retarded
pathophys vasovagal
paradoxical vagal activation and sympathetic withdrawal resulting in peripheral vasodilation, hypotension + bradycardia
