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3a > Paed:Cardio > Flashcards

Paed:Cardio Flashcards

1
Q

Explain the circulatory changes that happen at birth?

A
  • In fetus LAp low, RAp is higher as it receives all the systemic venous return and blood from placenta.
  • Foramen ovale is held open and blood flows across septum into LA.
  • With first breath, pulmonary resistance falls, so lung blood flow rises, and the LAp rises. meanwhile RAp falls as placenta removed from circulation
  • Pressure difference causes closure of the Foramen Ovale
  • Ductus arteriosus, connecting the pulmonary artery to the aorta, closes within hours to days
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2
Q

What are the features of Tetralogy of Fallot?

A
  • Large VSD
  • Overriding aorta
  • Pulmonary stenosis
  • Right ventricular hypertrophy
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3
Q

Symptoms of ToF

A
  • Severe cyanosis
  • SOB on exertion
  • Hypercapnia
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4
Q

What would you see on CXR of ToF

A

Boot shaped heart due to tilted apex

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5
Q

What would you hear on auscultation of ToF

A

Systolic ejection murmur

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6
Q

What are the changes in Transposition of the great vessels?

A

Aorta is connected to the RV
Pulmonary artery is connected to the LV.
Blue blood is therefore returned to the body and pink blood returned to lungs.

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7
Q

What is needed for TPA to be compatible with life?

A

Mixing. Must be a VSD/ASD/PDA present

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8
Q

Treatment of TPA?

A
  • PRostaglandins keep Ductus Arteriosus open

- Surgery to correct

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9
Q

What is Eisenmengers Sydnrome?

A

If there is high pulmonary blood flow due to a large LEFT>RIGHT shunt, the pulmonary arteries thicken and resistance to flow increases. Eventually the sjunt reverses and the patient becomes cyanotic.

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10
Q

What are the left> right shunts?

A

VSD, ASD, PDA. NOT BLUE.

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11
Q

What is VSD?

A

Blood from LV moves to RV, left to right shunt.

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12
Q

Signs and Symptoms of a VSD?

A

Symptoms usually mild.

Signs: - Loud pansystolic blowing murmur +/- a thrill.

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13
Q

What would you see on ECG of VSD?

A

Ventricular hypertrophy and strain

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14
Q

What would you see on CXR of VSD?

A

Pulmonary engorgement and cardiomegaly

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15
Q

Treatment of VSD?

A

Small ones close spontaneously. Large ones require surgery.

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16
Q

What is an ASD?

A

Hole in the septum causing blood to move from LA to RA. L>R shunt.

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17
Q

What is the most common type of ASD?

A

Secundum ASD

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18
Q

Symtptoms and signs of ASD?

A

Symptoms: Usually none
Signs: Split S2, systolic murmur.

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19
Q

ECG of ASD?

A

RBBB

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20
Q

CXR of ASD?

A

Cardiomegaly

Large pulmonary arteries

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21
Q

Management of ASD

A

is via Surgical Correction

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22
Q

What is patent ductus arteriosus

A

Persistent communication between the proximal Left pulmonary artery and the descending aorta.

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23
Q

What happens in PDA?

A

Due to fall in vascular resistance, blood moves from Aorta to Pulm Artery.

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24
Q

Symptoms and signs of PDA?

A

Signs: Murmur beneath left clavicle - continuos machinery murmur
Collapsing pulse
FtT
Loud S2

25
Q

Treatment of PDA

A

Oral or IV Ibuprofen

26
Q

What is AVSD?

A

Atrioventricular septal defect. Complete defect in the middle of heart with single five leaflet valve between atria and ventricles which leads to leak.

27
Q

What is AVSD most commonly seen in?

A

Trisomy 21 - Downs

28
Q

Symptoms of AVSD/

A

Breathless, poor weight gain, FtT

29
Q

Signs of AVSD?

A

Murmur from valvular regurgitation

30
Q

Treatment of AVSD?

A

Pulmonary artery banding

31
Q

What is Coarcation of the Aorta?

A

Narrowing of the aorta at the site of insertion of the ductus arteriosum

32
Q

Signs and symptoms of CoA?

A

Headaches and nosebleeds from htn.
Weak femoral pulses compared to brachials.
Bruit over scapula and back from collateral.
HTN in upper limbs

33
Q

CXR changes in COA

A

Dilated aorta indented at site of coarctation

34
Q

ECG changes in COA?

A

LVH

35
Q

Management of COA?

A

balloon dilation. risk of aneurysm formation tho.

36
Q

What are the symptoms of SVT?

A

Poor CO and oedema. Presents with sx of heart failure.

37
Q

Investigations of SVT?

A

ECG; Narrow complex tachycardia. May show P wave after QRS> Inverted T waves and short PR interval

38
Q

Managmenent of SVT?

A

Vagal stimulating maenouvers eg. cold ice pack to face

IV Adenosine.

39
Q

What is congential complete heart block?

A

Rare conditon related to presence of Anti-ro or Anti-la in normal serum. Linked with connective tissue disease. Antibody prevents development of normal electrical conduction system in the heart.

40
Q

Clincal features of congential complete heart block?

A

Fetal hydrops and intrauterine death.

May be sx free but may cause syncope.

41
Q

management of complete heart block?

A

Endo or epicardial pacemaker.

42
Q

What is Wolff-Parkinson-White syndrome?

A

Pre-excitation syndrome predisposiing to SVT.
Abnormal re-entry circuit of AV node and acessory conduction pathway connectring Atria to Ventricles or R or L cardiac borders.

43
Q

ECG changes in WPW?

A

Short PR interval and DELTA wave.

44
Q

Most common causaitive agent of IE?

A

Strep Viridans
Staph Aureus
Group D strep

45
Q

Who is at risk of IE?

A

Turbulent blood flow - VSD, PDA, COA

Prostethic material inserted

46
Q

Clinical features of IE

A 
Prologned fever
Myalgia 
Arthralgia
Headache
Weight loss
Night sweats
47
Q

Examination of IE

A 
Anaemia
Clubbing
Pallor
Splinter haemorraghes
Osler nodes
Janeway lesions
Necrotic skin lesiosn
Splenomegaly
Roth spots
Haematuria
Heart murmurs
48
Q

Investigations of IE?

A

FBC shows raised WCC, raised ESR and raised CRP
Blood cultures
Echocardiography to look for vegitations

49
Q

Management of IE?

A

High dose IV penicillin / vancomycin

Surgical removal of infected prostheses

50
Q

Prophylaxis of IE

A

Good dental hygeine and ?abx

51
Q

What is dialted cardiomyopathy?

A

Large poorly contracting heart. Diagnose on ECHO. Treat with Diuretics, ACE-i, and carvedilol

52
Q

What is Rheumatic Fever?

A

Systemic febrile illness caused by cross sensitivity reaction to group a beta haemolytic streps. Can result in permanent damage to heart valves.

53
Q

What are Jones diagnositc criteria?

A

Major criteria: Carditis, polyarthritis, erythema marginatum, subcutaneous nodules, sydenhams chorea
Minor criteria: fever, esr >20mm or CRP raised, arthralgia, ECG PR interval >0.2, prev rheum fever

54
Q

treatment of rheumatic fever?

A

Rest
Prednisolone
Penicillin abx

55
Q

Causes of heart failure?

A 
Congenital heart defects
AV malformations
Cardiomyopathy
Arrhytmias
Acute HTN
Anaemia
Cor pulmonale
56
Q

Symptoms of heart failure?

A

Infant: Feeding difficulties, easy fatiguability, exertional dyspnoea, diaphoresis when sleeping or eating, resp distress, vom, lethargy, cyanosis
Child: Decreased exercise tolerance, fatigue, decreased appetite, FtT, respiratory distress, syncope, frequent URTIs/asthma episodes

57
Q

Physical findings of heart failure?

A

Tachycardia
Tachypnoea
Cardiomegaly
hepatomegaly

58
Q

Management of heart failure

A

General: Sitting up, oxygen, Na and water restriction
Drugs: Diuretics, inotropic agents
Correct underlying cause

3a (25 decks)

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