Paed:Cardio Flashcards
Explain the circulatory changes that happen at birth?
- 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
What are the features of Tetralogy of Fallot?
- Large VSD
- Overriding aorta
- Pulmonary stenosis
- Right ventricular hypertrophy
Symptoms of ToF
- Severe cyanosis
- SOB on exertion
- Hypercapnia
What would you see on CXR of ToF
Boot shaped heart due to tilted apex
What would you hear on auscultation of ToF
Systolic ejection murmur
What are the changes in Transposition of the great vessels?
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.
What is needed for TPA to be compatible with life?
Mixing. Must be a VSD/ASD/PDA present
Treatment of TPA?
- PRostaglandins keep Ductus Arteriosus open
- Surgery to correct
What is Eisenmengers Sydnrome?
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.
What are the left> right shunts?
VSD, ASD, PDA. NOT BLUE.
What is VSD?
Blood from LV moves to RV, left to right shunt.
Signs and Symptoms of a VSD?
Symptoms usually mild.
Signs: - Loud pansystolic blowing murmur +/- a thrill.
What would you see on ECG of VSD?
Ventricular hypertrophy and strain
What would you see on CXR of VSD?
Pulmonary engorgement and cardiomegaly
Treatment of VSD?
Small ones close spontaneously. Large ones require surgery.
What is an ASD?
Hole in the septum causing blood to move from LA to RA. L>R shunt.
What is the most common type of ASD?
Secundum ASD
Symtptoms and signs of ASD?
Symptoms: Usually none
Signs: Split S2, systolic murmur.
ECG of ASD?
RBBB
CXR of ASD?
Cardiomegaly
Large pulmonary arteries
Management of ASD
is via Surgical Correction
What is patent ductus arteriosus
Persistent communication between the proximal Left pulmonary artery and the descending aorta.
What happens in PDA?
Due to fall in vascular resistance, blood moves from Aorta to Pulm Artery.
Symptoms and signs of PDA?
Signs: Murmur beneath left clavicle - continuos machinery murmur
Collapsing pulse
FtT
Loud S2
Treatment of PDA
Oral or IV Ibuprofen
What is AVSD?
Atrioventricular septal defect. Complete defect in the middle of heart with single five leaflet valve between atria and ventricles which leads to leak.
What is AVSD most commonly seen in?
Trisomy 21 - Downs
Symptoms of AVSD/
Breathless, poor weight gain, FtT
Signs of AVSD?
Murmur from valvular regurgitation
Treatment of AVSD?
Pulmonary artery banding
What is Coarcation of the Aorta?
Narrowing of the aorta at the site of insertion of the ductus arteriosum
Signs and symptoms of CoA?
Headaches and nosebleeds from htn.
Weak femoral pulses compared to brachials.
Bruit over scapula and back from collateral.
HTN in upper limbs
CXR changes in COA
Dilated aorta indented at site of coarctation
ECG changes in COA?
LVH
Management of COA?
balloon dilation. risk of aneurysm formation tho.
What are the symptoms of SVT?
Poor CO and oedema. Presents with sx of heart failure.
Investigations of SVT?
ECG; Narrow complex tachycardia. May show P wave after QRS> Inverted T waves and short PR interval
Managmenent of SVT?
Vagal stimulating maenouvers eg. cold ice pack to face
IV Adenosine.
What is congential complete heart block?
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.
Clincal features of congential complete heart block?
Fetal hydrops and intrauterine death.
May be sx free but may cause syncope.
management of complete heart block?
Endo or epicardial pacemaker.
What is Wolff-Parkinson-White syndrome?
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.
ECG changes in WPW?
Short PR interval and DELTA wave.
Most common causaitive agent of IE?
Strep Viridans
Staph Aureus
Group D strep
Who is at risk of IE?
Turbulent blood flow - VSD, PDA, COA
Prostethic material inserted
Clinical features of IE
Prologned fever Myalgia Arthralgia Headache Weight loss Night sweats
Examination of IE
Anaemia Clubbing Pallor Splinter haemorraghes Osler nodes Janeway lesions Necrotic skin lesiosn Splenomegaly Roth spots Haematuria Heart murmurs
Investigations of IE?
FBC shows raised WCC, raised ESR and raised CRP
Blood cultures
Echocardiography to look for vegitations
Management of IE?
High dose IV penicillin / vancomycin
Surgical removal of infected prostheses
Prophylaxis of IE
Good dental hygeine and ?abx
What is dialted cardiomyopathy?
Large poorly contracting heart. Diagnose on ECHO. Treat with Diuretics, ACE-i, and carvedilol
What is Rheumatic Fever?
Systemic febrile illness caused by cross sensitivity reaction to group a beta haemolytic streps. Can result in permanent damage to heart valves.
What are Jones diagnositc criteria?
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
treatment of rheumatic fever?
Rest
Prednisolone
Penicillin abx
Causes of heart failure?
Congenital heart defects AV malformations Cardiomyopathy Arrhytmias Acute HTN Anaemia Cor pulmonale
Symptoms of heart failure?
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
Physical findings of heart failure?
Tachycardia
Tachypnoea
Cardiomegaly
hepatomegaly
Management of heart failure
General: Sitting up, oxygen, Na and water restriction
Drugs: Diuretics, inotropic agents
Correct underlying cause
