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Medicine Finals - Paediatrics > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

What are the three fetal shunts?

A

Ductus venosus (umbilical vein to inferior vena cava)

Foramen ovale (right atrium to left atrium)

Ductus arteriosus (Pulmonary artery to aorta)

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2
Q

How can you keep the ductus arteriosus open and when might you want to keep it open?

A

Prostaglandin infusion

When there is a cardiac abnormality causing right->left shunt.

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3
Q

What are features of an innocent murmur?

A

Soft

Short

Systolic

Symptom-less

Situation dependent

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4
Q

What murmur is associated with an atrial septal defect?

A

Ejection systolic murmur, crescendo decrescendo

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5
Q

What murmur is associated with a PDA?

A

Machinery murmur of 2nd heart sound

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6
Q

What murmur is associated with Tetralogy of Fallot?

A

Ejection systolic murmur heard best at LUSE (pulmonary stenosis)

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7
Q

Which congenital heart conditions cause CYANOTIC heart disease?

A

Tetralogy of Fallot

Transposition of the great arteries

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8
Q

What murmur is associated with aortic stenosis? What other features are there?

A

Ejection systolic murmur, crescendo-decrescendo

Narrow pulse pressure

Slow rising pulse

Soft or absent S2

S4

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9
Q

How is aortic stenosis managed?

A

If asymptomatic -> observe

If symptomatic -> valve replacement

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10
Q

What is the most common complication of aortic stenosis?

A

Left ventricular outflow tract obstruction

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11
Q

What conditions are associated with pulmonary stenosis?

A

Tetralogy of Fallot

William syndrome

Noonan syndrome

Congenital rubella syndrome

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12
Q

How does pulmonary stenosis present?

A

Ejection systolic murmur - louder on inspiration

Often found incidentally

Symptoms can be fatigue, SOB, failure to thrive

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13
Q

What murmur is associated with pulmonary stenosis? What other signs are there?

A

Ejection systolic murmur loudest in the pulmonary area

Palpable thrill

Right ventricular heave due to RV Hypertrophy

Raised JVP

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14
Q

What are causes of heart failure in: Neonates, infants, and older children?

A

Neonates = due to obstructed circulation (Hypoplastic left heart syndrome, aortic stenosis, coaractation of the aorta, interruption of aortic arch)

Infants = due to high pulmonary blood flow (ventricular septal defect, atrioventricular septal defect, large PDA_

Older children (Eisenmenger syndrome, Rheumatic heart Disease, Cardiomyopathy)

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15
Q

Which heart conditions cause a left to right shunt?

A

ASD

VSD

PDA

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16
Q

Which heart conditions cause a right to left shunt?

A

Tetralogy of Fallot

Transposition of the great arteries

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17
Q

Which type of shunt causes cyanosis?

A

Right to left

18
Q

What are signs of heart failure in neonates/infants?

A

Breathlessness

Sweating

Poor feeding

Recurrent chest infections

Failure to thrive

19
Q

What are symptoms and signs of atrial septal defect?

A

Symptoms = wheeze, may be often asymptomatic

Signs =
Ejection systolic murmur

Fixed, widely split S2

20
Q

What is seen on CXR in atrial septal defect?

A

Cardiomegaly

Enlarged pulmonary arteries

Increased pulmonary vascular markings

21
Q

How does a ventricular septal defect present?

A

If it’s smaller than the aortic valve (<3mm) = asymptomatic, LOUD pan systolic murmur at LLSE, quiet pulmonary S2, CXR = normal.

If larger than aortic valve = presents with heart failure, recurrent chest infections, SOFT pan systolic murmur, LOUD pulmonary S2. CXR shows signs of heart failure.

22
Q

How is a ventricular septal defect managed?

A

Smaller asymptomatic VSD = close spontaneously

Larger symptomatic VSD = Surgical repair required

23
Q

What are signs of a patent ductus arteriosus?

A

Continuous machinery murmur

Left subclavicular thrill

Bounding collapsing pulse

Wide pulse pressure

Heaving apex beat

24
Q

How is a patent ductus arteriosus managed?

A

In preterm infants can give Indomethacin/Ibuprofen to help close the PDA

If asymptomatic - wait to see if it closes by 1 year

If symptomatic - needs closing

25
Q

What is Eisenmenger syndrome and which conditions typically can cause it?

A

When a heart condition causing a L to R shunt, eventually causes pulmonary HTN and therefore it becomes a R to L shunt

This leads to cyanosis

Causes= ASD, VSD, PDA,TOF

26
Q

How is Eisenmenger syndrome managed?

A

Complete heart-lung transplantation required

27
Q

Which congenital heart condition is associated with Turner syndrome?

A 
Coarctation of the aorta
Aortic stenosis (due to bicuspid aortic valve)
28
Q

How does coarctation of the aorta present?

A

Weak femoral pulses

Mid systolic murmur

Tachypnoea

Radio-femoral delay

Apical click

29
Q

How is coarctation of the aorta managed?

A

If critical, need to keep ductus arteriosus open with prostaglandin infusion whilst awaiting surgery

30
Q

What are the 4 features of Tetralogy of Fallot?

A
  1. Ventricular septal defect
  2. Right ventricular hypertrophy
  3. Pulmonary stenosis
  4. Overriding aorta
31
Q

How does Tetralogy of Fallot cause cyanosis?

A

Pulmonary stenosis means that there is higher pressure on R side of heart, this means that there is a R to L shunt through the VSD

32
Q

How does Tetralogy of Fallot present?

A

Ejection systolic murmur (due to pulmonary stenosis)

Cyanosis

“Tet spells” - cyanotic episodes, infant will typically squat

33
Q

What is seen on CXR in Tetralogy of Fallot?

A

Boot shaped heart

34
Q

How is Tetralogy of Fallot managed?

A

Surgical repair

35
Q

What is Ebstein’s Anomaly?

A

A congenital heart defect where the tricuspid valve is set lower than usual, causing the RA to be larger than usual and the RV to be smaller than usual

36
Q

What are signs of transposition of the great arteries?

A

Loud single S2

Prominent right ventricular impulse

37
Q

What does a continuous machinery murmur indicate?

A

Patent ductus arteriosus

38
Q

What can an ejection systolic murmur indicate?

A

Aortic stenosis - LLSE (crescendo-decrescendo)

Pulmonary stenosis - Pulmonary area

Atrial septal defect (crescendo-decrescendo)

39
Q

Aortic stenosis vs. ASD?

A

Aortic stenosis = narrow pulse pressure, slow rising pulse, soft S2

ASD = fixed splitting of S2

40
Q

What might be seen on an ECG in an ASD?

A

RBBB

41
Q

Which condition can cause patients with a DVT to develop a stroke?

A

Atrial septal defect

Medicine Finals - Paediatrics (15 decks)

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