Paediatric Cardiology Flashcards
Cyanotic heart conditions
Transposition of the Great arteries
Total Anomalous Pulmonary Venous drainage
Tricuspid atresia
Tetralogy of Fallot - if extensive pulmonary stenosis
Acyanotic heart conditions
Left to right shunts - ASD, VSD, PDA
Obstruction - Aortic, mitral or pulmonary stenosis, coarctation of the aorta
Treatment for patent ductus arteriosus
Indomethacin to neonate
Trans-catheter or surgical closure
Murmur for patent ductus arteriosus
Machine-like murmur
Continous
Tetrology of Fallot features
Pulmonary stenosis
Right ventricle hypertrophy
Overriding aorta
Ventricular septal defect
Murmur for Tetrology of Fallot
Pansystolic murmur
Aortic stenosis presentation
Fainting and dizziness
Chest pain on exertion - angina
Fatigue
Murmur for aortic stenosis
Ejection systolic -
second intercostal space, right sternal border
Carotid bruit
Treatment for aortic stenosis
Valve replacement
Murmur for pulmonary stenosis
Pansystolic murmur
Murmur for pulmonary stenosis
Pansystolic murmur - second intercostal space, left sternal border)
Transposition of the great arteries presentation
Cyanosis
Poor feeding
Poor weight gain - failure to thrive
Respiratory distress
Transposition of the great arteries murmur
No murmur
Transposition of the great arteries treatment
Prostin
Create a ASD
Arterial switch surgery
Tetrology of Fallot treatment
Prostin
Tetrology of Fallot treatment
Prostin
Fontan surgery
Innocent murmurs pathophysiology
Flow murmurs in children, caused by fast blood flow during systole
Innocent murmurs features
Soft Short Systolic Symptomless Situation dependent - changes with posture
When to refer an innocent murmurs
Murmur louder than 2/6
Diastolic murmurs
Louder on standing
Other symptoms - failure to thrive, feeding difficulty, cyanosis or shortness of breath
Investigations for murmurs
ECG
Chest Xray
Echocardiography
When does the ductus arteriosus normally close?
Stops functioning at 1-3 days of birth, and closes completely within the first 2-3 weeks of life
Risk factors for PDA
Prematurity
Rubella
Presentation of PDA
May be asymptomatic
Shortness of breath
Difficulty feeding
Poor weight gain
Lower respiratory tract infections
Risk factors for Tetrology of Fallot
Rubella infection
Increased age of the mother (40 + years)
Alcohol during pregnancy
Diabetic mother
Investigations for Tetrology of Fallot
Echocardiogram
Doppler flow studies
Chest Xray - boot shaped
Signs and Symptoms of Tetrology of Fallot
Cyanosis Clubbing Poor feeding Poor weight gain Ejection systolic murmur heard loudest in the pulmonary area “Tet spells”
“Tet spells”
Transient cyanotic episode
Caused by pulmonary vascular > systemic resistance
- e.g. exercise due to vasodilation
Treatment of tet spells
Older children may squat when a tet spell occurs.
Younger children can be positioned with their knees to their chest
Medical:
Oygen
Beta blockers
IV fluids
Morphine - decrease respiratory drive
Sodium bicarbonate can buffer metabolic acidosis
Phenylephrine infusion - increase systemic vascular resistance
Atrial septal defect presentation
SOB
Difficulty feeding
Poor weight gain
Lower respiratory tract infections
Eisenmenger syndrome
Pulmonary pressure > systemic pressure
Shunt reverses and forms a right to left shunt
Due to right sided hypertrophy
Complications of atrial septal defects
Stroke - VTE
AF or atrial flutter
Pulmonary hypertension and right sided HF
Eisenmenger syndrome
Atrial septal defect murmur
Mid-systolic, crescendo-decrescendo murmur
Fixed split second heart sound (S2) - increased blood flow via the pulmonary artery therefore closure of pulmonary and aortic valves is not in-sync
Conditions associated with ventricular septal defects
Down’s syndrome
Turner’s syndrome
Presentation of ventricular septal defects
Right sided heart failure:
Failure to thrive Poor feeding SOB Recurrent respiratory tract infections Hepatomegaly
Murmur for a ventricular septal defect
Pan systolic murmur at left lower sternal border
May have systolic thrill
Causes of Eisenmenger syndrome
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Signs or Eisenmengers syndrome
Raised JVP Hepatomegaly Right ventricular heave Loud P2 Peripheral oedema Pulmonary oedema - crackles
Hypoxia:
Cyanosis
Clubbing
Plethoric complection - polycythaemia
Management of Eisenmengers syndrome
- impossible to medically reverse condition
Supportive:
- oxygen
- venesection for polycythaemia
- anticoagulants - aspirin
- prophylaxtic abx - prevent infective endocarditis
- sildenafil - pulmonary hypertension
Coarctation of the aorta pathophysiology
Narrowing of the aortic arch around the ductus arteriosus
Condition associated with coarctation of the aorta
Turners syndrome
Presentation of coarctation of the aorta
- Abscent femoral pulses or radial - femoral delay
- unequal four limb blood pressure - higher in right arm
- systolic murmur
- left ventricular heave
- underdevelopment of left arm and lower limbs
- tachypnoea
- poor feeding
- grey and floppy baby
Signs of aortic stenosis
Thrill
Ejection click
Slow rising pulse and narrow pulse pressure
Complications of aortic stenosis
Left sided heart failure
Ventricular arrythmia
Bacterial endocarditis
Sudden death
Conditions associated with pulmonary stenosis
Tetralogy of Fallot
William syndrome
Noonan syndrome
Rubella
Presentation of pulmonary stenosis
Poor feeding
Failure to thrive
Fatigue on exertion
SOB
Signs of pulmonary stenosis
Ejection systolic murmur
Palpable thrill
Right ventricular heave
Raised JVP
Ebstein’s anomaly pathophysiology
The tricuspid valve is set lower in the right side of the heart so the right atrium is bigger than the right ventricle
Often associated with a ASD
Often right to left shunt
Ebstein’s anomaly presentation
Heart failure - oedema Gallop rythmn Cyanosis SOB Poor feeding Collapse or cardiac arrest
Pathophysiology of transposition of the great arteries
Aorta carries deoxygenated blood to the body from the right ventricle
Pulmonary artery carries oxygenated blood to the lungs via the left ventricle
Associated with a septal defect
