Paediatric cardiology Flashcards
What are the 8 commonest lesions/ problems that occur in paediatric hearts/cardiology
Ventricular septal defects (VSD) Patent Ductus Ateriosus (PDA) Artial Septal Defect (ASD) Pulmonary Stenosis Aortic Stenosis Coarctation of the Aorta Transposition of the Great Arteries Tetralogy of Fallot
How does Pulmonary stenosis present and how is it treated?
Can be asymptomatic if mild, if so just monitor.
If moderate or severe then can get dyspnoea and fatigue. Balloon valvoplasty is the treatment to stretch the valve. Regurgitation is a possible complication, however can often be well tolerated.
Will have ejection systolic murmur of upper left sternal border with radiation to the back.
How does aortic stenosis present and how is it treated?
It is mostly asymptomatic.
Will hear an ejection systolic murmur in upper right sternal boarder with radiation to the carotids.
If severe it will reduce exercise tolerence, cause exertional chest pain and syncope.
Balloon valvoplasty is the treatment. However if regurgitation occurs as a complication it is not well tolerated due to the higher pressure that exists in the aortic system when compared to the pulmonary system.
What is a ventricular septal defect and how is it treated?
This is when a hole forms in the septa between the ventricles. This can be categorised as either: subaortic perimembranous muscular
This causes a left to right shunt usually as the pressure is higher in the left side of the heart.
Presents with:
Pansystolic murmur lower left sternal edge, sometime with thrill.
Signs of cardiac faliure if a large VSD: oedma, breathlessness, fatigue
Biventricular hypertrophy and pulmonary hypertension.
Treated:
Patch closure via open heart surgery
Amplatzer or other occlusion device, done via catheter
What is Eisenmenger syndrome?
If a VSD is not fixed in childhood this syndrome can develop.
It is a combination of high blood pressure (pulmonary hypertension) and abnormal flow in the heart.
How do ASD present and how are they treated?
Atrial septal defects have a good chance of spontaneous closure
Can present sometimes with atrial fibrillation, heart faliure or pulmonary hypertension, pulomary flow mumur soft ejection murmur heard in the upper left sternal border, split second heart sound.
Treatment is either through open heart surgery or catheter.
What is an Atrioventriculo-septal defect?
Also called AV canal defect or Endocardial cushion defect. This is associated with Trisomy 21 (Down’s Syndrome)
Often these hearts just contain one AV valve, with an ASD just above the valve and a VSD just below it
What are Cyanotic heart conditions?
Any congenital heart defect that cause deoxygenated blood to bypass the lungs and enter the systemic circulation or allow mixed blood to enter the systemic circulation.
Fallot’s tetralogy
Transposition of the great arteries
What is transposition of the great arteries and how is it treated?
This is when the aorta is comeing out of the right ventricle and the pulmonary trunk is coming out of the right ventricle. SO the blood comes in from the systemic circulation in to the right atrium, then in to right ventricle, then instead of going through PT to lungs like it should it is pumped back out the aorta to the systemic circulation.
Operation to swap great arteries over.
To survive before the operation the ductus arteriosus needs to be open or a large VSD so you are at least getting mixed blood in systemic ciruclation.
If seen antenatally babies given prostigaldin to keep ducuts arteriosus open. Or if already closed do Rushkin procedure to open foramen ovale back up.
What is a complication of the surgery to fix the transposition of the great arteries?
The coronary arteries have to be moved from one stump to the other so they are coming out of the new aorta. If these get damaged then when the heart is repurfused the baby will have an myocardial infarction.
What abnormalities are present in Fallot’s tetralogy?
4 abnormalities:
Narrowing of right ventricular outflow tract
Pulmonary valve stenosis
Ventricular septal defect
Over-riding aorta -this straddles the ventricular defect.
There will be a right to left shunt
How does Fallot’s tetralogy present and how is it treated?
The baby will become centrally cyanosed.
However most babies with this condition are doing quite well and won’t need intervention until the full correction can take place at 6 months old (~5kg), then will need lifelong follow up as Right ventricular outflow tract obstruction can occur.
If the baby is very cyanosed then beta-blockers can be given and a Blalock- Taussing shunt (this brings blood from the right subclavian artery into the right pulmonary artery.
What is Coarctation of the aorta and how does it present?
This is a narrowing/ stricture of the aorta, most commonly in the descending part, close to the opening of the ductus arteriosis.
Delayed closure of the ductus arteriosus can delay identification/presentation of this abnormality.
Weak or absent femoral pulses
Radio-femoral delay
Systolic murmur- loudest on the back
Sudden deterioration and collapse
MRI can be used
How is Coarctation of the aorta managed?
Re-open PDA with prostigaldin
Resection surgery with end to end anastomosis
Subclavian patch repair- this is used if there is also hypoplasia of the aortic arch.
Balloon aortoplasty- good for stablising until more definative surgery can be done.
How is Patent Ductus arteriosis (Botalli) treated?
In pre-erm infants give diruetics, fluid restriction and prostigaldin inhibitors
If in term babies there is a good chance of spontaneous closure within 1st year so watch and wait as not prostigladin sensitive.
If at one year it is symptomatic do catheter closure.
