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Finals > Paediatric cardiology > Flashcards

Paediatric cardiology Flashcards

1
Q

Where does foetal blood get oxygen and nutrients and dispose of CO2 an lactate?f

A

-The placenta

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2
Q

What is the ductus arteriosus?

A

-Shunt in foetal circulation that allows blood to pass from the aorta to the pulmonary artery.

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3
Q

what is the foramen ovale?

A

-Foetal shunt that allows blood to pass from the right to the left atrium

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4
Q

What is the ductus venosus ?

A

-Foetal shunt that allows blood to pass from the umbilical vein the to inferior vena cava and bypass the liver

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5
Q

What happens to the patent foramen ovale at birth ?

A
  • When the baby takes its first breath, the alveoli expand decreasing pulmonary vascular resistance
  • This causes the pressure in the right atrium to fall
  • As left atrial pressure is then greater than right atrial pressure, it squashes the atrial septum closing the foramen ovale
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6
Q

What happens to the ductus arteriosus at birth ?

A
  • The increased blood oxygenation causes a drop in prostaglandins
  • As prostaglandins are required to keep it open, it causes it to close
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7
Q

What is a patent ductus arteriosus ?

A

-When the ductus arteriosus fails to close at birth

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8
Q

How does a PDA present? (5)

A
  • SOB
  • Difficulty feeding
  • Poor weight gain
  • LRTI
  • Murmur picked up on newborn examination
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9
Q

What murmur does a significant PDA cause?

A
  • Continuous crescendo-decrescendo ‘machinery’ murmur that may continue to the second heart sound.
  • Murmur heard at upper left sternal edge
  • Normal first heart sound
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10
Q

How is a PDA managed ?

A
  • Monitored with echoes until 1 yr
  • Indomethacin / ibuprogen to inhibit prostaglandins and also closure
  • Trans catheter or surgical closure
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11
Q

Explain the pathophysiology as to why a PDA leads to heart failure

A
  • It creates a left to right shunt : pressure is greater in the aorta and so blood flows from here to the pulmonary vessels
  • This leads to pulmonary hypertension and right sided heart strain as the RV struggles to contract against the increased resistance
  • This leads to right ventricular hypertrophy
  • Increased blood flow through pulmonary vessels returning to the left side of the heart leads to left ventricular hypertrophy
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12
Q

Give 2 RF for PDA

A
  • Prematurity
  • Maternal infections such as rubella
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13
Q

What is the most common kind of ASD?

A

-Ostium secondum : the septum secondum fails to fully close leaving a hole in the wall

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14
Q

Name 2 other kinds of ASD

A
  • Patent foramen ovale
  • Ostium primum : this tends to lead to an atrioventricular valve defect, making it an atrioventricular septal defect
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15
Q

What is the most common congenital heart defect in adults?

A

-Ostium secundum

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16
Q

What kind of ASD is seen in 25% of people with downs syndrome ?

A

-Ostium primum

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17
Q

Is an ASD an acyanotic or cyanotic heart defect?

A
  • Acyanotic

- Blood still flows to the pulmonary vessels and lungs to get oxygenated

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18
Q

What murmur is heard in an ASD?

A

-Mid systolic, crescendo-descrendo murmur heart loudest at the upper left sternal border

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19
Q

What happens to the 2nd heart sound in an ASD?

A
  • Fixed split second heart sound
  • This is because there is a greater volume of blood passing by the pulmonary valve
  • This means there is a slight delay in it closure compared to the aortic valve
  • However, this is on both inspiration and expiration
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20
Q

If an ASD is not picked up on newborn examinations, how might it present in childhood ?

A
  • SOB
  • Difficulty feeding
  • Poor weight gain
  • LRTI
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21
Q

If asymptomatic in childhood, how might an ASD present in adulthood ?

A
  • Dyspnoea
  • Heart failure
  • Stroke
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22
Q

Why is stroke a common complication of patients with an ASD who develop a venous thromboembolism ?

A
  • The clot travels to the right atrium passes through the ASD to the left atrium
  • From here, left ventricle, aorta and up to the brain
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23
Q

Give 4 complications of an ASD

A
  • Stroke
  • AF and atrial flutter
  • Pulmonary HTN and right sided HF
  • Eisenmenger syndrome
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24
Q

What medications are given to adults with an ASD to reduce the risk of clots and strokes

A

-Anticoagulant : aspirin, warfarin, DOACs

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25
Q

What 2 genetic conditions are commonly associated with VSD?

A
  • Down’s syndrome
  • Turner’s syndrome
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26
Q

What murmur is often heard in antenatal scans in VSD?

A
  • Pan-systolic
  • More prominent at the left lower sternal border in the third and fourth intercostal spaces
  • Possible systolic thrill on palpation
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27
Q

Give 3 causes of a pan-systolic murmur

A
  • Ventricular septal defect
  • Mitral regurgitation
  • Tricuspid regurgitation
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28
Q

If not picked up as a newborn, how might a VSD present?

A
  • Poor feeding
  • Dyspnoea
  • Tachypnoea
  • Failure to thrive
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29
Q

What a patients with a VSD at increased risk of ?

A
  • Infective endocarditis
  • If having surgery, prophylactic antibiotics should be given
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30
Q

What is Eisenmenger syndrome ?

A

-When blood flows from the right to the left side of the heart through a structural lesion, bypassing the lungs

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31
Q

What 3 underlying lesions can cause Eisenmenger syndrome ?

A
  • Atrial septal defect
  • Ventricular septal defect
  • Patent ductus arteriosus
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32
Q

Explain the pathophysiology behind why Eisenmenger syndrome develops

A
  • ASD or VSD allows left -> right shunt
  • This leads to pulmonary HTN
  • Eventually pulmonary pressure > systemic pressure
  • This creates right -> left shunt
  • Deoxygenated blood bypasses the lungs and enters the body
  • This causes cyanosis
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33
Q

Give 4 examination findings associated with the pulmonnary HTN seen in Eisenmenger syndrome

A
  • Right ventricular heave
  • Loud P2
  • Raised JVP
  • Peripheral oedema
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34
Q

Explain the cyanosis seen in Eisenmenger syndrome

A
  • Blue discoloration of the skin due to low oxygen sats in the blood
  • BM will produce more RBC and haemoglobin leading to polycythaemia
  • Polycythaemia = plethoric complexion
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35
Q

Give 4 examination findings associated with the right to left shunt and chronic hypoxia in Eisenmenger syndrome

A
  • Cyanosis
  • Clubbing
  • Dyspnoea
  • Plethoric compexion (red complexion related to polcythaemia)
36
Q

What is the only definite treatment for Eisenmenger syndrome ?

A

Heart-lung transplant -> it is too late to reverse underlying cause

37
Q

Define cyanotic heart disease

A

-When blood is able to bypass the pulmonary circulation and the lungs

38
Q

Give 4 heart defects that cause a right to left shunt and so cyanotic heart disease

A
  • ASD
  • VSD
  • Patent ductus arteriosus
  • Transposition of the great arteries
39
Q

What is a flow murmur ?

A

-Innocent murmur heard in children and are caused by fast blood flow through various areas of the heart during systole.

40
Q

Give the 5 S’s of flow murmurs

A
  • Soft
  • Short
  • Systolic
  • Symptomless
  • Situation dependent : E.g. quieter on standing or only appears when child is unwell or feverish
41
Q

Give 3 causes of ejection-systolic murmurs

A
  • Aortic stenosis
  • Pulmonary stenosis
  • Hypertrophic obstructive cardiomyopathy
42
Q

Explain the pathophysiology behind splitting of the second heart sound

A
  • During inspiration, the lungs and heart are pulled open = negative intra-thoracic pressure
  • The right side of the heart then fills faster
  • The increased volume in the right ventricle causes it to take longer to empty = delay in pulmonary valve closing.
  • Pulmonary valve closing later than aortic valve = ‘split’ second heart sound
43
Q

What is transposition of the great arteries ?

A
  • Attachments of the aorta and pulmonary trunk to the heart are swapped
  • The RV pumps blood into the aorta
  • The LV pumps blood into the pulmonary vessels
44
Q

What 3 conditions can transposition of the great arteries be associated with ?

A
  • VSD
  • Coarctation of the aorta
  • Pulmonary stenosis
45
Q

How does transposition of the great arteries present ?

A
  • Usually diagnosed on antenatal USS
  • If not : baby will present with cyanosis at birth
46
Q

How is transposition of the great arteries managed ?

A
  • Prostaglandin infusion to maintain ductus arteriosus to allow blood to flow from aorta to pulmonary arteries for oxygenation
  • Balloon septostomy
  • Open heart surgery = definitive. A cardiopulmonary bypass machine is used to perform an atrial switch within a few days of birth
47
Q

What is a balloon septostomy ?

A

-A catheter is inserted into the foramen ovale via the umbilicus and a balloon is inflated to create a large atrial septal defect.

48
Q

How is PDA managed ?

A

-Indomethacin/ibuprofen can be given as a neonate to inhibit prostaglandin synthesis
-Monitor to 1 year - trans-catheter or surgical closure if it looks like it won’t close on its own

49
Q

What is seen on ECG in on ostium secundum ASD

A

RBBB with RAD

50
Q

What is seen on ECG in an ostium primum ASD

A

RBBB with LAD, prolonged PR interval

51
Q

Give 4 complications of an ASD

A

-Eisenmenger syndrome
-Stroke in the context of a VTE
-AF or atrial flutter
-Pulmonary HTN and right sided heart failure

52
Q

what is the most common cause of congenital heart disease

A

VSD

53
Q

Give 3 causes of a pan systolic murmur

A

VSD
Mitral regurg
Tricuspid regurg

54
Q

what is coarctation of the aorta

A

Congenital narrowing of the aorta

55
Q

12 week old infant
Ejection systolic murmur
Sat on right arm : 99%
Sat on left foot : 90%

A

Coarctation of the aorta

56
Q

How may coarctation of the aorta present in a neonate

A

-Neonate : weak femoral pulses , differing BP/O2 sats in arms and legs. Ejection sytstolic mumur

57
Q

Where would the murmur be heard in coarctation of the aorta

A

Left infraclavicular area and below the left scapula

58
Q

How would coarctation of the aorta present in infancy

A

Infancy : heart failure -> tachypnoea, poor feeding, grey and floppy

59
Q

What additional signs may develop over time in coarctation of the aorta

A

-Left ventricular heave
-Underdeveloped left arm in reduced subclavian artery blood flow
-Underdevelopment of the legs

60
Q

How is severe coarctation of the aorta managed

A

Prostaglandin E to keep ductus arteriosus open while awaiting surgery

61
Q

What are the signs of more significant aortic valve stenosis

A

Fatigue
SOB
Dizziness
Fainting

All worse on exertion

62
Q

what murmur is heard on aortic valve stenosis

A

Ejection systolic
Loudest at second intercostal space, right sternal border
Crescendo decrescendo
Radiates to carotids

63
Q

What are 4 other signs of aortic valve stenosis

A

Ejection click before murmur
Palpable thrill in systole
Slow rising pulse
Narrow pulse pressure

64
Q

How can aortic valve stenosis be managed

A

Percutaneous balloon aortic valvuloplasty
Surgical aortic valvotomy
Valve replacement

65
Q

Give 5 complications of aortic valve stenosis

A

Left ventricular outflow tract obstruction
HF
Ventricular arrhythmia
Bacterial endocarditis
Sudden death on exertion

66
Q

Give 4 associations with pulmonary valve stenosis

A

TOF
Williams
Noonan’s
Congenital rubella syndrome

67
Q

what murmur is heard in pulmonary valve stenosis

A

Ejection systolic : second intercostal space left sternal border

68
Q

What are 3 other signs of pulmonary valve stenosis

A

Palpable thrill in pulmonary area
Right ventricular heave
Raised JVP with giant a waves

69
Q

How is mild pulmonary valve stenosis managed

A

‘watching and waiting’

70
Q

How is symptomatic pulmonary valve stenosis managed

A

-> Balloon valvuloplasty

71
Q

what 4 things make up the TOF

A

-> Pulmonary valve stenosis
-> Overriding aorta
-> Right ventricular hypertrophy
-> VSD

72
Q

What determines the severity of TOF

A
  • Degree of pulmonary valve stenosis
  • The greater it is, the greater the resistance and more blood is pumped through the right -> left shunt -> cyanosis
73
Q

Give 4 RF for TOF

A

Rubella infection
Increased maternal age
Alcohol in pregnancy
Diabetic mother

74
Q

what would a chest x ray show in TOF

A

Boot shaped heart -> right ventricular thickening

75
Q

what murmur is heard in TOF

A

Ejection systolic
Left
2nd intercostal space
Due to pulmonary value stenosis

76
Q

Give 5 signs of TOF

A

Tet spells
Cyanosis
Clubbing
Poor feeding
Poor weight gain

77
Q

what are tet spells

A
  • Intermittent cyanotic episode when a child is exerting themselves (e.g. crying,exercise)
    -Tacynpnoea
78
Q

How is conservative management of a tet spells

A

Children - squat
Babies -position knees to chest

79
Q

How can TOF be managed in neonates ?

A

Prostaglandin infusion to maintain ductus arteriosus

80
Q

What medication can be used in cyanotic episodes in TOF

A

BB

81
Q

what can be used in transposition of the great arteries to maintain until surgery

A

-> Prostaglandin : maintain ductus arteriosus
-> Balloon septostomy to create a large ASD through the foramen ovale

82
Q

what is the definite management of transposition of the great arteries

A

Open heart surgery

83
Q

what is ebstein’s anomaly

A

Tricuspid valve is set lower than the right

84
Q

what can cause ebetein’s anomaly

A

Lithium in-utero

85
Q

What is associated with ebstein’s anomaly

A

Wolff-Parkinson White syndrome
PFO or ASD

86
Q

Give 5 features of ebstein’s anomaly

A

Cyanosis
Prominent ‘a’ wave in JVP
Hepatomegaly
Tricuspid regurg -> pansystolic murmur
RBBB -> widely split S1 and S2

Finals (92 decks)

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