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Paediatrics > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

How can congenital heart disease present?

A

Murmur, heart failure, shock or cyanosis.
May also have been detected on antenatal cardiac ultrasound

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2
Q

What are some signs of heart failure in a child?

A

Poor weight gain/faltering growth, tachypnoea, tachycardia, heart murmur/gallop rhythm, cardiomegaly, hepatomegaly, cool peripheries

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3
Q

What are causes of heart failure more commonly seen in neonates?

A

Hypoplastic left heart syndrome
Coarctation of the aorta
Aortic stenosis

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4
Q

What are causes of heart failure more common in infants?

A

Ventricular/atrioventricular septal defect
Large persistent ductus arteriosus

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5
Q

what are causes of heart failure more common in older children and adolescents?

A

Eisenmenger syndrome
Rheumatic heart disease
Cardiomyopathy

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6
Q

What is eisenmenger syndrome?

A

Irreversibly raised pulmonary vascular resistance increases pressure so there is a right to left flow through a structural heart lesion, therefore blood flow bypasses the lungs

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7
Q

What murmur will be heard with an atrial septal defect?

A

Mis-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border

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8
Q

What kind of murmur can be heard from a ventricular septal defect?

A

Pan-systolic murmur heard loudest at the left lower sternal border

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9
Q

What kind of murmur can be heard from a patent ductus arteriosus?

A

Continuous crescendo-decrescendo ‘machinery’ murmur

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10
Q

What are signs related to chronic hypoxia from a right to left shunt?

A

Cyanosis, clubbing, dyspnoea, plethoric complexion (red complexion related to polycythaemia)

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11
Q

What is involved in the medical management of eisenmenger syndrome?

A

Oxygen can help symptoms
Sildenafil to treat pulmonary hypertension
Treat arrhythmias
Venesection to treat polycythaemia
Anticoagulation to prevent thrombosis
Prophylactic antibiotics for prevention of infective endocarditis

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12
Q

What are typical features of innocent murmurs? (All begin with S)

A

Soft
Short
Systolic
Symptomless
Situation dependent

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13
Q

What features of a murmur would prompt further investigation and referral to paediatric cardiologist?

A

Murmur louder than 2/6, diastolic murmurs, louder on standing
Other symptoms like failure to thrive, feeding difficulty, cyanosis or SOB

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14
Q

What investigations can be done to investigate a murmur in a child?

A

ECG, CXR, echocardiography

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15
Q

What is the likeliest cause of a pansystolic murmur heard loudest at the 5 intercostal space, mid-clavicular line?

A

Mitral regurgitation

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16
Q

What is the likeliest cause of a pansystolic murmur heard loudest at the fifth intercostal space, left sternal border?

A

Tricuspid regurgitation

17
Q

What is the likeliest cause of a pansystolic murmur heard loudest at the left lower sternal border?

A

Ventricular septal defect

18
Q

What is the likeliest cause of a ejection-systolic murmur heard loudest at the second intercostal space, right sternal border?

A

Aortic stenosis

19
Q

What is the likeliest cause of a ejection-systolic murmur heard loudest at the second intercostal space, left sternal border?

A

Pulmonary stenosis

20
Q

What is the likeliest cause of a ejection-systolic murmur heard loudest at the fourth intercostal space on the left sternal border?

A

Hypertrophic obstructive cardiomyopathy

21
Q

Is splitting of the second heart sound always pathological?

A

Can be normal during inspiration however if its a fixed split (does not change inspiration and expiration) then this is pathological

22
Q

Why do you get a fixed split second heart sound with atrial septal defects?

A

As blood flows form left to right atrium, it takes longer for the right atrium to empty before th pulmonary valve can close

23
Q

What genetic conditions are commonly associated with ventricular septal defects?

A

Down’s syndrome and turners syndrome

24
Q

What effect will a VSD have on the heart in the long term?

A
  1. More blood being pumped from right ventricle as blood shunted left to right, leads to right sided overload and heart failure.
  2. Increased blood flowing through pulmonary vessels increases pressure causing pulmonary hypertension.
  3. Pressure in right side of heart can become greater than left, causing right to left shunt, patient will become cyanosed
25
Q

What are causes of a pansystolic murmur?

A

VSD, tricuspid regurgitation, mitral regurgitation

26
Q

What is the treatment for VSD?

A

Monitor- small VSDs often close spontaneously
Surgery- transvenous catheter closure, open heart surgery
\

27
Q

Why are prophylactic antibiotics given during ventricular septal defect surgeries?

A

Reduced the risk of infective endocarditis which there is an increased risk of with VSDs anyway

28
Q

What is the most common ASD?

A

Ostium secundum- this is where the second secundum fails to close fully leaving a hole in the wall

29
Q

What is the atrial septal defect caused by the failure of the septum primum to close fully? What other defects does this lead to?

A

Ostium primum
Atrioventricular valve defects- making it an atrioventricular septal defect

30
Q

What are some complications of ASDs?

A

Stroke, atrial fibrillation/flutter, eisenmenger syndrome, pulmonary hypertension and right sided heart failure

31
Q

If a patient has a large stoke after a DVT what underlying pathology needs to be considered?

A

Atrial septal defect

32
Q

What is the management of ASDs?

A

Refer to paediatric cardiologist
Watching and waiting may be appropriate
Transvenous catheter closure or open heart surgery may be appropriate
Anticoagulants given in adults to reduce risk of clots and stroke

33
Q

what are risk factors for congenital heart disease?

A

Maternal infection (e.g rubella), teratogenic medication and alcohol/smoking
family history
poorly controlled type 1/2 diabetes in mother

34
Q
A
35
Q

What congenital heart defect is associated with turners syndrome? What murmur would this produce?

A

Bicuspid aortic valve, an ejection systolic murmur

36
Q

What are features on examination with a patent ductus arteriosus?

A

Left subclavicular thrill, continuous machinery murmur, wide pulse pressure, heaving apex beat and a large volume, bounding, collapsing pulse

Paediatrics (16 decks)

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