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Phase 3a Medicine > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

What is ventricular septal defect?

A

VSD - MC congenital heart disease.
spontaneously happen in 50% pts.

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2
Q

Aetiology of Ventricular septal defect

A

congenital VSD association with chromosomal disorders:
- downs syndrome
- edwards syndrome
- patau syndrome
- cri-du chat syndrome

congenital infections

acquired causes:
- post-myocardial infarction

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3
Q

can VSD be detected in utero and how?

A

yes during 20week scan.

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4
Q

tell me some post natal presentations of ventricular septal defect

A

failure to thrive
features of HF: hepatomegaly, tachypnoea, tachycardia, pallor

classically - pan-systolic murmur - louder in smaller defects

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5
Q

how would you manage a ventricular septal defect?

A

if small VSD asymptomatic : they often close spontaneously and simple require monitoring

moderate to large VSD : result in degree of HF in 1st few months:
nutritional support
med for HF: diuretics
surgical closure of the defect

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6
Q

complications of ventricular septal defects

A

aortic regurgitation : due to poorly supported right coronary cusp results in cusp prolapse.

infective endocarditis
right HF
pulmonary HTN: pregnancy CI in women with pulmonary HTN - 30-50% mortality

eisenmenger’s complex - due to prolonged pulmonary htn from left to right shunt = RV hypertrophy = increase RV pressure. = exceeds LV pressure = reversal of blood flow. = clubbing and cyanosis.

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7
Q

what is the eisenmengers complex an indication for ?

A

heart-lung transplant

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8
Q

what is an atrial septal defect?

A

most likely congenital found in adulthood.

50% pts dead by 50.

2 types:
ostium secundum - MC
ostium primum

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9
Q

features of atrial septal defects

A

ejection systolic murmur, fixed splitting of s2

embolism might pass from venous system to left side of heart = stroke

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10
Q

tell me about ostium secundum - 70% of ASDs

ecg finding

A

associated with holt-oram syndrome - (tri-phalangeal thumbs)

ecg: RBBB with Right axis deviation

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11
Q

tell me about ostium primum

A

presents earlier than ostium secundum defects

associated with abnormal AV valves

ECG: RBBB with left axis deviation , prolonged PR interval

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12
Q

what is tetralogy of fallot?

A

mc cyanotic congenital heart disease.

presents around 1-2 mths - could not be picked up by 6 mths.

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13
Q

why does TOF happen.

A

anterior malalignment of the aorticopulmonary septum

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14
Q

4 characteristic features of tetralogy of fallot

A

ventricular septal defect
RV hypertrophy
RV outflow tract obstruction, pulmonary stenosis
overriding aorta

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15
Q

in TOF what determines the degree of cyanosis and clinical severity?

A

the severity of the right ventricular outflow tract obstruction (pulmonary stenosis)

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16
Q

other general features of TOF

A

cyanosis : unrepaired TOF infants could get episodic hyper cyanotic “tet” spells due to near occlusion of RV outflow tract.

right to left shunt
ejection systolic murmur at left sternal edge - due to pulmonary stenosis (VSD doesnt usually cause murmur)

right sided aortic arch - 25% pts

cxr : “boot-shaped” heart,
ECG: RV hypertrophy

17
Q

tell me a little bit about tet spell - TOF

A

in unrepaired TOF infants

hypercyanotic spell due to near occlusion of RV outflow tract.

features :
tachypnoea
severe cyanosis could result in loss of conciousness

typically when:
infant upset
in pain
fever

18
Q

how would you manage TOF?

A

surgical repair in 2 parts

cyanotic episodes : beta blockers to reduce infundibular spasm

19
Q

at birth what is the most common lesion in patients with TOF?

A

transposition of the great arteries.

20
Q

what is heart failure?

cause?

A

heart unable to pump enough blood to meet met needs of body.

structural or functional heart disease.

21
Q

classifying heart disease by ejection fraction

A

either normal LVEF or abnormal LVEF.

measure using echocardiography

reduced LVEF = <35%-40%. - HF-rEF - 50% of HF pts.

other 50% : HF-pEF - preserved LVEF.

22
Q

systolic vs diastolic dysfunction - HF

A

HF-rEF : systolic dysfunction - impaired myocardial contraction during systole

HF-pEF: diastolic dysfunction : impaired ventricular filling during diastole.

23
Q

can you give me some causes of systolic dysfunction?

A

ischaemic heart disease
dilated cardiomyopathy
myocarditis
arrhythmias

24
Q

can you give me some causes of diastolic dysfunction?

A

hypertrophic obstructive cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis

25
Q

categorising HF by time

A

acute : acute exacerbation of chronic HF.
urgent sx due to LV failure = pulmonary oedema.

26
Q

categorising HF by left/right

A

HF-rEF and HF-pEF most develop left HF.
due to :
increased ventricular afterload (arterial htn/aortic stenosis)
backflow to LV

right HF : caused by increased RV afterload (pulmonary htn) or increased RV preload (tricuspid regurgitation)

27
Q

what signs does lv failure typically result in?

A

pulmonary oedema :
- dyspnoea
-orthopnoea
- paroxysmal noctural dyspnoea
- bibasal fine crackles

28
Q

what signs does rv failure typically result in ?

A

peripheral oedema - ankle/sacral odema

raised jugular venous pressure
hepatomegaly
weight gain bc of fluid retention
anorexia (cardiac cachexia)

29
Q

what does it mean by high-output HF?

A

where normal heart cant pump enough blood to meet the metabolic needs of body

30
Q

causes of high output HF

A

anaemia
pagets disease
arteriovenous malformation
pregnancy
thyrotoxicosis
thiamine deficiency (wet beri-beri)

31
Q

different between afterload and preload - hf?

A

preload - amount of blood in the ventricle at the end of diastole (before contraction)

afterload - resistance the ventricle must overcome to pump blood out during systole

32
Q

features of chronic heart failure

A

dyspnoea

cough: possible worse at night : pink/frothy sputum

orthopnoea
paroxysmal noctural dyspnoea

wheeze : cardiac wheeze

bibasal crackles on auscultation

signs of right sided HF: raised JVP , ankle oedema and hepatomegaly

weight loss : cardiac cachexia : 15% pts - could be hidden by weight gained secondary to edema

33
Q

diagnosing chronic heart failure?
1st line
what to do ?

A

1st line: N-terminal pro-B-type natriuretic peptide (NT-proBNP) blood test

if high : specialist assessment (transthoracic echocardiography too) within 2 weeks

if raised : within 6 weeks

34
Q

what is bnp and what are high levels?

A

b-type natriuretic peptide - produced by LV myocardium responding to strain. - very high levels = poor prognosis

high levels are:
bnp : >400 pg/ml (116 pmol/l)
NTproBNP: >2000 pg/ml (236 pmmol/l)

raised levels are :
bnp : 100-400 pg/ml (29-116 pmol/l)
NTproBNP: 400- 2000 pg/mol (47-236 pmol/l)

normal levels:
bnp: <100 pg/ml (29 pmol/l)
NTproBNP: <400 pg/ml (47 pmol/l)

35
Q

name some factors that can increase BNP

A

lv hypertrophy
sepsis
copd
diabetes
age over 70
liver cirrhosis
hypoxemia - includes pulmonary embolism
rv overload
tachycardia
ischaemia

36
Q

factors decreasing bnp levels

A

obesity
diuretics
acei
beta-blockers
aldosterone antagonists
angiotensin 2 receptor blockers

37
Q

what is the classification used to classify severity of chronic heart failure?

A

NYHA - new york heart association

class 1 -4

1: no sx. no limitation : ordinary physical exercise doesnt cause undue fatigue, dyspnoea or palpitations

2: mild sx. slight limitation of physical activity. comfortable at rest- ordinary activity = fatigue, palpitations/dyspnoea

  1. moderate sx. marked limitation of physical activity. comfortable at rest - less than ordinary activity = sx.
  2. severe sx. cant do physical activity without discomfort. hf sx present at rest - increased discomfort with any physical activity.
38
Q

How to manage chronic heart failure?

A

1st line: ace-inhibitor and beta blocker.
start 1 drug at a time. clinical judgement on which one

2nd line:

3rd line:

Phase 3a Medicine (16 decks)

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