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Paediatrics > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

Diagnostic criteria of acute rheumatic fever

A 
Jones Criteria (SPACE CAFE) 2 major OR 1 major + 2 minor
MAJOR: 
Subcutaneous nodules
Pancarditis
Arthritis (poly-)
Chorea
Erythema Marginatum
MINOR:
CRP/ESR raised
Arthralgia
Fever
ECG: prolonged PR
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2
Q

Circulatory changes after birth

A

Activation of breathing - distension of lungs - dilation of pulmonary vasculature - reduced resistance - reduced RA pressure - LA pressure forces septum primum closed - functional closure of foramen ovale in first few minutes (complete closure by 12m)
Clamping of cord + temperature fall - contraction of Wharton’s jelly - high resistance in umbilical vein and artery - blood ceases to flow through umbilical vein and ductus venosus by few days after birth
Increased O2 saturation + rapid fall in PG levels (after placenta removed) - contriction of smooth muscle in ductus arteriosus and imbilical arteries within first few hours - complete obliteration after a few weeks (ligamentum arteriousus)

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3
Q

Red flags for pathological mumurs

A 
Holosystolic
Diastolic
Grade 3 or higher
Harsh quality
Abnormal S2
Maximal murmur intensity at ULSB
Systolic click
Increased intensity on standing
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4
Q

7 S’s of innocent murmurs

A

Systolic
Short duration (not pansystolic)
Single (no clicks or added HS)
Small (limited to small area, non-radiating)
Soft (low amplitude)
Sensitive (changes with position or respiration)
Sweet (not harsh sounding)

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5
Q

The 8 benign murmurs

A

5 systolic:
- Stills (vibratory murmur) - 2-6, rare in infants
- Pulmonary flow (young kids - adults)
- Peripheral pulmonary arterial stenosis (kids under 1, or older kids recovering from RTI)
Supraclavicular or brachiocephalic systolic murmur (any age)
Aortic Systolic flow murmur (high output states - fever, anaemia, hyperthyroid)
3 Continuous:
Venous hum (3-6y)
Patent ductus arteriosus (physiologic in first few months)
Mammary souffle (late pregnancy and lactating women)

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6
Q

Acyanotic Congenital Heart Lesions (6)

A 
Atrial septal defect
Ventricular septal defect
Patent Ductus Arteriosus
Pulmonic Stenosis
Coarctation of the Aorta
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7
Q

Cyanotic Congenital Heart Lesions

A

Tetralogy of Fallot (most common after neonatal period)
Transposition of the Great Arteries (more common cause of cyanosis in first days of life)
Truncus Arteriosus

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8
Q

Congenital heart lesions associated with trisomy 21

A 
atrioventricular septal defect
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Tetralogy of Fallot
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9
Q

Congenital heart lesions associated with Turner syndrome

A

Coarctation of aorta, aortic stenosis (due to bicuspid valve), left ventricular hypertrophy

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10
Q

Congenital heart lesions associated with Marfan syndrome

A

Mitral valve prolapse
Aortic root dilatation
Aortic regurgitation
(Aortic dissection develops in later life)

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11
Q

What are the components of the Tetralogy of Fallot?

A
  1. Pulmonic stenosis (subvalvular)
  2. RV hypertrophy
  3. Overriding aorta
  4. Ventricular septal defect

Due to abnormal anterior cephalad displacement of infundibulur portion of interventricular septum

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12
Q

CXR in patient with tetralogy of Fallot

A

“Boot-shaped” heart - prominent RV with small pulmonary artery
+ Reduced pulmonary vascular markings

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13
Q

Management of acute rheumatic fever

A

Oral antibiotics (benpen or amoxyl first line - macrolides, cephs or clindamycin if allergic to penicillins)
Symptom/complication management:
Arthritis: NSAIDs or aspirin
CHF: frusemide, ACE-i (if severe), steroids
A Fib: digoxin
Severe Chorea: CBZ

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14
Q

Complications of acute rheumatic fever

A

Rheumatic heart disease (30-50%)

Typically affects mitral valve, may have mixed mitral and aortic disease

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15
Q

Jones criteria

A

Space cafe

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16
Q

Diagnostic criteria for acute rheumatic fever

A 
Jones Criteria: evidence of GAS + 2 major OR 1 major and 2 minor
SPACE CAFE
Subcutaneous nodules
Pancarditis
Arthritis (poly)
Chorea
Erythema Marginatum

CRP/ESR elevated
Arthralgia
Fever
ECG: Prolonged PR interval

17
Q

Presentation of heart failure in children of different ages

A 
(Basically a sick child presentation)
Infants: 
tachypnoea and diaphoresis during feeds + reduced volume of feeds and poor weight gain
Easy fatigability
Irritability

Young children:
GI symptoms (abdo pain, n+v, reduced appetite), FTT
easy fatigability
Recurrent cough with wheeze

Older children:
similar to adult

18
Q

Causes of heart failure in utero

A

foetal hydrops due to anaemia (most commonly haemolysis due to blood group incompatibility)

19
Q

Management of Heart failure in children

A

Similar to that of adults + increased caloric intake
High-flow O2, diuretics, ACE-i, inotropes, non-invasive positive pressure ventilation, correct metabolic acidosis, hypolygaemia or anaemia if present

20
Q

ASD: symptoms, murmur, management, complications

A

2nd most common CHD
Usually asymptomatic OR SOBOE, fatigue, recurrent LRTI
Murmur: systolic at ULSB (+/- mid-diastolic rumble at LLSB), RV heave and wide, fixed split S2
Should be repaired by school-age if asymptomatic
Indications for repair earlier: significant shunt, symptomatic
Complications: Heart failure (less commonly than VSD), pulmonary vascular disease, Stroke

21
Q

VSD: symptoms, murmur, management

A

Presentation: either asympotmatic or will develop heart failure (10% by 12m)
Murmur: harsh pansystolic, best heart at LSB +/- mid-diastolic rumble at mitral area
Mx: Closure indicated if CHF or pulmonary vascular disease (50% will close spontaneously by 2y, therefore leave until that point unless symptomatic)

22
Q

Patent ductus arteriosus presentation, murmur, management

A

Symptoms: asymptomatic OR tachycardia, poor feeding, FTT, recurrent LRTI, fatigue, SOB, palpitations
Murmur: continuous machine-like murmur, heard best at subclavicular region
Mx: indomethacin in premature infants, surgical repair or ligation by minimally invasive techniques

23
Q

Causes of heart failure in neonates and infants

A 
o	Congenital heart disease
o	Sepsis
o	Anaemia
o	Inborn errors of metabolism
o	Respiratory illness
24
Q

Causes of heart failure in children older than 2m

A 
o	L sided obstructions (often missed earlier in life)
	Aortic stenosis
	Coarctation of aorta
o	Renal failure
o	Hypertension
25
Q

Causes of heart failure in adolescents

A

o Cocaine, amphetamines
o Arrhythmia
o Cardiomyopathy

26
Q

Congenital heart malformation associated with Noonan syndrome

A

Pulmonary stenosis

27
Q

What kind of genetic abnormalities are NOT associated with pulmonary stenosis

A

Chromosomal defects e.g T21, T18 or T13

28
Q

Causes of hypertension in children

A

Primary (uncommon in children)
Renal (75% of secondary) = glomerulonephritis, HUS, obstructive uropathy, VUR, polycystic kidneys)
CVS(15%) - coarctation
Endocrine (5%) - phaeo, hyperthyroid, CAH, Addison’s, Cushing’s
Other (5%) - neuroblastoma, neurofibromatosis, steroid therapy, raised ICP

29
Q

Management of SVT in children

A

Valsalva (blow into blocked straw)
Ice pack held to face for few seconds
Adenosine

30
Q

Possible causes for tachycardia in a child

A 
Heart failure
Hypovolaemia
Hypoxia
Hyperthyroidism
Hyperglycaemia (DKA)
31
Q

How to best hear a venous hum

A

Above the right clavicle with the child sitting upright

32
Q

At what age is a VSD normally detected, why

A

Usually not until after 1 months, normal decrease in pulmonary vascular resistance allows left to right shunting to occur, causing murmur

33
Q

How do you explain coarctation of the aorta with normal femoral pulses

A

Preductal coarctation of the aorta (femoral pulses normal because of blood flow from pulmonary artery to aorta through a patent ductus arteriosus)
Associated with other cardiac defects

34
Q

Most valuable signs of heart failure in infancy

A

Hepatosplenomegaly is the most reliable sign

Oedema and ascites occur less commonly
Raised JVP is not reliable

35
Q

Cardiac sequelae of congenital rubella

A

Persistent PDA
Pumonary stenosis
ASD

36
Q

Fixed splitting of S2 + murmur =

A

ASD

Paediatrics (20 decks)

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