Paediatric Cardiology Flashcards
Describe the aetiology of congenital heart disease
Combination of genetic susceptibility plus environmental insult, mainly from drugs, infections and/or maternal disease
What drugs are associated with increased risk of congenital heart disease?
Alcohol Amphetamines Cocaine Ecstasy Phenytoin Lithium
Which infections are associated with increased risk of congenital heart disease?
Toxoplasmosis HepB Rubella CMV HSV
Give two maternal illnesses that are associated with increased risk of CHD
Diabetes Mellitus SLE
Which chromosomal abnormalities are associated with CHD? Which CHDs are they associated with?
Trisomy 13 (Patau) - VSD, ASD Trisomy 18 (Edward’s) - VSD, PDA Trisomy 21 (Down’s) - AVSD Turner - Coarctation of aorta Noonan - Pulmonary stenosis Williams - supravalvular aortic stenosis 22q11 deletion syndrome
List the 8 most common congenital heart defects
• Ventricular Septal Defect (VSD) • Patent Ductus Arteriosus (PDA) • Atrial Septal Defect (ASD) • Pulmonary Stenosis • Aortic Stenosis • Coarctation of the Aorta • Transposition of Great Arteries • Tetralogy of Fallot
What triad of symptoms is commonly present in paediatric heart failure patients?
Tachypnoea/dyspnoea Tachycardia Hepatomegaly
What is the main sign on heart failure from the parent’s perspective?
Poor feeding - breathlessness, sweating, not feeding for very long - subsequent failure to thrive
Which pulses should be felt when examining babies?
Brachial Femoral
What are the main treatment options for congenital heart disease?
Medication Palliative procedures - BT shunt - balloon valvoplasty - Prostaglandin infusion - pulmonary banding Heart transplant
What proportion of paediatric murmurs are innocent? Are they systolic or diastolic?
70 - 80% Systolic - diastolic murmurs are pathological
Give four types of innocent heart murmurs
Still’s murmur - LV outflow murmur Pulmonary outflow murmur Carotid/brachiocephalic arterial bruits Venous hum
Describe the thought processes involved in distinguishing between innocent and pathological paediatric murmurs
Are there any symptoms and signs of heart disease? Are there any predisposing medical conditions? What are the characteristics of the murmur?
What cardinal features indicate that a murmur is likely to be pathological?
Diastolic murmur (always pathological) If systolic: - Holosystolic (pansystolic) murmur - Harsh murmur - Abnormal heart sounds - Early or mid-systolic click - Grade 3 murmur or greater - Heard over upper left sternal border
Give seven features of innocent heart murmurs
Sensitive (changes with child’s position or with respiration) Short duration (not holosystolic) Single (no associated clicks or gallops) Small (murmur limited to a small area and not radiating) Soft (low amplitude) Sweet (not harsh-sounding) Systolic (occurs and is limited to systole)
Describe the four components of Tetralogy of Fallot
- stenosis of RV outflow tract 2. right ventricular hypertrophy 3. ventricular septal defect 4. overriding aorta
Which components of ToF require treatment?
Stenosis of RV outflow tract and ventricular septal defect; treatment of these will resolve the other two problems
What behaviour in older children is characteristic of a right to left shunt?
Squatting to rest when exercising; kinks the femoral arteries, increasing pressure in the LV outflow tract and reducing the right to left shunt.
What type of murmur is caused by ASD?
Systolic murmur with a split S2
What type of murmur is caused by VSD?
Pansystolic murmur heard at the left lower sternal border
What type of cyanosis can be caused by PDA and/or coarctation of the aorta?
Cyanosis of the lower extremities
Describe the management options for VSD
Closure of VSD - Amplatzer device - patch closure If severe, may require heart AND lung transplant
What is Eisenmenger’s syndrome?
Development of a right to left shunt due to pulmonary hypertension
What drug can be given to a PDA patient to help the ductus arteriosus to close?
Indomethacin (prostaglandin E inhibitor)
