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Paediatrics > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

What are the 8 most common lesions?

A
  • 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
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2
Q

What is the aetiology of congenital cardiac issues?

A
  • Genetic Susceptibility -Environmental Hazard
  • Teratogenic Insult - 18 to 60 days post conception
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3
Q

What are environmental factors that can affect the fetus?

A
  • DRUGS - Alcohol, Amphetamines, Cocaine, Ecstasy, Phenytoin, Lithium
  • INFECTIONS - TORCH and others (Toxoplasma, Rubella, CMV, Herpes)
  • MATERNAL - Diabetes Mellitus, Systemic Lupus Erythematosus
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4
Q

What are the risks of cardiac disease due to congenital issue?

A
  • 6 - 10% of all CHD have underlying chromosomal problem
  • 30% of chromosomal abnormalities have CHD
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5
Q

What are the cardiac effects associated with the trisomys?

A
  • Trisomy 13 90%
    • esp. VSD and ASD
  • Trisomy 18 80%
    • esp VSD and PDA
  • Trisomy 21 40%
    • esp AVSD (Atrio -Ventricular Septal Defect)
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6
Q

What are the cardiac abnormalities associated with Turners, Noonan’s and Williams?

A
  • Turner : Co-arctation of aorta
  • Noonan : Pulmonary Stenosis
  • Williams : Supravalvular AS
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7
Q

What are symptoms on a history suggestive of paeds cardiac problem?

A
  • Feeding, Weight and Development
  • Cyanosis
  • Tachypnoea, Dyspnoea
  • Exercise Tolerance
  • Chest Pain
  • Syncope
  • Palpitation
  • Joint Problems
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8
Q

What should be looked for on examination of paeds cardiac?

A
  • Weight and Height
  • Dysmorphic features
  • Cyanosis
  • Clubbing
  • Tachy-/Dyspnoea
  • Pulses/Apex (femoral pulses!)
  • Heart Sounds (clicks, split, 3rd and 4th)
  • Murmurs
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9
Q

What Ix do we do?

A
  • Blood Pressure
  • O2 saturation, arterial BGA
  • ECG (12 lead, 24hrs, event monitor)
  • CXR
  • Echocardiogram
  • Catheter
  • Angiography
  • MRI/A
  • Exercise testing (ECG, sO2)
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10
Q

How do we characterise murmurs?

A
  • Timing in cardiac cycle
    • systole/diastole
  • Duration
    • Early / Mid / Late
    • Ejection / Holo or Pan Systolic
  • Pitch/quality
    • Harsh or Mixed Frequency (Turbulence)
    • Soft or Indeterminate
    • Vibratory / Pure Frequency (Laminar Flow)
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11
Q

What are the majority of murmurs and what are they?

A

innocent murmurs

  • Stills Murmur
  • Pulmonary outflow murmur
  • Carotid Arterial Bruit
  • Venous Hum
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12
Q

What age does Still murmur present?

What are the characteristics?

A
  • Age 2-7 years
  • Soft systolic; vibratory, musical,”twangy”
  • Apex,left sternal border
  • Increases in supine position and with exercise
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13
Q

What age does pulmonary outflow obstruction present?

Characteristics?

A
  • Age 8-10 years
  • Soft systolic; vibratory
  • Upper left sternal border, well localised, not radiating to back
  • Increases in supine position, with exercise
  • Often children with narrow chest
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14
Q

What age do Carotid/Brachiocephalic Arterial Bruits present?

Characteristics?

A
  • Age 2-10 years
  • 1/6-2/6 systolic; harsh
  • Supraclavicular, radiates to neck
  • Increases with exercise, decreases on turning head or extending neck
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15
Q

What age does Venous Hum present?

Characteristics?

A
  • Age 3-8 years
  • Soft, indistinct
  • Continuous murmur, sometimes with diastolic accentuation
  • Supraclavicular
  • Only in upright position, disappears on lying down or when turning head
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16
Q

What are the main Ventricular Septal Defects?

A

L to R shunt

  • Susubaortic
  • Perimembranous
  • Muscular
17
Q

What is the common triad seen in VSD?

A

Tachycardia, Tachypnoea, Hepatomegaly

18
Q

Outline the murmur heard in VSD?

A

Pansystolic murmur, heard in the left lower sternal edge.

Sometimes with a thrill too.

19
Q

What is the management of VSD?

A

Closure of the VSD.

Amplatzer device

Autologous patch closure

20
Q

Clinical features in Atrial Septal defect.

A

Few childhood signs, good chance of spontaneous closure.

May present in adulthood with AF, Hf and Pulmonary Hypertension.

21
Q

What is the general pathophysiology of an AVSD?

A
  • Absence of the AV septum - with osmium primum ASD and high VSD.
22
Q

Which chromosomal abnormalities is associated with AVSD?

A

Trisomy 21 (Down’s Syndrome)

23
Q

What murmur would be heard in AVSD?

A
  • Ejection systolic murmur - cressendo and decresendo
  • Loudest at the upper left sternal edge, radiates to the back.
24
Q

Clinlcal features of aortic stenosis?

A

Mostly asymptomatic - if severe there may be reduced exercise tolerance, external dyspnea and fatigue.

Ejection systolic murmur upper left sternal edge which radiates to the carotids.

25
Q

What is the treatment of aortic stenosis?

A

Balloon valvoplasty - rupturing the valve open.

26
Q

What are the clinical features of Pulmonary stenosis?

A

Asymptomatic in mild stenosis, in moderate and severe can cause exertional dyspnea and fatigue.

Ejection systolic murmur, upper left sternal edge which radiates to the back.

27
Q

Management of pulmonary stenosis?

A

Balloon valvoplasty

28
Q

What is the main risk factor for patent ductus arteriosus?

A

Preterm birth

29
Q

Management of Patent Ductus arteriosus?

A

Fluid restricition

Diuretics

Prostaglandin inhibitors

Surgical Ligation

30
Q

Imaging modality of choice in aortic coarctation?

A

MRI

31
Q

What is the treatment of Aortic Coarctation?

A

Reopen PDA with prostaglandins E1/E2

Resection with end to end anastomosis

Subclavian patch repair

Ballon aortoplasty

32
Q

What is transposition of the great arteries?

A

The great arteries are in the wrong position - RV and aorta are attached and the LV and pulmonary are attached.

Resulting in a closed circulation with no oxygen getting into the systemic circulation.

33
Q

What is the treatment of transposition of the great arteries?

A

Shunt creation - allows the bloods to mix.

Surgical correction - very risky, especially in terms of teh coronaries (MI risk)

34
Q

What are the 4 features of Fallot’s Tetralogy and the management of it?

A

Pulmonary Stenosis
RVH

High VSD
Overriding Aorta

Management:

  • Palliative - shunt the subclavian
  • at 6 months - corrective procedure

Paediatrics (32 decks)

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