Paediatric Cardiology Flashcards
What are the 8 most common lesions?
- 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 is the aetiology of congenital cardiac issues?
- Genetic Susceptibility -Environmental Hazard
- Teratogenic Insult - 18 to 60 days post conception
What are environmental factors that can affect the fetus?
- DRUGS - Alcohol, Amphetamines, Cocaine, Ecstasy, Phenytoin, Lithium
- INFECTIONS - TORCH and others (Toxoplasma, Rubella, CMV, Herpes)
- MATERNAL - Diabetes Mellitus, Systemic Lupus Erythematosus
What are the risks of cardiac disease due to congenital issue?
- 6 - 10% of all CHD have underlying chromosomal problem
- 30% of chromosomal abnormalities have CHD
What are the cardiac effects associated with the trisomys?
- Trisomy 13 90%
- esp. VSD and ASD
- Trisomy 18 80%
- esp VSD and PDA
- Trisomy 21 40%
- esp AVSD (Atrio -Ventricular Septal Defect)
What are the cardiac abnormalities associated with Turners, Noonan’s and Williams?
- Turner : Co-arctation of aorta
- Noonan : Pulmonary Stenosis
- Williams : Supravalvular AS
What are symptoms on a history suggestive of paeds cardiac problem?
- Feeding, Weight and Development
- Cyanosis
- Tachypnoea, Dyspnoea
- Exercise Tolerance
- Chest Pain
- Syncope
- Palpitation
- Joint Problems
What should be looked for on examination of paeds cardiac?
- Weight and Height
- Dysmorphic features
- Cyanosis
- Clubbing
- Tachy-/Dyspnoea
- Pulses/Apex (femoral pulses!)
- Heart Sounds (clicks, split, 3rd and 4th)
- Murmurs
What Ix do we do?
- Blood Pressure
- O2 saturation, arterial BGA
- ECG (12 lead, 24hrs, event monitor)
- CXR
- Echocardiogram
- Catheter
- Angiography
- MRI/A
- Exercise testing (ECG, sO2)
How do we characterise murmurs?
- 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)
What are the majority of murmurs and what are they?
innocent murmurs
- Stills Murmur
- Pulmonary outflow murmur
- Carotid Arterial Bruit
- Venous Hum
What age does Still murmur present?
What are the characteristics?
- Age 2-7 years
- Soft systolic; vibratory, musical,”twangy”
- Apex,left sternal border
- Increases in supine position and with exercise
What age does pulmonary outflow obstruction present?
Characteristics?
- 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
What age do Carotid/Brachiocephalic Arterial Bruits present?
Characteristics?
- Age 2-10 years
- 1/6-2/6 systolic; harsh
- Supraclavicular, radiates to neck
- Increases with exercise, decreases on turning head or extending neck
What age does Venous Hum present?
Characteristics?
- 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
What are the main Ventricular Septal Defects?
L to R shunt
- Susubaortic
- Perimembranous
- Muscular
What is the common triad seen in VSD?
Tachycardia, Tachypnoea, Hepatomegaly
Outline the murmur heard in VSD?
Pansystolic murmur, heard in the left lower sternal edge.
Sometimes with a thrill too.
What is the management of VSD?
Closure of the VSD.
Amplatzer device
Autologous patch closure
Clinical features in Atrial Septal defect.
Few childhood signs, good chance of spontaneous closure.
May present in adulthood with AF, Hf and Pulmonary Hypertension.
What is the general pathophysiology of an AVSD?
- Absence of the AV septum - with osmium primum ASD and high VSD.
Which chromosomal abnormalities is associated with AVSD?
Trisomy 21 (Down’s Syndrome)
What murmur would be heard in AVSD?
- Ejection systolic murmur - cressendo and decresendo
- Loudest at the upper left sternal edge, radiates to the back.
Clinlcal features of aortic stenosis?
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.
What is the treatment of aortic stenosis?
Balloon valvoplasty - rupturing the valve open.
What are the clinical features of Pulmonary stenosis?
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.
Management of pulmonary stenosis?
Balloon valvoplasty
What is the main risk factor for patent ductus arteriosus?
Preterm birth
Management of Patent Ductus arteriosus?
Fluid restricition
Diuretics
Prostaglandin inhibitors
Surgical Ligation
Imaging modality of choice in aortic coarctation?
MRI
What is the treatment of Aortic Coarctation?
Reopen PDA with prostaglandins E1/E2
Resection with end to end anastomosis
Subclavian patch repair
Ballon aortoplasty
What is transposition of the great arteries?
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.
What is the treatment of transposition of the great arteries?
Shunt creation - allows the bloods to mix.
Surgical correction - very risky, especially in terms of teh coronaries (MI risk)
What are the 4 features of Fallot’s Tetralogy and the management of it?
Pulmonary Stenosis
RVH
High VSD
Overriding Aorta
Management:
- Palliative - shunt the subclavian
- at 6 months - corrective procedure
