Paediatric Cardiology Flashcards by Martin Beattie

What are the commonly inherited paediatric heart diseases?

1 - Cardiomyopathy

2 - Long QT syndrome

3 - Marfan syndrome

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What are the commonly acquired paediatric heart diseases?

Kawasaki

Rheumatic fever

Infective endocarditis

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What is the main cardiovascular complication of Kawasaki disease?

Aneurysms of coronary arteries

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What are the most common lesions accounting for 80% of congenital heart disease?

Ventricular Septal Defect

Patent Ductus Arteriosus

Atrial Septal Defect

Pulmonary stenosis

Aortic stenosis

Coarctation of the aorta

Transposition of great arteries

Tetralogy of Fallot

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When do teratogenic insult to the fetus occur?

18-60 days post conception

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What are the environmental factors that contribute to paediatric cardiac lesions?

1) Drugs
2) Infections
3) Maternal factors

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What are common drugs that can cause paediatric cardiac lesions?

Alcohol

Amphetamines

Phenytoin

Lithium

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What infections can cause paediatric cardiac lesions?

Toxoplasma

Rubella

CMV

Herpes

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What are some maternal factors that can contribute to paediatriac cardiac lesions?

Diabetes Mellitus

SLE

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What percentage of paediatric congenital heart disease cases have chromosomal problems?

6-10%

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What are the most common chromosomal abnormalities observed in congenital heart disease and what are the proprotions for each?

Trisomy 13 (90%)

Trisomy 18 (80%)

Trisomy 21 (40%)

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What are the most common cardiac lesions seen in Trisomy 13?

VSD

ASD

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What are the most common cardiac lesions seen in Trisomy 18?

VSD

PDA

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What are the most common cardiac lesions seen in Trisomy 21?

AVSD

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What are other commonly observed genetic syndromes in patients with congenital heart conditions?

Turner syndrome

Noonan syndrome

Williams syndrome

22q11 deletion syndrome

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With which physical defect is Turner syndrome associated?

Co-arctation of aorta

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With which physical defect is Noonan syndrome associated?

Pulmonary stenosis

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With which physical defect is Williams syndrome associated?

Supravalvular AS

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What questions are important to ask in a paediatric patient you suspect of having a congenital heart condition?

1 - How is their feeding, weight and development?

2 - Signs of cyanosis

3 - Rapid breathing

4 - SOB

5 - Poor exercise tolerance

6 - Chest pain

What features can be observed on examination of a child with a congenital heart defect?

Reduced weight and height
Cyanosis
Finger clubbing
Radio-femoral delay
Murmurs

What investigations can be performed to help diagnose a congenital heart defect?

1 - O2 sats

2 - ECG

3 - Echocardiogram

4 - Exercise testing

5 - Angiogram

What are the principles of treatment of paediatric heart defects?

1) Fix it
2) If it cant be fixed, use ballon valvo-plasty, shunt, prostaglandins etc.
3) Replace the defective structure

What are the common harmless murmurs?

1 - Still’s murmur

2 - Pulmonary outflow murmur

3 - Carotid bruits

4 - Venous Hum

What are the 3 main types of VSD’s?

1 - Subaortic

2 - Perimembranous

3 - Muscular

What type of shunt occurs as a result of VSD's?

Left to right shunt

What else are VSD's commonly known and why do they have this alternative name?

Acyanotic heart defect Acyanotic because the blood is not by-passing the lungs as happens in right to left shunts

How does a VSD present clinically?

1 - Pansystolic murmur on LLSE 2 - Tachycardia (sign of heart failure in children) 3 - Tachypnoea (sign of heart failure in children) 4 - Hepatomegaly (sign of heart failure in children)

What are the long term complications of VSD?

1 - Ventricular hypertrophy 2 - Pulmonary hypertension

What is eisenmenger syndrome?

The reversal of a L-R shunt into a R-L shunt resulting in cyanosis

How can VSD's be closed?

Amplatzer device Patch closure

What are the features of ASD's?

- Few clinical signs in early childhood - Often closes spontaneously - Sometimes detected in adulthood with AF

With which Trisomy ar Atrioventricular-septal defects associated?

Trisomy 21

What are the clinical features of pulmonary stenosis in children?

Ejection systolic murmur upper left sternal border with radiation to back

What are the symptoms of a child with aortic stenosis?

Exercise intolerance Exertional chest pain Syncope

What are features of an aortic stenosis murmur in children?

Ejection systolic murmur Upper right sternal border Radiates to carotids

Which blood vessel supplies oxygenatedblood to the fetal heart?

Umbilical vein

What changes occur in fetal circulation at birth?

1 - Pulmonary blood increases 2 - Systemic vascular resistance increases 3 - Ductus arteriosus closes 4 - Foramen Ovale closes 5 - Ductus Venosus closes

In which group of infants is patent ductus arteriosus most common?

Pre-term infants

What treatments can be given to help close a patent ductus arteriosus?

1 - Prostaglandin inhibitors 2 - Diuretics

What is co-arctation of the aorta?

Kink in descending aorta wall Kink is close to ductus arteriosus

What are some clinical features of co-arctation of the aorta?

Radio-femoral delay

How can co-arctation of the aorta be imaged?

Echocardiogram MRI

How are co-arctations of the aorta managed?

1 - Re-open PDA with prostaglandins 2 - Resect the coarcted part and anastamosis 3 - Ballon aortoplasty

What happens in transposition of the great arteries?

Aorta connected to right ventricle Pulmonary veins connected to left ventricle No oxygenated blood being moved around body

What are the clinical features of Fallot's Tetralogy?

1 - Malposition of aorta 2 - Pulmonary stenosis 3 - Right ventricular hypertrophy 4 - VSD