Paediatric Cardiology Flashcards
8 common causes of congenital heart disease
- Ventricular septal defect (VSD)
- Patent ductus arteriosus (PDA)
- Atrial septal defect (ASD)
- Pulmonary stenosis
- Aortic stenosis
- Coarctation of the aorta
- Transposition of the great arteries
- Tetralogy of Fallot
types of paediatric heart disease
• Congenital heart defects
• Screening and monitoring inherited disease; cardiomyopathy, long QT syndrome, Marfan
syndrome etc.
• Acquired disease : Kawasaki, Rheumatic Fever, bacterial Endocarditis
• Arrhythmias, mainly SVT
teratogenic drugs
o Alcohol o Amphetamines o Cocaine o Ecstasy o Phenytoin lithium
teratogenic infection
TORCH
materal causes of teratogenesis
DM
SLE
chromosomal disorders and their defects: trisomy 13
90%
VSD and ASD
chromosomal disorders and their defects: trisomy 18
80%
VSD and PDA
chromosomal disorders and their defects: trisomy 21
40%
AVSD
chromosomal disorders and their defects: turner
co-arctation of aorta
chromosomal disorders and their defects: noonan
pulmonary stenosis
chromosomal disorders and their defects: williams
supravalvular AS
history in paeds cardiology
- Feeding, Weight and Development
- Cyanosis
- Tachypnoea, Dyspnoea
- Exercise Tolerance
- Chest Pain
- Syncope
- Palpitation
- Joint Problems
examination in paeds cardiology
- Weight and Height
- Dysmorphic features
- Cyanosis
- Clubbing
- Tachy-/Dyspnoea
- Pulses/Apex (femoral pulses!)
- Heart Sounds (clicks, split, 3rd and 4th)
- Murmurs
investigations in paeds cardiology
- Blood Pressure
- O2 saturation, arterial BGA
- ECG (12 lead, 24hrs, event monitor)
- CXR
- Echocardiogram
- Catheter
- Angiography
- MRI/A
- Exercise testing (ECG, sO2)
treatment principles in paeds cardiology
• If you can fix it -> fix it • If you can’t fix it -> improve the situation : - medication o Palliative procedure, e.g. o BT shunt, balloon valvoo Plasty, Prostaglandin o Infusion, pulmonary o Banding • If you can do neither ->replace it
characterisation of murmurs
• Timing in Cardiac Cycle o Systole / Diastole / Continuous • Duration o Early / Mid / Late o Ejection / Holo or Pan Systolic • Pitch / Quality o Harsh or Mixed Frequency (Turbulence) o Soft or Indeterminate o Vibratory / Pure Frequency (Laminar Flow)
common features of the innocent murmurs
- Systolic murmur (continuous in venous hum)
- No other signs of cardiac disease
- Soft murmur, grade 1/6 or 2/6
- Vibratory, musical
- Localised
- Varies with position, respiration, exercise
name the innocent murmurs
Stills - LV outflow murmur
Pulmonary outflow murmur
carotid/brachiocephalic arterial bruits
venous hum
Still’s murmur
- Age 2-7 years
- Soft systolic; vibratory, musical, ”twangy”
- Apex, left sternal border
- Increases in supine position and with exercise
Pulmonary outflow murmur
- 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
carotid/brachiocephalic arterial bruits
- Age 2-10 years
- 1/6-2/6 systolic; harsh
- Supraclavicular, radiates to neck
- Increases with exercise, decreases on turning head or extending neck
venous hum
- 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
types of VSD
subaortic
perimembranous
muscular
shunt in VSD
L to R
clinical presentation of VSD
• Pansystolic murmur lower left sternal edge,
sometimes with thrill
• In very small VSDs, early systolic murmur
• In very large VSDs diastolic rumble due to relative
mitral stenosis
• Signs of cardiac failure in large VSDs, eventually
leading to biventricular hypertrophy and pulmonary
hypertension
ASD deatures
There are few clinical signs of these in early childhood, with a good chance of spontaneous closure.
They are sometimes detected in adulthood with atrial fibrillation, heart failure or pulmonary
hypertension. Wide fixed splitting of 2nd heart sound, pulmonary flow murmur.
AVSD
associated with trisomy 21
AV valve with ostium primum ASD and high VSD
pulmonary stenosis features
Pulmonary stenosis is asymptomatic when its mild. In moderate and severe stenosis patients have
exertional dyspnoea and fatigue. Ejection systolic murmur upper left sternal border with radiation to
back.
aortic stenosis features
This is mostly asymptomatic. If severe there is reduced exercise tolerance, exertional chest pain and
syncope. Ejection systolic murmur in upper right sternal border, radiation into carotids
changes in the foetal circulation at birth
- Pulmonary Vascular Resistance Falls
- Pulmonary Blood Flow Rises
- Systemic Vascular Resistance is increased
- Ductus Arteriosus Closes
- Foramen Ovale Closes
- Ductus Venosus Closes
patient ductus arteriosus management
Very common in pre-term infants, treatment with fluid restriction/diuretics, prostaglandin inhibitors
(Indomethacin, Ibuprofen), surgical ligation. In term babies good chance of spontaneous closure, not
prostaglandin sensitive.
management of coarctation of the aorta
- Re-open PDA with Prostaglandin E1 or E2
- Resection with end-to-end anastomosis
- Subclavian patch repair
- Balloon Aortoplasty
tetralogy of fallot
over riding aorta
VSD
pulmonary stenosis
RV hypertrophy
