Paediatric Cardiology Flashcards
1
Q
Examples of diseases acquired in paediatric cardiology
A
Kawasaki
Rheumatic fever
Bacterial endocarditis
2
Q
8 commonest lesions for congenital heart disease
A
Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrial septal defect (ASD) Pulmonary stenosis Aortic stenosis Coarctation of aorta Transposition of great arteries Teratology of fallot
3
Q
Most common congenital heart disease
A
Ventricular septal defect
4
Q
Causes of congenital heart disease
A
Genetic susceptibility (environmental hazard)
Teratogenic insult
- 18 - 20 days post conception
5
Q
Environmental factors causing congenital heart disease
A
Drugs - alcohol - amphetamines - cocaine - ecstasy - Phenytoin - Lithium (anti depressants) Infections - Toxoplasma - Rubella - CMV - herpes Maternal DM - trophic cardiomyopathy SLE - antibodies can cross placenta and specifically attack the conduction system of the heart and destroy the his bundle and end up with congenital heart block
6
Q
Most common environmental cause of congenital heart disease
A
Maternal DM
7
Q
How many of all CHD have an underlying chromosomal problem?
A
6-10%
8
Q
How many of chromosomal abnormalities have CHD?
A
30%
9
Q
How many of trisomy 18 have CHD?
A
80%
10
Q
What is trisomy 18 associated with?
A
VSD
PDA
11
Q
What is trisomy 21 associated with?
A
AVSD
12
Q
How many of trisomy 21 has CHD?
A
40%
13
Q
What do all children with trisomys get screened for?
A
Heart disease
14
Q
What is Turners syndrome associated with?
A
Co arctation of the aorta
Bicuspid aortic valve
15
Q
What is noonans syndrome associated with?
A
Pulmonary stenosis
16
Q
What is Williams syndrome associated with?
A
Supravalvular AS
17
Q
Presentation of congenital heart disease
A
Cyanosis Tachypnoea Dyspnoea Exercise tolerance Chest pain / stitches Syncope Palpitation Joint problems
18
Q
What is a presenting sign of coarctation of aorta?
A
Weak femoral pulse
19
Q
What is a late presenting sign of coarctation of aorta, i.e. found in teenagers?
A
Radial femoral delay
20
Q
Investigations for congenital heart defects
A
BP O2 sats, arterial BGA ECG CXR Echo Angiography Catheter MRI / A Exercise testing (ECG, sO2)
21
Q
What is dextrocardia?
A
The heart is on the wrong side of the body
22
Q
Palliative procedures used in congenital heart diseases
A
BT shunt
Balloon valvopathy
Prostaglandin infusion
Pulmonary banding
23
Q
Different timings in cardiac cycles of murmurs
A
Systole
Diastole
Continous
24
Q
Different duration in cardiac cycles of murmurs
A
Early Mid Late Ejection Holo Pan systolic
25
Different pitch / quality of murmurs
Harsh or mixed frequency (turbulence)
Soft or indeterminate
Vibratory / pure frequency (laminar flow)
26
What % of murmurs are innocent murmurs?
70-80%
27
What is an innocent murmur?
Nothing wrong with the heart, it is just making a noise
28
4 types of innocent murmurs
Still's murmur (LV outflow murmur)
Primary outflow murmur
Carotid / Brachiocephalic arterial bruits
Venous Hum
29
Common features of innocent murmurs
```
Systolic murmur (exception - continuous in venous hum)
No other signs of cardiac disease
Quiet, soft murmur, grade 1/6 or 2/6
Vibratory, musical
Localised
Varies with
- respiration
- position
- exercise
```
30
Grades of murmurs
1/6 / 2/6 = quiet and soft
3/6 = loud
5/6 = loud and thrill
6/6 = can hear from EOB without stethoscope
31
Innocent murmurs vary with.....
Position
respiration
exercise
32
What age gets still's murmur?
2 - 5 y /o
33
Features of stills murmur
Vibratory
Musical
"Twangy"
34
Where is stills murmur found?
Apex, left sternal border
35
What does Stills murmur increase with?
Supine position
| Exercise
36
What age gets primary outflow murmur?
8 - 10 years
37
Features of primary outflow murmur
Soft systolic
| Vibratory
38
Where can you hear a primary outflow murmur?
Upper left sternal border
Well localised
Not radiating to back
39
Who is a primary outflow murmur often heard in?
Children with a narrow chest
40
What does primary outflow murmurs increase in....
Supine position
| Exercise
41
What age gets carotid / brachiocephalic arterial bruits?
2-10 years
42
Features of carotid / brachiocephalic arterial bruits
1/6 - 2/6 systolic
| harsh
43
Where can you hear carotid / brachiocephalic arterial bruits?
Supraclavicular
| Radiates to neck
44
Carotid / brachiocephalic arterial bruits increase with....
Exercise
45
Carotid / brachiocephalic arterial bruits decrease with......
Turning head
| Extending neck
46
What age do you get venous hums?
3 - 8 years
47
Features of venous hums
Soft
Indistinct
Continuous murmur
Sometimes with diastolic accentuation
48
Where can you hear venous hums?
Supraclavicular
49
When can you hear venous hums?
Only in upright position
50
When do venous hums disappear?
Lying down
| Turning head
51
3 main types of VSD
Subaortic
Perimembranous
Muscular
52
What is a VSD?
Left to right shunt
53
Presentation of VSD
Pansystolic murmur lower left sternal edge (4 / 5th IC) sometimes with thrill
Very small VSDs = early systolic murmur
Very large VSDs = diastolic rumble due to relative mitral stenosis
Signs of cardiac failure / HF in large VSDs - eventually leading to biventricular hypertrophy and Pulmonary HTN
54
What is Eisenmenger syndrome?
Right to left shunt
55
What do you become with Eisenmenger syndrome?
Cyanotic
56
How do you close a VSD?
Amplatzer device
- if VSD small and in good position
- occlusion device - plug the hole and endocardium grows over it
Patch closure
- too big or in a position where cant fiddle around with catheter
- open heart surgery with cardiopulmonary bypass
57
What is there a good chance of with atrial septal defects?
Spontaneous closure
58
What can ASD present with in adulthood?
AF
HF
Pulmonary HTN
59
What do you hear with a ASD?
wide fixed splitting of 2nd heart sound
| Pulmonary flow murmur
60
Treatment of ASD
Atrial septa defect occlusion device in situ
61
Atrioventricular septal defect or endocardial cushions defect or AV canal defect are associated with what?
Trisomy 21
62
Presentation of pulmonary stenosis
Mild = asymptomatic
| Moderate / severe = exertional dyspnoea and fatigue
63
What do you hear in pulmonary stenosis?
Ejection systolic murmur upper left sternal border
Radiation to back
Loud then quiet again
64
Treatment of pulmonary stenosis
Balloon valvuloplasty
65
What is there a risk of when treating pulmonary stenosis with a balloon valvuloplasty?
Pulmonary regurgitation
66
Presentation of aortic stenosis
```
Mostly asymptomatic
If severe
- reduced exercise tolerance
- exertional chest pain
- syncope
```
67
What can you hear in aortic stenosis?
Ejection systolic murmur
Upper right sternal border
Radiation to carotids
68
Treatment of aortic stenosis
Balloon aortic valvuloplasty
69
What happens in a bicuspid aortic valve?
There are two parts to the valve instead of 3
70
Changes at birth to the foetal circulation
```
Pulmonary vascular resistance falls
Pulmonary blood flow rises
Systemic vascular resistance is increased
Ductus arteriosus closes
Foramen ovale closes
Ductus venosus closes
```
71
In the foetus, what do veins carry?
Blood TOWARDS the heart
72
Who is patent ductus arteriosus common in?
Pre term infants
73
Treatment of patent ductus arteriosus
Fluid restriction / diuretics
Prostaglandin inhibitors - Indomethacin
Surgical ligation
74
In who is there a chance of spontaneous closure of PDA?
Term babies
75
What is coarctation of aorta?
Congenital narrowing of the aorta
76
Where is coarctation of the aorta usually found?
In the descending part of the arch
77
Treatment of coarctation of the aorta
Re-open PDA with prostaglandin E1 or E2
Resection with end to end anastomoses
- resection of the bit of the aorta that is kinked
Subclavian patch repair
Balloon aortoplasty
- balloon dilatation of the coarctated area
78
Pathology of transposition of the great arteries
Aorta comes out of your right ventricle and the pulmonary artery comes out of the left ventricle
79
Treatment of transposition of the great arteries
A shunt
If known antenatally - umbilical venous catheter to keep duct open
Rashkinds atrial septostomy
80
Features of fallot's teratology
Pulmonary stenosis
Right ventricular hypertrophy
High VSD
Overriding aorta
81
What does fallot's teratology lead to?
Cyanosis
82
Treatment of fallot's teratology
Palliative shunt
83
Presentation of HF in children
```
Tachypnoea
- cant feed / failure to thrive
- cold sweat
Tachycardia
Hepatomegaly
```
84
Signs of PDA
```
Left subclavicular thrill
Continuous 'machinery' murmur
Large volume, bounding and collapsing pulse
Wide pulse pressure
Heaving apex beat
```
85
Example of the a prostaglandin used in the management of ductus arteriosus for duct dependent congenital heart disease
Alprostadil
86
Cyanotic CHD presenting within the first days of life indicates what?
Transposition of great arteries
87
Cyanotic CHD presenting at 1 - 2 months of age indicates what?
Teratology of fallot
88
What can Ebsteins anomaly be described as?
'Atrialisation' of the ventricle
89
Features of Ebsteins anomaly
Low insertion of tricuspid valve resulting in a large right atrium and a small right ventricle causing tricuspid incontinence
90
Associations of Ebsteins anomaly
Tricuspid incontinence
| WPW syndrome
91
Exposure to what may cause Ebsteins anomaly?
Lithium in utero
92
What does a VSD increase the risk of?
Endocarditis
