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Paeds > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

Examples of diseases acquired in paediatric cardiology

A

Kawasaki
Rheumatic fever
Bacterial endocarditis

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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
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3
Q

Most common congenital heart disease

A

Ventricular septal defect

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4
Q

Causes of congenital heart disease

A

Genetic susceptibility (environmental hazard)
Teratogenic insult
- 18 - 20 days post conception

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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
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6
Q

Most common environmental cause of congenital heart disease

A

Maternal DM

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7
Q

How many of all CHD have an underlying chromosomal problem?

A

6-10%

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8
Q

How many of chromosomal abnormalities have CHD?

A

30%

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9
Q

How many of trisomy 18 have CHD?

A

80%

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10
Q

What is trisomy 18 associated with?

A

VSD

PDA

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11
Q

What is trisomy 21 associated with?

A

AVSD

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12
Q

How many of trisomy 21 has CHD?

A

40%

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13
Q

What do all children with trisomys get screened for?

A

Heart disease

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14
Q

What is Turners syndrome associated with?

A

Co arctation of the aorta

Bicuspid aortic valve

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15
Q

What is noonans syndrome associated with?

A

Pulmonary stenosis

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16
Q

What is Williams syndrome associated with?

A

Supravalvular AS

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17
Q

Presentation of congenital heart disease

A 
Cyanosis
Tachypnoea
Dyspnoea 
Exercise tolerance 
Chest pain / stitches
Syncope
Palpitation 
Joint problems
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18
Q

What is a presenting sign of coarctation of aorta?

A

Weak femoral pulse

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19
Q

What is a late presenting sign of coarctation of aorta, i.e. found in teenagers?

A

Radial femoral delay

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20
Q

Investigations for congenital heart defects

A 
BP
O2 sats, arterial BGA
ECG
CXR
Echo 
Angiography 
Catheter
MRI / A
Exercise testing (ECG, sO2)
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21
Q

What is dextrocardia?

A

The heart is on the wrong side of the body

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22
Q

Palliative procedures used in congenital heart diseases

A

BT shunt
Balloon valvopathy
Prostaglandin infusion
Pulmonary banding

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23
Q

Different timings in cardiac cycles of murmurs

A

Systole
Diastole
Continous

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24
Q

Different duration in cardiac cycles of murmurs

A 
Early
Mid 
Late
Ejection 
Holo 
Pan systolic
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25
Q

Different pitch / quality of murmurs

A

Harsh or mixed frequency (turbulence)
Soft or indeterminate
Vibratory / pure frequency (laminar flow)

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26
Q

What % of murmurs are innocent murmurs?

A

70-80%

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27
Q

What is an innocent murmur?

A

Nothing wrong with the heart, it is just making a noise

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28
Q

4 types of innocent murmurs

A

Still’s murmur (LV outflow murmur)
Primary outflow murmur
Carotid / Brachiocephalic arterial bruits
Venous Hum

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29
Q

Common features of innocent murmurs

A 
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
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30
Q

Grades of murmurs

A

1/6 / 2/6 = quiet and soft
3/6 = loud
5/6 = loud and thrill
6/6 = can hear from EOB without stethoscope

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31
Q

Innocent murmurs vary with…..

A

Position
respiration
exercise

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32
Q

What age gets still’s murmur?

A

2 - 5 y /o

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33
Q

Features of stills murmur

A

Vibratory
Musical
“Twangy”

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34
Q

Where is stills murmur found?

A

Apex, left sternal border

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35
Q

What does Stills murmur increase with?

A

Supine position

Exercise

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36
Q

What age gets primary outflow murmur?

A

8 - 10 years

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37
Q

Features of primary outflow murmur

A

Soft systolic

Vibratory

38
Q

Where can you hear a primary outflow murmur?

A

Upper left sternal border
Well localised
Not radiating to back

39
Q

Who is a primary outflow murmur often heard in?

A

Children with a narrow chest

40
Q

What does primary outflow murmurs increase in….

A

Supine position

Exercise

41
Q

What age gets carotid / brachiocephalic arterial bruits?

A

2-10 years

42
Q

Features of carotid / brachiocephalic arterial bruits

A

1/6 - 2/6 systolic

harsh

43
Q

Where can you hear carotid / brachiocephalic arterial bruits?

A

Supraclavicular

Radiates to neck

44
Q

Carotid / brachiocephalic arterial bruits increase with….

A

Exercise

45
Q

Carotid / brachiocephalic arterial bruits decrease with……

A

Turning head

Extending neck

46
Q

What age do you get venous hums?

A

3 - 8 years

47
Q

Features of venous hums

A

Soft
Indistinct
Continuous murmur
Sometimes with diastolic accentuation

48
Q

Where can you hear venous hums?

A

Supraclavicular

49
Q

When can you hear venous hums?

A

Only in upright position

50
Q

When do venous hums disappear?

A

Lying down

Turning head

51
Q

3 main types of VSD

A

Subaortic
Perimembranous
Muscular

52
Q

What is a VSD?

A

Left to right shunt

53
Q

Presentation of VSD

A

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
Q

What is Eisenmenger syndrome?

A

Right to left shunt

55
Q

What do you become with Eisenmenger syndrome?

A

Cyanotic

56
Q

How do you close a VSD?

A

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
Q

What is there a good chance of with atrial septal defects?

A

Spontaneous closure

58
Q

What can ASD present with in adulthood?

A

AF
HF
Pulmonary HTN

59
Q

What do you hear with a ASD?

A

wide fixed splitting of 2nd heart sound

Pulmonary flow murmur

60
Q

Treatment of ASD

A

Atrial septa defect occlusion device in situ

61
Q

Atrioventricular septal defect or endocardial cushions defect or AV canal defect are associated with what?

A

Trisomy 21

62
Q

Presentation of pulmonary stenosis

A

Mild = asymptomatic

Moderate / severe = exertional dyspnoea and fatigue

63
Q

What do you hear in pulmonary stenosis?

A

Ejection systolic murmur upper left sternal border
Radiation to back
Loud then quiet again

64
Q

Treatment of pulmonary stenosis

A

Balloon valvuloplasty

65
Q

What is there a risk of when treating pulmonary stenosis with a balloon valvuloplasty?

A

Pulmonary regurgitation

66
Q

Presentation of aortic stenosis

A 
Mostly asymptomatic
If severe
- reduced exercise tolerance 
- exertional chest pain 
- syncope
67
Q

What can you hear in aortic stenosis?

A

Ejection systolic murmur
Upper right sternal border
Radiation to carotids

68
Q

Treatment of aortic stenosis

A

Balloon aortic valvuloplasty

69
Q

What happens in a bicuspid aortic valve?

A

There are two parts to the valve instead of 3

70
Q

Changes at birth to the foetal circulation

A 
Pulmonary vascular resistance falls 
Pulmonary blood flow rises 
Systemic vascular resistance is increased 
Ductus arteriosus closes
Foramen ovale closes
Ductus venosus closes
71
Q

In the foetus, what do veins carry?

A

Blood TOWARDS the heart

72
Q

Who is patent ductus arteriosus common in?

A

Pre term infants

73
Q

Treatment of patent ductus arteriosus

A

Fluid restriction / diuretics
Prostaglandin inhibitors - Indomethacin
Surgical ligation

74
Q

In who is there a chance of spontaneous closure of PDA?

A

Term babies

75
Q

What is coarctation of aorta?

A

Congenital narrowing of the aorta

76
Q

Where is coarctation of the aorta usually found?

A

In the descending part of the arch

77
Q

Treatment of coarctation of the aorta

A

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
Q

Pathology of transposition of the great arteries

A

Aorta comes out of your right ventricle and the pulmonary artery comes out of the left ventricle

79
Q

Treatment of transposition of the great arteries

A

A shunt
If known antenatally - umbilical venous catheter to keep duct open
Rashkinds atrial septostomy

80
Q

Features of fallot’s teratology

A

Pulmonary stenosis
Right ventricular hypertrophy
High VSD
Overriding aorta

81
Q

What does fallot’s teratology lead to?

A

Cyanosis

82
Q

Treatment of fallot’s teratology

A

Palliative shunt

83
Q

Presentation of HF in children

A 
Tachypnoea
- cant feed / failure to thrive
- cold sweat
Tachycardia
Hepatomegaly
84
Q

Signs of PDA

A 
Left subclavicular thrill 
Continuous 'machinery' murmur 
Large volume, bounding and collapsing pulse 
Wide pulse pressure
Heaving apex beat
85
Q

Example of the a prostaglandin used in the management of ductus arteriosus for duct dependent congenital heart disease

A

Alprostadil

86
Q

Cyanotic CHD presenting within the first days of life indicates what?

A

Transposition of great arteries

87
Q

Cyanotic CHD presenting at 1 - 2 months of age indicates what?

A

Teratology of fallot

88
Q

What can Ebsteins anomaly be described as?

A

‘Atrialisation’ of the ventricle

89
Q

Features of Ebsteins anomaly

A

Low insertion of tricuspid valve resulting in a large right atrium and a small right ventricle causing tricuspid incontinence

90
Q

Associations of Ebsteins anomaly

A

Tricuspid incontinence

WPW syndrome

91
Q

Exposure to what may cause Ebsteins anomaly?

A

Lithium in utero

92
Q

What does a VSD increase the risk of?

A

Endocarditis

Paeds (28 decks)

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