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Paediatrics > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

Name the eight commonest congenital heart defects

A
  • Ventricular septal defect
  • Patent ductus arteriosus
  • Atrial septal defect
  • Pulmonary stenosis
  • Aortic stenosis
  • Coarctation of the aorta
  • Transposition of the great arteries
  • Tetralogy of Fallot
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2
Q

What is the aetiology of congenital heart defects

A
  • Genetic susceptibility
  • Teratogenic insult (18-60 days post conception)
  • Drugs: alcohol, amphetamines, cocain, ecstasy, phenytoin and lithium
  • Infections: toxoplasma, rubella, CMV and herpes
  • Maternal: diabetes and systemic lupus
  • Chromosomal abnormalities
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3
Q

Which chromosomal abnormalities are associated with congenital heart defects?

A
  • Trisomy 13 and 18
  • Trisomy 21 (AVSD)
  • Turner (Co-arctation of the aorta)
  • Noonan (pulmonary stenosis)
  • Williams (supravalvular aortic stenosis)
  • 22q11 deletion syndrome (De George syndrome)
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4
Q

What features might be present in a history in a child with congenital heart defect?

A
  • Feeding, weight and development
  • Cyanosis (central - L to R shunt)
  • Tachypnoea and dyspnoea
  • Exercise tolerance
  • Chest pain
  • Syncope
  • Palpitation
  • Joint problems
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5
Q

What would you examine in a child with a possible congenital heart defect?

A
  • Weight and height
  • Dysmorphic features
  • Cyanosis
  • Clubbing
  • Tachy/dyspnoea
  • Pulses/apex beat
  • Heart sounds
  • Murmurs
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6
Q

What investigations can you do for a child with a suspected congenital heart defect?

A
  • Blood pressure
  • O2 sats, ABG
  • ECG
  • CXR
  • ECHO
  • Catheter
  • Angiography
  • MRI/A
  • Exercise testing
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7
Q

What are the features of heart failure in children?

A
  • Tachypnoea
  • Hepatomegaly
  • Tachycardia
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8
Q

What are the treatment principles for congenital heart defects in children?

A
  • If you can fix it then fix it
  • If you can’t fix it then improve the situation medication, palliative procedures (BT shunt, balloon valvoplasty etc.)
  • If you can do neither then replace it
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9
Q

How are murmurs characterised?

A
  • Timing in cardiac cycle: systolic/diastole/continuous
  • Duration: early/mid/late and ejection/pansystolic
  • Pitch/quality
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10
Q

What are the common features of the innocent murmurs?

A
  • Systolic murmur
  • No other signs of cardiac disease
  • Soft murmur
  • Vibratory, musical
  • Localised
  • Varies with position, respiration and exercise
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11
Q

What are the features of Still’s murmur?

A
  • LV outflow murmur
  • Age 2-7 years
  • Soft systolic, vibratory, musical, twangy
  • Apex: left sternal border
  • Increases in supine position and with exercise
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12
Q

What are the features of a pulmonary outflow murmur?

A
  • Age 8-10 years
  • Soft systolic vibratory
  • Upper left sternal border
  • Well localised
  • Not radiating to back
  • Increases in supine position and with exercise
  • Often children with narrow chest
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13
Q

What are the features of carotid/brachiocephalic arterial bruits?

A
  • Age 2-10yrs
  • Systolic and harsh
  • Supraclavicular
  • Radiates to the neck
  • Increases with exercise,decreases on turning head or extending neck
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14
Q

What are the features of a venous hum?

A
  • Age 3-8 years
  • Soft and indistinct
  • Continuous (sometimes has diastolic accentuation)
  • Supraclavicular
  • Only in upright position, disappears on lying down or turning head
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15
Q

What are the three main types of ventricular septal defects (L to R shunt)?

A
  • Subaortic
  • Perimembranous
  • Muscular
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16
Q

How does a ventral septal defect present?

A
  • Pansystolic murmur at the lower left sternal edge +/- thrill
  • Small VSDs: early systolic murmur
  • Large VSDs: diastolic rumble (relative mitral stenosis)
  • Signs of cardiac failure in large VSDs: biventricular hypertrophy and pulmonary hypertension
17
Q

What are the consequences of VSD if left untreated?

A
  • LVH
  • RVH
  • Pulmonary hypertension
18
Q

How can VSD be treated?

A
  • Amplatzer or other occlusion device: trans catheter

- Patch closure: open heart surgery

19
Q

How do atrial septal defects present?

A
  • Few clinical signs in early childhood (may spontaneously close)
  • May present in adulthood with AF, HF or pulmonary hypertension
  • Splitting of 2nd heart sound, pulmonary flow murmur
20
Q

How can an ASD be treated?

A

Occlusion device

21
Q

What is the biggest probelm with an AVSD?

A

There is only one AV valve

22
Q

How does pulmonary stenosis present?

A
  • Asymptomatic in mild
  • Exertional dyspnoea and fatigue in moderate to severe
  • Ejection systolic murmur upper left sternal border with radiation to the back
  • Can get worse as children grow (
23
Q

How can pulmonary stenosis be managed?

A

Balloon valvoplasty

24
Q

How does aortic stenosis present?

A
  • Mostly symptomatic
  • If severe: reduced exercise tolerance, exertional chest pain and syncope
  • Ejection systolic murmur, upper right sternal border and radiation into the carotids
25
Q

How can aortic stenosis be treated?

A

Balloon aortic valvuloplasty

26
Q

What changes occur in the fetal circulation at birth?

A
  • Pulmonary vascular resistance falls
  • Pulmonary blood flow rises
  • Systemic vascular resistance is increased
  • Ductus arteriosus closes
  • Foramen ovale closes
  • Ductus venosus closes
27
Q

In the foetus which blood vessels take blood to and from the heart from the placentan through the umbilicus?

A
  • Umbilical vein goes to the heart

- Umbilical artery returns the bloods to the placenta

28
Q

How can patent ductus arteriosus be treated in pre- term babies?

A
  • Fluid restriction/diuretics
  • Prostaglandin inhibitors (ibuprofen, indomethacin)
  • Surgical ligation
29
Q

What happens to term babies that have patent ductus arteriosus?

A
  • Most have spontaneous closure

- Not prostaglandin sensitive

30
Q

How can coarctation of the aorta be investigated?

A
  • ECHO

- MRI

31
Q

How can coarctation of the aorta be managed?

A
  • Reopen DA with prostaglandins
  • Resection with end to end anastomosis
  • Subclavian patch repair
  • Balloon aortoplasty
32
Q

How can transposition of the great arteries be managed?

A
  • Rashkind’s atrial septostomy

- Switch procedure

33
Q

What are the features of tetralogy of Fallot?

A
  • Pulmonary valve stenosis (+right outflow obstruction): determines prognosis
  • RVH
  • VSD
  • Overiding aorta

Paediatrics (17 decks)

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