Paediatric cardiology Flashcards
What are the 6 features of an innocent murmur in paediatrics?
Soft (Grade II/VI) Systolic Short Standing/sitting (Varies with position) Sternal edge (left) Symptomless Sounds (S1 and S2 are normal) Special tests normal (ECG, echo)
4 year old girl seen in Paediatric assessment unit with fever and coryzal symptoms for the past 7 days. On examination, she is miserable and febrile. All other observations are normal. Cardiovascular exam showed Grade 2 systolic murmur, head loudest over lower left sternal edge. Murmur is quieter when she is sitting down. After a period of observation, she improves and is discharged home. What is the best way to manage her murmur? A) Cardiology referral B) Commence diuretics C) No action D) Perform an echo E) Review in one month
Review in 1 month
During a febrile illness or anaemia, innocent or flow murmurs are often heard because of increased cardiac output. Therefore it is important to examine the child when such other illnesses have been corrected. It still might be a pathological murmur.
Give 3 causes of left-to-right shunts which result in breathlessness?
Atrial Septal Defect Ventricular Septal Defect Patent ductus arteriosus
Give 3 causes of right-to-left shunts which result in cyanosis?
Tetralogy of Fallot Transposition of the great arteries
Give 2 causes of outflow obstruction in a well child (asymptomatic) but with a murmur?
Aortic stenosis Pulmonary stenosis
Give a cause of outflow obstruction in a sick neonate (collapsed with shock)
Coarctation of the aorta
What are some causes of heart failure?
Give 3 signs and symptoms of heart failure?
Signs
- Poor weight gain or ‘faltering growth’
- Tachypnoea
- Tachycardia
- Heart murmur, gallop rhythm
- Enlarged heart
- Hepatomegaly
- Cool peripheries
Symptoms
- Breathlessness (particularly on feeding or exertion)
- Sweating
- Poor feeding
- Recurrent chest infections
What investigations to perform if suspect heart failure?
ECG
- Secundum ASD –> right axis deviation, RBBB, RSR1 in V1 (3R’s)
- Partial AVSD –> negative QRS deflection in lead AVF
Chest X-ray
- Enlarged heart
- Enlarged pulmonary arteries
- Increased pulmonary vascular markings
Once in a specialist setting: Echo (diagnostic)
What are the SSx of a small VSD?
Asymptomatic
Loud pansystolic murmur at the left lower sternal edge (where the defect is)
Quiet P2 sound
What are the SSx of a large VSD?
Symptoms
- Heart failure with breathlessness and failure to thrive after 1 week old
- Recurrent chest infections
Signs
- Tachypnoea, tachycardia and enlarged liver from heart failure
- Active precordium
- Soft pansystolic murmur or no murmur (implying large defect)
- Apical mid-diastolic murmur (from increased flow across the mitral valve after the blood has circulated through the lungs)
What is the Mx of VSD?
If small - nothing
If large - diuretics and captopril, then surgery at 3 - 6 months of age.
What are the SSx of a PDA?
Machinery like murmur best heard behind the left clavicle and occurs in diastole, also heart at ULSE
Collapsing or bounding pulse
Usually symptomless unless large, then Right to left shunt may occur
What are the SSx of transposition of the great arteries?
Acute heart failure
Loud single S2 heart sound
Possible murmur (due to increased blood flow)
Prominent right ventricular impulse
Ejection systolic murmur best heard at the upper left sternal edge and louder on inspiration.
You also hear fixed splitting of the S2 heart sound and the child is well, what is the most likely diagnosis?
Atrial Septal Defect
