Paediatric Cardiology Flashcards
3 factors that increase susceptibility to cardiac issues in children
Genetics
Teratogenic insult (18-60 days post-conception)
Environmental
Environmental factors that increase susceptibility to cardiac issues in children
Drugs, Alcohol, Amphetamines, Lithium, Cocaine, Phenytoin
Infection - TORCH
Maternal - Diabetes mellitus, SLE
Why is diabetes mellitus in the mother a risk factor for cardiac issues in children?
Transient cardiomyopathy
Genetic conditions that are associated with cardiac problems in children
Trisomy 13 (90%) Trisomy 18 (80%) Trisomy 21 (40%)
What cardiac condition is specifically associated with trisomy 21?
Atrioventricular Septal Defect (AVSD)
Turners syndrome 45 X is associated with which cardiac condition?
Coarctation of aorta
Noonan syndrome is associated with which cardiac condition?
Pulmonary stenosis
Williams Syndrome is associated with which cardiac condition?
Supravalvular aortic stenosis
22q11 deletion syndrome (DiGeorge) is associated with ?
Behavioural phenotype
What occurs to cause central cyanosis?
Right to left shunt
Decreased amount of oxygen in the body
Presentation of a child with cardiac problems
Breathless and sweating during feed Tachycardic Tachypnoea Hepatomegaly - three signs of heart failure
What kind of flow is predicted in a baby’s heart and why?
Predictably a turbulent flow due to size/dimensions of heart and high heart rate
Aspects of history in children with suspected heart problems
Feeding issues Weight and development Tachypnoea, dyspnoea Palpitations Chest pain (mostly MSK in children) Exercise tolerance Syncope Joint problems
Examination of child with suspected heart problems
Weight and height Dysmorphic features Cyanosis Clubbing Tachy/dyspnoea Pulses - apex/femoral - radial femoral delay - apex extending on left indicates hypertrophy Heart sounds Murmurs
An apex beat radiating to the left indicates what change in the heart?
Hypertrophy
Which heart sounds do we listen for in examination of a child?
Click
Split
3rd and 4th
Investigations in a child with suspected heart problems
Blood pressure Oxygen saturations Arterial BG ECG Chest X ray ECHO Catheter Angiography MRI/A Exercise testing
Possible procedures for cardiac issues in a child
Medication (palliative)
Balloon valvoplasty
Blalock Taussig Shunt
Transplant
Murmurs
Timing - Systole/Diastole/continuous Duration - Early/Middle/Late Pitch/quality Most are innocent Systolic Soft Vibratory/musical Localised Vary with position, respiration and exercise
Describe most common murmur
Systolic
Soft
Features of Still’s/ Left ventricle outflow murmur
Systolic
Soft
Left sternal border
Increases on lying down, exercise
Presents in 2-7 years old
When does a still’s murmur most commonly present
Children 2-7 years old
Features of pulmonary outflow murmur
Upper left sternal border
Does not radiate to the back
Features of carotid/brachiocephalic bruit
Increases with exercise
Decreases when turning head
Features of a venous hum and which patients most likely to present
3-8 years old Soft, indistinctive Diastole Supraclavicular Decreases on lying down
3 types of ventricular septal defect
Muscular
Subaortic
Perimembranous
What shunt occurs in ventricular septal defect?
Left to right
Left ventricle has high pressure
Acyanotic defect- doesn’t affect oxygen
Consequence of large ventricular septal defect
Heart failure
Biventricular hypertrophy
Pulmonary hypertension
What is eisenmenger syndrome?
Fluid overload
Laying down of cells increases pulmonary vascular resistance
Right ventricular hypertrophy Pressure increase Pulmonary arteries Further irritation Cycle of resistance increase
Investigation for eisenmenger syndrome
Doppler - jet during systole
Treatment of eisenmenger syndrome/ ventricular septal defect
Closure - transcatheter, Amplatzer If too large Open heart surgery - left atrium accessed via mitral valve - pericardium used for patch closure
Name of closure device for ventricular septal defect
Amplatzer
Mechanism of healing from ventricular septal closure
Endocardium grows over
IV septum immobilised for life but no consequence
Signs or symptoms of atrial septal defect
No signs
Incidental finding in adult with A fib, heart failure or pulmonary hypertension
Features of atrial septal defect
Wide fixed splitting of second heart sound, pulmonary flow murmur
Left to right shunt (acyanotic)
Investigation for atrial septal defect
Doppler
Right atrium visibly larger, can see shunt
Features of atrial septal defect associated with Trisomy 21
Mitral and tricuspid valve fusion
Complete AVSD
Symptoms of mild pulmonary stenosis
Asymptomatic
Symptoms and signs of moderate to severe pulmonary stenosis
Exertional dyspnoea
Fatigue
Ejection Systolic murmur of upper left sternal border
Crescendo decrescendo after first heart sound
Treatment for pulmonary stenosis
Balloon valvoplasty
Signs of severe aortic stenosis
Other forms asymptomatic Exercise tolerance reduced Chest pain Syncope Ejection systolic murmur Upper Right Sternal Border radiates to carotids
Treatment for aortic stenosis
Balloon Aortic Valvoplasty via femoral artery
Treatment for Patent Ductus Arteriosus
Fluid restriction/diuretics
Surgical ligation
Prostaglandin inhibitors
Common in preterm babies
Term babies spontaneous closure - not prostaglandin sensitive
Investigations coarctation of aorta
MRI
US
Treatment coarctation of aorta
Reopen ductus arterosus with prostaglandin E1 or E2
Resection with end to end anastomosis
Subclavian patch repair
Balloon aortoplasty
Treatment Transposition of Great arteries
Venous catheter Prostaglandins Rashkind balloon Atrial Sepostomy -Catheter via femoral vein to right atrium Switch procedure -Great arteries placed on appropriate ventricle -Cut aorta above coronary arteries -Plug into aorta
Fallot’s tetralogy
Stenosis causes overflow obstruction
Shunt increased - become more cyanotic
Bootshaped heart - right ventricle hypertrophy
Full correction at 6 months
Features of a venous hum and which patients most likely to present
3-8 years old Soft, indistinctive Diastole Supraclavicular Decreases on lying down
3 types of ventricular septal defect
Muscular
Subaortic
Perimembranous
What shunt occurs in ventricular septal defect?
Left to right
Left ventricle has high pressure
Acyanotic defect- doesn’t affect oxygen
Consequence of large ventricular septal defect
Heart failure
Biventricular hypertrophy
Pulmonary hypertension
What is eisenmenger syndrome?
Fluid overload
Laying down of cells increases pulmonary vascular resistance
Right ventricular hypertrophy Pressure increase Pulmonary arteries Further irritation Cycle of resistance increase
Investigation for eisenmenger syndrome
Doppler - jet during systole
Treatment of eisenmenger syndrome/ ventricular septal defect
Closure - transcatheter, Amplatzer If too large Open heart surgery - left atrium accessed via mitral valve - pericardium used for patch closure
Name of closure device for ventricular septal defect
Amplatzer
Mechanism of healing from ventricular septal closure
Endocardium grows over
IV septum immobilised for life but no consequence
Signs or symptoms of atrial septal defect
No signs
Incidental finding in adult with A fib, heart failure or pulmonary hypertension
Features of atrial septal defect
Wide fixed splitting of second heart sound, pulmonary flow murmur
Left to right shunt (acyanotic)
Investigation for atrial septal defect
Doppler
Right atrium visibly larger, can see shunt
Features of atrial septal defect associated with Trisomy 21
Mitral and tricuspid valve fusion
Complete AVSD
Symptoms of mild pulmonary stenosis
Asymptomatic
Symptoms and signs of moderate to severe pulmonary stenosis
Exertional dyspnoea
Fatigue
Ejection Systolic murmur of upper left sternal border
Crescendo decrescendo after first heart sound
Treatment for pulmonary stenosis
Balloon valvoplasty
Signs of severe aortic stenosis
Other forms asymptomatic Exercise tolerance reduced Chest pain Syncope Ejection systolic murmur Upper Right Sternal Border radiates to carotids
Treatment for aortic stenosis
Balloon Aortic Valvoplasty via femoral artery
Treatment for Patent Ductus Arteriosus
Fluid restriction/diuretics
Surgical ligation
Prostaglandin inhibitors
Common in preterm babies
Term babies spontaneous closure - not prostaglandin sensitive
Investigations coarctation of aorta
MRI
US
Treatment coarctation of aorta
Reopen ductus arterosus with prostaglandin E1 or E2
Resection with end to end anastomosis
Subclavian patch repair
Balloon aortoplasty
Treatment Transposition of Great arteries
Venous catheter Prostaglandins Rashkind balloon Atrial Sepostomy -Catheter via femoral vein to right atrium Switch procedure -Great arteries placed on appropriate ventricle -Cut aorta above coronary arteries -Plug into aorta
Fallot’s tetralogy
Stenosis causes overflow obstruction
Shunt increased - become more cyanotic
Bootshaped heart - right ventricle hypertrophy
Full correction at 6 months
