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Paediatrics > Paediatric Cardiology > Flashcards

Paediatric Cardiology Flashcards

1
Q

3 factors that increase susceptibility to cardiac issues in children

A

Genetics
Teratogenic insult (18-60 days post-conception)
Environmental

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2
Q

Environmental factors that increase susceptibility to cardiac issues in children

A

Drugs, Alcohol, Amphetamines, Lithium, Cocaine, Phenytoin
Infection - TORCH
Maternal - Diabetes mellitus, SLE

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3
Q

Why is diabetes mellitus in the mother a risk factor for cardiac issues in children?

A

Transient cardiomyopathy

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4
Q

Genetic conditions that are associated with cardiac problems in children

A 
Trisomy 13 (90%)
Trisomy 18 (80%)
Trisomy 21 (40%)
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5
Q

What cardiac condition is specifically associated with trisomy 21?

A

Atrioventricular Septal Defect (AVSD)

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6
Q

Turners syndrome 45 X is associated with which cardiac condition?

A

Coarctation of aorta

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7
Q

Noonan syndrome is associated with which cardiac condition?

A

Pulmonary stenosis

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8
Q

Williams Syndrome is associated with which cardiac condition?

A

Supravalvular aortic stenosis

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9
Q

22q11 deletion syndrome (DiGeorge) is associated with ?

A

Behavioural phenotype

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10
Q

What occurs to cause central cyanosis?

A

Right to left shunt

Decreased amount of oxygen in the body

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11
Q

Presentation of a child with cardiac problems

A 
Breathless and sweating during feed
Tachycardic
Tachypnoea
Hepatomegaly
- three signs of heart failure
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12
Q

What kind of flow is predicted in a baby’s heart and why?

A

Predictably a turbulent flow due to size/dimensions of heart and high heart rate

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13
Q

Aspects of history in children with suspected heart problems

A 
Feeding issues
Weight and development
Tachypnoea, dyspnoea
Palpitations
Chest pain (mostly MSK in children)
Exercise tolerance
Syncope
Joint problems
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14
Q

Examination of child with suspected heart problems

A 
Weight and height
Dysmorphic features
Cyanosis
Clubbing
Tachy/dyspnoea
Pulses - apex/femoral
- radial femoral delay
- apex extending on left indicates hypertrophy
Heart sounds
Murmurs
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15
Q

An apex beat radiating to the left indicates what change in the heart?

A

Hypertrophy

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16
Q

Which heart sounds do we listen for in examination of a child?

A

Click
Split
3rd and 4th

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17
Q

Investigations in a child with suspected heart problems

A 
Blood pressure
Oxygen saturations
Arterial BG
ECG
Chest X ray
ECHO
Catheter
Angiography
MRI/A
Exercise testing
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18
Q

Possible procedures for cardiac issues in a child

A

Medication (palliative)
Balloon valvoplasty
Blalock Taussig Shunt
Transplant

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19
Q

Murmurs

A 
Timing - Systole/Diastole/continuous
Duration - Early/Middle/Late
Pitch/quality
Most are innocent
Systolic
Soft
Vibratory/musical
Localised
Vary with position, respiration and exercise
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20
Q

Describe most common murmur

A

Systolic

Soft

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21
Q

Features of Still’s/ Left ventricle outflow murmur

A

Systolic
Soft
Left sternal border
Increases on lying down, exercise

Presents in 2-7 years old

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22
Q

When does a still’s murmur most commonly present

A

Children 2-7 years old

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23
Q

Features of pulmonary outflow murmur

A

Upper left sternal border

Does not radiate to the back

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24
Q

Features of carotid/brachiocephalic bruit

A

Increases with exercise

Decreases when turning head

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25
Q

Features of a venous hum and which patients most likely to present

A 
3-8 years old
Soft, indistinctive
Diastole
Supraclavicular
Decreases on lying down
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26
Q

3 types of ventricular septal defect

A

Muscular
Subaortic
Perimembranous

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27
Q

What shunt occurs in ventricular septal defect?

A

Left to right
Left ventricle has high pressure
Acyanotic defect- doesn’t affect oxygen

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28
Q

Consequence of large ventricular septal defect

A

Heart failure
Biventricular hypertrophy
Pulmonary hypertension

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29
Q

What is eisenmenger syndrome?

A

Fluid overload
Laying down of cells increases pulmonary vascular resistance

Right ventricular hypertrophy
Pressure increase
Pulmonary arteries
Further irritation
Cycle of resistance increase
30
Q

Investigation for eisenmenger syndrome

A

Doppler - jet during systole

31
Q

Treatment of eisenmenger syndrome/ ventricular septal defect

A 
Closure - transcatheter, Amplatzer
If too large
Open heart surgery
- left atrium accessed via mitral valve
- pericardium used for patch closure
32
Q

Name of closure device for ventricular septal defect

A

Amplatzer

33
Q

Mechanism of healing from ventricular septal closure

A

Endocardium grows over

IV septum immobilised for life but no consequence

34
Q

Signs or symptoms of atrial septal defect

A

No signs

Incidental finding in adult with A fib, heart failure or pulmonary hypertension

35
Q

Features of atrial septal defect

A

Wide fixed splitting of second heart sound, pulmonary flow murmur
Left to right shunt (acyanotic)

36
Q

Investigation for atrial septal defect

A

Doppler

Right atrium visibly larger, can see shunt

37
Q

Features of atrial septal defect associated with Trisomy 21

A

Mitral and tricuspid valve fusion

Complete AVSD

38
Q

Symptoms of mild pulmonary stenosis

A

Asymptomatic

39
Q

Symptoms and signs of moderate to severe pulmonary stenosis

A

Exertional dyspnoea
Fatigue
Ejection Systolic murmur of upper left sternal border
Crescendo decrescendo after first heart sound

40
Q

Treatment for pulmonary stenosis

A

Balloon valvoplasty

41
Q

Signs of severe aortic stenosis

A 
Other forms asymptomatic
Exercise tolerance reduced
Chest pain
Syncope
Ejection systolic murmur Upper Right Sternal Border radiates to carotids
42
Q

Treatment for aortic stenosis

A

Balloon Aortic Valvoplasty via femoral artery

43
Q

Treatment for Patent Ductus Arteriosus

A

Fluid restriction/diuretics
Surgical ligation
Prostaglandin inhibitors

Common in preterm babies
Term babies spontaneous closure - not prostaglandin sensitive

44
Q

Investigations coarctation of aorta

A

MRI

US

45
Q

Treatment coarctation of aorta

A

Reopen ductus arterosus with prostaglandin E1 or E2
Resection with end to end anastomosis
Subclavian patch repair
Balloon aortoplasty

46
Q

Treatment Transposition of Great arteries

A 
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
47
Q

Fallot’s tetralogy

A

Stenosis causes overflow obstruction
Shunt increased - become more cyanotic
Bootshaped heart - right ventricle hypertrophy
Full correction at 6 months

48
Q

Features of a venous hum and which patients most likely to present

A 
3-8 years old
Soft, indistinctive
Diastole
Supraclavicular
Decreases on lying down
49
Q

3 types of ventricular septal defect

A

Muscular
Subaortic
Perimembranous

50
Q

What shunt occurs in ventricular septal defect?

A

Left to right
Left ventricle has high pressure
Acyanotic defect- doesn’t affect oxygen

51
Q

Consequence of large ventricular septal defect

A

Heart failure
Biventricular hypertrophy
Pulmonary hypertension

52
Q

What is eisenmenger syndrome?

A

Fluid overload
Laying down of cells increases pulmonary vascular resistance

Right ventricular hypertrophy
Pressure increase
Pulmonary arteries
Further irritation
Cycle of resistance increase
53
Q

Investigation for eisenmenger syndrome

A

Doppler - jet during systole

54
Q

Treatment of eisenmenger syndrome/ ventricular septal defect

A 
Closure - transcatheter, Amplatzer
If too large
Open heart surgery
- left atrium accessed via mitral valve
- pericardium used for patch closure
55
Q

Name of closure device for ventricular septal defect

A

Amplatzer

56
Q

Mechanism of healing from ventricular septal closure

A

Endocardium grows over

IV septum immobilised for life but no consequence

57
Q

Signs or symptoms of atrial septal defect

A

No signs

Incidental finding in adult with A fib, heart failure or pulmonary hypertension

58
Q

Features of atrial septal defect

A

Wide fixed splitting of second heart sound, pulmonary flow murmur
Left to right shunt (acyanotic)

59
Q

Investigation for atrial septal defect

A

Doppler

Right atrium visibly larger, can see shunt

60
Q

Features of atrial septal defect associated with Trisomy 21

A

Mitral and tricuspid valve fusion

Complete AVSD

61
Q

Symptoms of mild pulmonary stenosis

A

Asymptomatic

62
Q

Symptoms and signs of moderate to severe pulmonary stenosis

A

Exertional dyspnoea
Fatigue
Ejection Systolic murmur of upper left sternal border
Crescendo decrescendo after first heart sound

63
Q

Treatment for pulmonary stenosis

A

Balloon valvoplasty

64
Q

Signs of severe aortic stenosis

A 
Other forms asymptomatic
Exercise tolerance reduced
Chest pain
Syncope
Ejection systolic murmur Upper Right Sternal Border radiates to carotids
65
Q

Treatment for aortic stenosis

A

Balloon Aortic Valvoplasty via femoral artery

66
Q

Treatment for Patent Ductus Arteriosus

A

Fluid restriction/diuretics
Surgical ligation
Prostaglandin inhibitors

Common in preterm babies
Term babies spontaneous closure - not prostaglandin sensitive

67
Q

Investigations coarctation of aorta

A

MRI

US

68
Q

Treatment coarctation of aorta

A

Reopen ductus arterosus with prostaglandin E1 or E2
Resection with end to end anastomosis
Subclavian patch repair
Balloon aortoplasty

69
Q

Treatment Transposition of Great arteries

A 
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
70
Q

Fallot’s tetralogy

A

Stenosis causes overflow obstruction
Shunt increased - become more cyanotic
Bootshaped heart - right ventricle hypertrophy
Full correction at 6 months

Paediatrics (10 decks)

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