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Phase 3a > Paediatric cardiology medicine > Flashcards

Paediatric cardiology medicine Flashcards

1
Q

What are the 3 main categories of congenital heart disease?

A
  1. Holes - ASD, PDA, VSD, AVSD
  2. Stenosis - coarctation of aorta, AS, PS
  3. Complex / cyanotic (right to left shunt) - transposition of great arteries, tetralogy of fallots
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2
Q

What would be the symptoms of acute cardiac decompensation?

A 
poor feeding
dyspnoea
tachycardia
bradycardia (imminent arrest)
hepatomegaly
cool peripheries
acidosis
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3
Q

What type of CHD is caused by fetal alcohol syndrome?

What CHDs are common in Downs syndrome?

A

Atrial septal defects in fetal alcohol syndrome

ASDs and AVSDs in Downs syndrome

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4
Q

What are the 3 types of atrial septal defect?

A
  1. Ostium secundum = most common, occurs in middle of atrial septum
  2. Ostium primum = occurs low in atrial septum
  3. AVSD
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5
Q

What would be heard on auscultation in a patient with atrial septal defect?

What are the symptoms of an atrial septum defect?

A

Fixed and widely split S2
Ejection systolic murmur in pulmonary area

Palpitations, arrhythmias
Recurrent LRTI + wheeze

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6
Q

ASD - investigations and management

CXR?
ECG?
Management?

A

CXR = Cardiomegaly, globular heart

ECG = RVH, RBBB, superior QRS axis

Management - surgical correction

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7
Q

What is patent ductus arteriosis?

A

Tube connecting aorta and pulmonary artery

Patent = preterm
Persistent = term babies at >1 month
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8
Q

What are the clinical features of a large PDA?

A

Large PDA = CCF + pulmonary HTN

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9
Q

What are the signs on examination of patent ductus arteriosis?

(ECG and CXR often normal)

A

Galloping, collapsing pulse
Heaves and thrills
Continuous machinery murmur in pulmonary area

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10
Q

What is the treatment for PDA?

A
  • Surgery to remove endocarditis risk
  • Ibuprofen / Indomethacin (prostaglandin inhibitor) to close
  • If persistent - surgery at 1 year
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11
Q

Which CHD has the highest risk of endocarditis?

A

VSDs

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12
Q

How do VSDs present

  • Clinically
  • On auscultation
A
  • Usually mild presentation of CHD symptoms
  • Loud pansystolic murmur in lower left sternal edge +/- thrill
  • Loudness inversely proportional to size of VSD
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13
Q

What are the general symptoms of CHD?

A

Failure to thrive / poor feedings
Tachypnoea
Hepatomegaly
Oedema

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14
Q

What are the main investigations for VSD?

A

CXR - cardiomegaly, enlarged PA, pulmonary oedema (HF)
ECG - LVH
Echo - visualise defect

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15
Q

What is the management for VSD?

A

Spontaneous closure if small (20% by 9 months)

Large VSD

  • Diuretics for heart failure
  • Calorie input (NG?)
  • Surgery
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16
Q

What is a complete AVSD?

A

A single 5-leaflet valve between atria and ventricle

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17
Q

What are the features of AVSD?

A
  • present at antenatal USS
  • Cyanosis at birth
  • HF at 2-3 weeks
  • No murmur
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18
Q

What are the investigations and managements for AVSD?

A

ECG normal
Echocardiogram
Screening in Down’s syndrome

Tx = surgical repair by 5 years old to avoid pulmonary HTN

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19
Q

How would a VSD present?

A 
Small - asymptomatic, normal growth
Moderate - poor feeding, FTT, SOB
Large - as above + sweaty and pale
Presents at 6-8 weeks
Persistent pulmonary htn if the newborn may establish at 12 months
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20
Q

What is the pathphysiology of aortic stenosis?

A

Aortic valves are partially fused, restricting bloodflow from the LV.
Often associated with CoA and mitral valve stenosis

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21
Q

What are the clinical features of aortic stenosis?

What is heard on auscultation?

A

Asymptomatic
Critical AS = severe heart failure causing collapse and shock

Ejection systlic murmur in upper right sternal edge, radiating to carotids

22
Q

What would be seen on imaging of aortic stenosis?

What would be seen on ECG?

A

May be normal or have prominent LV

Deep S wave and tall R wave in V2
Downgoing T wave in V6

23
Q

How is aortic stenosis managed in children?

A

Regular echocardiograms
Balloon valvotomy in children with symptoms on exercise
Balloon dilation in older children
Eventually will need valve replacement

24
Q

What are the clinical features of pulmonary stenosis?

A

PV leaflets partially fuse - restricting bloodflow from RV

Usually asymptomatic
Ejection systolic murmur in ULSE, may radiate to back

25
How is Pulmonary stenosis diagnosed and managed?
Usually clinical diagnosis ECG - RV hypertrophy Mx = transcatheter ballon dilatation
26
What is the basic science of transposition of the great arteries?
Aorta connected to RV and PA connected to LV - O2 blood sent to lungs and deoxygenated blood to body INCOMPATIBLE WITH LIFE
27
What are the clinical features of transposition of the great arteries? What would be heard on auscultation?
Profound cyanosis (due to mixing) Presents on day 2 when ductus arteriosus closes Collapse Acidosis Second heart sound loud and single
28
What investigations would be appropriate for a transposition of the great arteries?
Check for 22q deletion (DiGeorge syndrome) CXR - 'egg on the side' appearance of heart ECG normal Echo - shows abnormality
29
How is transposition of the great arteries treated?
*Maintain patency of ductus arteriosus with prostaglandin infusion* Balloon atrial septostomy Surgery in first few days of life
30
What are the 4 pathological features of tetralogy of fallot?
1. Large VSD 2. Overriding of the aorta 3. Sub-pulmonary stenosis 4. Right ventricular hypertrpohy
31
What are the signs and symptoms of tetralogy of fallot? What genetic mutations is it associated with?
``` Cyanosis (R-L shunt) which gradually worsens with sudden severe exacerbations - MI/stroke risk Breathless Pallor Irritability Easily tiring on breast feeding - trisomy 21 - 22q deletion ```
32
How is tetralogy of fallot diagnosed? What would be heard on auscultatino?
Cardinal features on echo CXR = small heart and 'boot shaped' apex Harsh ejection systolic murmur in LLSE
33
How is tetralogy of fallot managed?
Close VSD + relieve RV outflow obstru ction | Shunt to increase pulmonary flow
34
What is Ebstein's anomaly? What is the cause? What would be heart on auscultation? What would be seen on imaging?
Posterior leaflets of tricuspid valve are displaces anteriorly Lithium in pregnancy ``` Tricuspid regurg (pan-systolic murmur) Tricuspid stenosis (mid-diastolic murmur) ``` Enlargement of the right atrium
35
What is Kawasaki's disease? Who does it predominantly affect? What is the major complication of Kawasaki's?
Idiopathic self-limiting systemic vasculitis that most commonly affects children 6 months- 5 years Asian ethnicity Coronary artery aneurysm
36
What are the signs and symptoms of Kawasaki's disease? (MyHEART)
Marked FEVER - for 5 days and ≥4 diagnostic criteria: ``` My - mucosal involvement (strawberry tongue) H - Hands and feet swell E - Eyes = bilateral conjunctivitis A - (lymph)Adenopathy R - Rash = truncal and polymorphic T = temperature (>5 days) ```
37
What are the 3 phases of Kawasaki's disease?
1. Acute febrile 1-2 weeks (MyHEART) 2. Subacute 4-6 weeks (remission of fever) - Develop coronary artery aneurysms - Thrombocytosis, desquamation of digits 3. Convalescent 6-12 weeks - resolution of clinical signs
38
How is Kawasaki's disease diagnosed?
``` Clinical Raised: ESR CRP AST A1-Antitrypsin platelets bilirubin ``` *Echo = shows aneurysms*
39
What is the treatment for Kawasaki's disease? What is the prognosis for Kawasaki's?
1. High dose aspirin 2. IV Immunoglobulin (add pred if no response) 3. Cardiac follow up prognosis = good if treated promptly
40
What is Henoch-Schonlein Pupura (HSP)?
IgA mediated, autoimmune hypersensitivity vasculitis of childhood. It affects the skin, joints, gut and kidneys
41
What are the risk factors for HSP?
Infections (group A streptococcus, mycoplasma, EBV) Vaccinations Environmental (allergens, pesticides,insect bites)
42
What is the clinical presentation of HSP?
Classic triad: 1. Purpura (non-blanching) 2. Arthritis / arthralgia 3. Abdominal pain ``` Other: - low grade fever renal involvement - scrotal oedema intusseception - headaches ```
43
How would you diagnose HSP?
``` Urinalysis - Hb, Pro Raised ESR Raised anti-streptolysin O titres (group A strep) Raised serum IgA Raised WCC ```
44
What is the management for HSP? What is the prognosis? What are the possible complications?
Usually self limiting NSAIDS for joint pain Corticosteroids for arthralgia / may help abdo pain Most recover in 2 months GI bleeds, ileus, haemoptysis, AKI
45
What are the signs of infective endocarditis? What are the causative organisms?
``` Fever Heart failure Anaemia Rash Splenomegaly Haematuria (micro) Hands - clubbing, splinter haemorrhages NEW MURMUR ``` staphs and streps
46
What are the investigations for endocarditis?
Positive blood cultures from different sites at different times Echo
47
What is the management for infective endocarditis?
Benzylpenicillin + gentamycin | Advise oral hygeine
48
What is rheumatic fever?
Systemic febrile illness caused by a cross-sensitivity reaction to Group A beta-haemolytic streptococcus (eg strep throat) It is more common in LEDCs
49
What is the diagnostic criteria for rheumatic fever?
The Jones criteria | 2 major / 1 major + 2 minor plus evidence of preceding strep infection.
50
What are the major criteria for diagnosing Rheumatic fever? (The Jones criteria)
- Carditis (+ve echo / changed murmur / CCF / cardiomegaly - Polyarthritis - Erythema marginatum - Subcutaneous nodules - Sydenham's chorea (neuro)
51
What are the minor criteria for diagnosing Rheumatic fever? (The Jones criteria)
- Fever - raised ESR or crp - Arthralgia (pain but no swelling) - ECG - PR interval <0.2 secs - Previous rheumatic fever or HD
52
What is the treatment for rheumatic fever?
- Mainly rest and aspirin - Benzylpenicillin then phenoxymethylpenicillin (for throat) - prednisolone may halp - Can give prophylactic ABx if sore throat in high incidence area / previous rheumatic fever

Phase 3a (13 decks)

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