Paediatric Cardiovascular and Resp - TOF, TGA, PDA, VSD, Coarctation, Ebstein's anomaly, Laryngomalacia Flashcards
Acyanotic congenital heart disease
-most common causes
VSD - MOST COMMON
ASD - present later
PDA
Coarctation
AV stenosis
Cyanotic congenital heart disease
-most common causes
Tetralogy of Fallot - more common, but presents at 1-2months
Transposition of the great arteries - presents at birth
Tricuspid atresia
Ebstein’s anomaly
Patent ductus arteriosis
-pathophysiology
-risk factors
-presentation
-management
Connection between pulmonary trunk and descending aorta
-normally closes with first breaths from increased pulmonary flow and prostaglandin clearance
Premature
Maternal rubella in 1st trimester
Left subclavicular thrill
Continuous machinery murmur
Large volume, collapsing pulse
Wide pulse pressure
Apex beat
Indomethacin or ibuprofen => close connection
Tetralogy of Fallot
-what is it
-risk factors
-presentation
-investigations
-management
Pulmonary stenosis
VSD
Overriding aorta - ventricular blood from left and right enters aorta
RVH
Downs, DiGeorge
Maternal rubella
Sudden hypercyanotic/Tet spells when crying or feeding
Improved by squatting
Murmur
Fussy, tire easily
Difficulty breathing
Palpitations
Fainting
Clubbing
SaO2, ECG, CXR
ECHO!
Surgical correction
Transposition of the great arteries
-what is it
-risk factors
-presentation
-investigations
-management
Pulmonary artery comes from LV
Aorta comes from RV
Cyanosis
High RR
Loud single S2
Prominent RV impulse
SaO2, ECG,
CXR - Egg on side
Echo
KEEP DUCTUS ARTERIOSIS OPEN TO ALLOW FOR OXYGENATED BLOOD TO ENTER BODY CIRCULATION
-prostaglandin E1 + ventilator
Surgical correction
VSD
-causes
-presentation
-management
-complications
Chromosonal
-Downs, Edwards, Patau
Congenital infection
Found in 20wk anomaly scan
-failure to thrive
-HF - hepatomegaly, high HR, RR, pale but not cyanotic
pansystolic murmur
If asymptomatic, can close spontaneously - monitor
Symptomatic => HF in months
-nutritional support
-HF meds
-surgical closure of defect
Aortic regurg
IE
RHF
PHTN - pregnancy contraindicated due to high mortality
Eisenmenger’s complex
Eisenmenger’s complex
-what is it
Prolonged pulmonary HTN from L => R shunt
RVH eventually exceeds LV pressure => cyanosis and clubbing
INDICATION FOR HEART LUNG TRANSPLANT
Coarctation of aorta
-risk factors
-presentation
Turners - bicuspid AV
Infancy - HF
Adult - HTN
Radiofemoral delay
Mid systolic murmur, MAXIMAL OVER BACK
Apical click from AV
Notching of inferior border of ribs - from enlarged intercostal arteries
Transient tachypnoea of the newborn
-what is it
-risk factor
-presentation
-investigations
-management
Most common cause of respiratory distress in the newborn
-delayed resorption of fluid in the lungs
Common in CSection as lung fluid isn’t squeezed out
CXR - hyperinflation of lungs, fluid in horizontal fissure
Observation, supportive care - settles in 2days
Supplementary O2
Ebstein’s anomaly
-what is it
-risk factors
-presentation
Low insertion of tricuspid valve => large atrium, small ventricle
-septal and posterior leaflet of tricuspid attached to walls and septum of RV
May be caused by lithium exposure
Associated with
-patent foramen ovale
-ASD
-WPW
Cyanosis
Prominent a wave in distended JVP
Hepatomegaly, tricuspid regurg
RBBB => widely split S1, S2
Congenital diaphragmatic hernia
-what is it
-presentation
GI herniates through diaphragm into thoracic cavity due to incomplete formation of the diaphragm
-limits space for lung development, can lead to pulmonary hypoplasia, pulmonary HTN
Can be detected on antenatal US
Postnatal presentation
-difficulty breathing
-concave abdomen
-reduced breath sounds
Pulmonary hypoplasia
-what is it
-causes
Undeveloped lungs in neonates
-oligohydramnios
-congenital diaphragmatic hernia
Meconium aspiration syndrome
-what is it
-risk factors
-presentation
Respiratory distress in newborn as result of meconium in trachea
Risk factors
-maternal HTN
-preeclampsia
-chorioamnionitis
-smoking
-substance use
-post term delivery
Respiratory distress
-cyanosed
-high RR
Laryngomalacia
-what is it
-presentation
-investigations
-management
Flaccid larynx which collapses when breathing
Stridor - intermittent
-when supine, feeding or agitated
Worsen in severity during 1st 8 months, resolve by 18-24th months
Rare - Resp distress, failure to thrive, cyanosis
SaO2, blood gases taken if desaturating
If severe or diagnostic uncertainty - laryngoscopy, bronchoscopy
Majority are self limiting
Symptomatic relief - hyperextension of neck when stridulous
If severe - surgery
-tracheostomy, laryngoplasty, exicision of redundant mucosa
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