PAEDIATRIC CARDIOVASCULAR DISORDERS

Question 1

CONGENITAL HEART DISEASE

Answer 1

Major cause of death in the first year of life
Many contributing factors:
- Genetics
- Environmental (maternal conditions, antepartal bleeding,
prematurity)

Categorized:
- Cyanosis causing
- Causes increased or decreased blood flow into
pulmonary circulation
- Cause obstruction of blood flow from the ventricles

LOOK AT TEXTBOOK FOR ALL PED DISORDERS FORR SUREE

Question 2

COARCTATION OF THE AORTA

Answer 2

• Abnormal narrowing of aorta just proximal to the
  insertion of the ductus arteriosis
  
  • Acyanotic
  • Causes obstruction of blood flow from ventricles to
    systemic circulation
  • Typically won’t see signs until 15 hours birth once ductus
    arteriosis closes

Severe symptoms:
- low CO
- poor tissue perfusion
- acidosis
- hypotension

May be asymptomatic leading to other issues
- cramping, dizziness, HAs, fainting, epistaxis, HTN

Question 3

TETRALOGY OF FALLOT

Answer 3

Presence of the 4 defects:
- Ventricular Septal Defect
- Pulmonary Stenosis (biggest determinant)
- Overriding aorta
- Right ventricular hypertrophy

Outcome is chronic, severe hypoxia, compensates by:
- Polycythemia
- Development of collateral bronchial vessels
- Enlargement of the nail beds (clubbing)
Cyanosis at birth
Episodes of cyanosis and hypoxia during first year of life

Complications:
- emboli
- stroke
- seizures
- brain abscess
- LOC
- sudden death

Can cause a right to left shunt (pulmonary resistance > systemic resistance).

Can cause left to right shunt (systemic resistance < pulmonary resistance).

Question 4

PATENT DUCTUS ARTERIOSIS

Answer 4

Ductus arteriosus is the artery connecting the aorta and pulmonary artery

Failure of the fetal ductus arteriosis to functionally close within the first 15 hours after birth

This allows for blood to flow from higher pressure aorta to the lower pressure pulmonary artery

Left to right shunt

Clinically
- Asymptomatic, or
- Pulmonary overcirculation – dyspnea, fatigue, poor
feeding
- Murmur
- Low diastolic pressure, widened pulse pressure,
bounding pulses

Question 5

ATRIAL SEPTAL DEFECT

Answer 5

An opening in the septal wall between the two atria

3 types:
- Ostium primum ASD – opening low in the atrial septum
(mitral valve abnormalities)
- Ostium secundum ASD – opening in the middle of the
atrial septum (most common)
- Sinus venosus ASD – opening high in atrial wall near the
junction of the superior vena cava (partial anomalous
pulmonary venous connection)

Can have left to right shunting of blood

Patent foramen ovale – when the foramen ovale does not close
- Normally, when lungs become functional, pulmonary
pressure decreases and left atrial pressure exceeds that
of the right, this forces the septum to functionally close
the foramen ovale

Asymptomatic, may have minor issues such as a small murmur and some SOB on exertion

Complications: stroke, pulmonary hypertension

Question 6

KAWASKI DISEASE

Answer 6

Acute, systemic vasculitis
- Small capillaries, arterioles, and venules become inflamed
- Heart becomes inflamed
- Coronary artery thickening
- Scarring, calcification and stenosis of vessels

Demographic: highest in asian children

May be due to an immunologic response to an infectious, toxic, or antigenic substance

Clinically:
- strawberry tongue
- erythema of the palms and soles
- rash
- lymphadenopathy
- fever
- conjunctivitis
- myocarditis
- thrombocytosis

Complication: cardiac sequelae, coronary aneurysm