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Year 5: Conditions > Paediatrics- Cardiology > Flashcards

Paediatrics- Cardiology Flashcards

1
Q

What class of condition is patent ductus arteriosus

A

Left to right shunt

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2
Q

What is patent ductus arteriosus

A

Foetal vascular communication between the aortic arch and the main pulmonary artery

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3
Q

When does the ductus arteriosus normally close

A

• Functional Closure:
◦ In term babies occurs within 12-24 hours of delivery

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4
Q

At what time is it classed as patent ductus arteriosus

A

• Failure to close within 72 hours= Patent ductus arteriosus

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5
Q

Risk factors for patent ductus arteriosus

A

RISK FACTORS:
• Rubella infection in 1st trimester
• Prematurity (ALL preterm babies will have PDA)
• Chromosomal abnormalities (e.g. Down’s syndrome)

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6
Q

What type of shunt is caused by patent ductus arteriosus

A

• Results in left to right shunt of blood from aorta back into lungs (high pressure to low pressure)

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7
Q

Presentation of patent ductus arteriosus

A

• Can be asymptomatic
• Murmur: Continuous ‘machine-like’ murmur (Gibson murmur) in upper left sternal edge
• Left subclavicular thrill
• Wide pulse pressure
• Large volume bounding pulse
• Apnoeic
• Bradycardia
• High O2 requirement
• Heart failure signs: due to increased circulatory load can lead to pulmonary hypertension and then heart failure

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8
Q

Investigations for patent ductus arteriosus

A

• Doppler Echocardiogram: Will display left-to-right shunting

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9
Q

Management of patent ductus arteriosus

A

1) Ductal closure:
• IV indomethacin (NSAID): BUT, can reduce cerebral blood flow and flow to the kidneys
• Ibuprofen: has less effect on kidney
• Paracetamol: ^

2) Surgical ligation or percutaneous catheter device closure:
◦ Coil/device closure through cardiac catheter at 1 year old

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10
Q

Complications of patent ductus arteriosus

A

• Bacterial endocarditis
• Pulmonary vascular disease
• Respiratory Distress Syndrome
• Necrotising enterocolitis
• Congestive heart failure

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11
Q

What class of condition is atrial septal defect

A

Left to right shunt

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12
Q

What is atrial septal defect

A

Congenital heart defect characterised by an opening in the interarterial septum, causing a left-to-right shunt

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13
Q

What are two types of atrial septal defect

A

Secondum ASD

Primium/partial ASD

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14
Q

What is secuondum ASD

A

• Most common ASD
• Defect in atrial septum
• Foramen ovale does not close

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15
Q

What is Primium/partial ASD

A

‣ Associated with defect in atrioventricular septum

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16
Q

Presentation of atrial septal defect

A

• Asymptomatic: Commonly
• Recurrent chest infections/wheeze
• Ejection Systolic Murmur:
• Left upper sternal border (due to increased flow across pulmonary valve)
• Radiates to back
• Fixed wide splitting S2 heart sound: difficult to hear

• Arrhythmias: when 40+ years old

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17
Q

Investigations for atrial septal defect

A

• Chest X-Ray:
• Cardiomegaly
• Enlarged pulmonary arteries
• Increased pulmonary vascular markings
• ECG:
◦ Secundum: Partial RBBB is common

• Echo:
‣ Demonstrates left to right shunting

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18
Q

When is treatment for atrial septal defect indicated

A

• Treatment indicated if ASD large enough to cause right ventricular dilatation OR if pulmonary:systemic blood flow is >1.5

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19
Q

What age is treatment for atrial septal defect done

A

• Treatment undertaken at 3-5 years old
• Defect may close over time

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20
Q

Management of the two types of atrial septal defect

A

Secundum:
• Cardiac catheterisation with occlusive device

Primium:
• Open heart repair

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21
Q

What type of condition is ventricular septal defect

A

Left to right shunt

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22
Q

How is ventricular septal defect classified

A

Classified by size:
◦ Small (<3mm): Smaller than aortic valve
◦ Large (>3mm): Larger than aortic valve

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23
Q

What is presentation of small ventricular septal defect

A

• Small:
‣ Asymptomatic
‣ LOUD pansystolic murmur:
◦ Left lower sternal edge
◦ Louder murmur= smaller defect
‣ Soft pulmonary 2nd sound (P2)
‣ Breathless
‣ Normal saturations
‣ Poor feeding
‣ Tiredness

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24
Q

What is presentation of large ventricular septal defect

A

• Large:
‣ Heart Failure:
‣ SOB
‣ Recurrent chest infections
‣ Hepatomegaly
‣ Tachycardia
‣ Pallor
‣ Failure to thrive/poor feeding after 1 week old
‣ SOFT pansystolic murmur:
◦ Left lower sternal edge
◦ Soft sound indicates larger defect
‣ Apical mid-diastolic murmur (due to increased flow across mitral valve)
‣ Loud pulmonary 2nd sound (due to pulmonary hypertension)

25
Invetsigations for ventricular septal defect
• VSD can be detected in utero during routine 2 week scan • Chest X-Ray: Heart failure ABCDE • ECG: Hypertrophy- tall R waves • Echo: Left-to-right shunting
26
Management of small ventricular septal defect
• Small: ◦ Close spontaneously ◦ Would then no longer be at risk of infective endocarditis (can give prophylactic amoxicillin for high risk groups)
27
Management of large ventricular septal defect
• Large: ‣ Heart Failure treatment: • CDC ◦ C: Calories: additional calorie input needed ◦ D: Diuretics: e.g. furosemide ◦ C: Catopril ‣ Open surgery: ‣ Surgery at 3-6 months ‣ Prevents permanent lung damage from pulmonary hypertension (prevents Eisenmenger syndrome)
28
Complications of ventricular septal defect
• Bacterial endocarditis: Small VSD at risk • Eisenmenger syndrome: Permanent lung damage from pulmonary hypertension in large VSD causing a right-to-left shunt forming (cyanotic)
29
What test determines presence of heart disease causing cyanosis in baby
Hyperoxia test (Nitrogen Washout)
30
How does hyperoxia test (nitrogen washout) work
• Infant placed in 100% oxygen (headbox or ventilator) for 10min ◦ Take blood gas ◦ If O2 <15kPa then cyanotic cardiac cause ◦ If >20kPa then respiratory cause
31
What type of condition is Tetrology of fallot
Cyanotic- right to left shunt
32
What makes up Tetrology of fallot
Most common cyanotic heart disease characterised 4 major features: ◦ Large Ventricular Septal Defect ◦ Overriding aorta at VSD (blood flows from both ventricles into the aorta) ◦ Pulmonary stenosis: Causes right ventricular outflow obstruction ◦ Right Ventricular Hypertrophy
33
Presentation of Tetrology of fallot
• Presentation within first 2 months of life • Cyanosis • Hypercyanotic spells (Tet spells): ◦ Rapid increase in cyanosis ◦ Irritability ◦ Can be triggered by inconsolable crying or feeding ◦ SOB ◦ Pallor ◦ Older children would squat to recover ◦ Not usually seen initially (later stage if unrepaired) • Loud harsh ejection systolic murmur: ◦ Left lower sternal edge ◦ Due to pulmonary stenosis ◦ From day 1 of life • Clubbing: In older children
34
Invetsigations for Tetrology of fallot
• Can be diagnosed antenatally • Chest X-Ray: • Small heart • Boot-shaped: Uptilted apex due to right ventricular hypertrophy (usually in older child) • Maybe right sided aortic arch • Decreased pulmonary vascular markings due to reduced pulmonary flow • ECG: Normal at birth, right ventricular hypertrophy when older • Echo: ‣ Location of ventricular septal defect ‣ Severity of right ventricular outflow obstruction ‣ Right-to-left shunt
35
General management of Tetrology of fallot
• Medical first, then surgical management at 6 months of life 1) Prostaglandin E1 infusion: • Give to neonates to maintain patent ductus arteriosus (allowing blood flow from aorta to pulmonary arteries) 2) Surgical correction after 6 months of life
36
Management of severe/prolonged cyanosis in Tetrology of fallot
1) Blalock-Taussig shunt: Tube between subclavian and pulmonary artery • Sedation with morphine • IV propranolol • IV fluids • Bicarbonate to correct acidosis
37
What type of condition is transposition of great arteries
Cyanotic- right to left shunt
38
What is transposition of great arteries
Aorta connected to right ventricle and pulmonary artery connected to left ventricle (arteries have switched).
39
Pathophysiology of transposition of great arteries
• Oxygenated blood goes to lungs • Deoxygenated blood goes to systemic circulation • Therefore, usually fatal immediately ◦ BUT, condition is often found alongside VSDs, ASDs, PDAs etc which aid mixing of blood in short term
40
Presentation of transposition of great arteries
• Cyanosis: • Predominant symptom • Usually by day 2 of life due to ductal closure reducing mixing of oxygenated and deoxygenated blood. • Cyanosis less severe if there is more mixing from other septal defects (e.g VSDs, ASDs) • Cyanosis always present • Loud S2 • No murmur • Tachypnoea: If severe cyanosis
41
Invetsigations for transposition of great arteries
• Chest X-Ray: • Narrow upper mediastinum with an ‘egg on side’ appearance of the cardiac shadow • Increased pulmonary vascular markings due to increased pulmonary flow • ECG: normal • Echo: ◦ Demonstrates abnormal arterial connections ◦ Right-to-left shunt
42
Management of transposition of great arteries
1) Immediate Prostaglandin infusion: ◦ Maintain PDA patency to enable mixing of blood and reduce cyanosis • Correct acidosis • Some may need Balloon Atrial Septoplasty: ◦ Balloon used to tear atrial septum to enable mixing of blood 2) SURGERY: ‣ Arterial switch procedure: ◦ Performed in first few days of life ◦ Arteries switched over
43
What type of condition is Eisenmenger syndrome
Cyanotic- right to left shunt
44
What is Eisenmenger syndrome
Reversal of the left-to-right shunt in a congenital heart defect due to persistent pulmonary hypertension: results in a Cyanotic Right-to-Left Shunt.
45
Pathophysiology of Eisenmenger syndrome
• High pulmonary flow from left-to-right shunt left untreated (e.g large VSD or chronic PDA) ◦ Leads to pulmonary artery thickening ‣ This decreases pulmonary vasculature resistance • Eventually shunt decreases and child becomes less symptomatic ◦ When child is teenager, shunt reverses and becomes blue+cyanotic ‣ Results in right sided heart failure when adult
46
Presentation of Eisenmenger syndrome
• Cyanosis: typically affecting lower extremities when teenager • Blue • Clubbing • Right ventricular failure: by 40-50 years old, can cause death
47
Management of Eisenmenger syndrome
• Heart transplantation
48
What is complete atrioventricular septal defect
Single large defect connecting all atria and ventricles (single 5 leaflet common valve). No directionality in mixing of blood
49
What condition commonly associated with complete atrioventricular septal defect
• Commonly found in Down’s Syndrome
50
Presentation of complete atrioventricular septal defect
• Cyanosis: ‣ At birth • Heart failure: • At 2-3 weeks of life • No murmur
51
Investigations for complete atrioventricular septal defect
• Antenatal ultrasound screening • Routine echo: Screening done in a newborn with Down’s syndrome
52
Management of complete atrioventricular septal defect
• Treat heart failure medically • Surgical repair at 3-6 months of age
53
What type of condition is coarctation of the aorta
Non-Cyanotic: outflow obstruction
54
Definition of coarctation of the aorta
Narrowing of descending aorta near ligamentum arteriosum
55
Pathophysiology of coarctation of aorta
• Most occur at origin of ductus arteriosus ◦ Most common presentation is at 48 hours when ductus arteriosus closes, causing aorta to constrict
56
What conditions is coarctation of the aorta associated with
• Turner’s syndrome • Bicuspid aortic valve • Berry aneurysms
57
Presentation of coarctation of the aorta
• Normal examination on 1st day of life • Acute circulatory collapse on DAY 2: Due to ductus arteriosus closing • Sick looking baby • Heart failure signs • Absent femoral pulses • Ejection systolic murmur • NO CYANOSIS: Due to no mixing of blood, just obstructed flow • ‘Rib notching’: Occurs due to large collateral intercostal arteries forming
58
Investigations for coarctation of the aorta
• Blood pressure: • Higher BP in upper limb compared to lower limb • Chest X-ray: ‣ Rib notching ‣ Heart failure signs • Echo
59
Management of coarctation of the aorta
• Prostaglandin E1 (Alprostadil): To maintain patency of ductus arteriosus in neonates • Surgical Repair OR Balloon Angioplasty ± stenting

Year 5: Conditions (17 decks)

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