BIGDAD - Birth/ pregnancy - Immunisations - Growth - Diet (input & output) - Allergies - Development

PROV 1. Pulmonary stenosis 2. RV hypertrophy 3. Overriding aorta (sits directly over VSD instead of LV = blood from both ventricles) 4. VSD

Paediatrics - General & Cardio Flashcards by Stephanie Harris

Paeds systems review

BIGDAD

Birth/ pregnancy
Immunisations
Growth
Diet (input & output)
Allergies
Development

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Adolescent systems review

HEADSS

Housing/ home/ environment
Education/ employment
Activities
Drugs
Sexuality
Suicide/depression

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Denver development screening questions

Smiling (6wks)
Turns to sound (6mnths)
Sitting (9mnths)
First words (18mnths)
Walking (18mnths)
Stairs (3yrs)
3 word sentences (3yrs)

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Closure of foramen ovale

Usu in first few breaths (due to LA pressure increase due to breathing)

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Closure of ductus arteriosus

Usu w/i first few hrs to days, often Day 2-3 (becomes ligamentum arteriosum)
- Prostaglandin – ‘PROPs’ open the ductus arteriosus (^pO2 lowers PGE2)
- Indomethacin (prostaglandin inhibitor) – ‘INvolutes’ the ductus arteriosus
DA connects pulmonary artery to descending aorta

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Cyanotic congenital HD causes

5T + H

Tetralogy of Fallot
Transposition of great arteries
Total anomalous pulmonary drainage
Truncus arteriosus
Tricuspid atresia
Hypoplastic left heart

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Cyanotic heart disease

<85% SaO2 - caused by not enough oxygenated blood reaching tissues/ too much deoxygenated blood reaching tissues
Usu R –> L shunt

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Acyanotic congenital HD causes

4 'non-Ts'
- ASD
- VSD
- AVSD (can have both acyanotic &amp; cyanotic features) 
- PDA 
(Usu L --> R shunt)

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Ductal dependent congenital HD

Circulation is dependent on a patent ductus arteriosus (PDA) to preserve systemic circulation (L) or pulmonary circulation e.g. TOF w pulmonary atresia or TGA
–> may rapidly decline on 2-3 Day due to closure of ductus arteriosus

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TOF features

PROV

Pulmonary stenosis
RV hypertrophy
Overriding aorta (sits directly over VSD instead of LV = blood from both ventricles)
VSD

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TOF risk factors

Downs syndrome ("fall DOWN a lot" due to tet spells)
DiGeorge syndrome - chromosome 22 deletion ("Sir George di Fallot")

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Onset of cyanosis wks/mnths after birth, difficulty feeding, failure to thrive, tet spells, harsh ejection systolic murmur over pulmonary area (identified w/i first 2mnths of life), clubbing

TOF

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TOF murmur

harsh EJS over left sternal edge (pulmonary area)

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Cyanotic child squats to avoid fainting

Tet spell in TOF (cyanotic for 15mins due to vasospasm, may lead to syncope, child often squats to increase venous return to heart, usu self-limiting but can lead to MI, stroke or death if untreated)

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Boot-shaped heart on CXR (coeur-en-sabot)

TOF (“booted out of the TOF”)

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Term baby presents w cyanosis & feeding difficulty at Day 2-3

TGA (usu ductal dependent according to Monash EMQs)

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Early cyanosis, single S2, usu no murmur (may be flow murmur)

TGA

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TGA features

switching of great vessels (aorta –> RV, pulmonary artery –> LV), only compatible w life if ASD, VSD or PDA

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“Egg on a string” CXR

TGA (RV hypertrophy) NB: CXR may be normal in early life

TGA management

Prostaglandin E1 (maintain PDA)
Balloon atrial septostomy (temporary - buys time until surgery)
Surgery - arterial switch operation (w/i 1st week of life)

Patent ductus arteriosus

failure of closure of ductus arteriosus by 1 month after expected due date (EDD)
L –> R shunt

PDA risk factors

prematurity, congenital rubella syndrome

premature child, bounding pulse, continuous murmur

PDA

Many children asymptomatic for a long time
If severe may lead to heart failure (FTT, tachypnoea, difficulty feeding)

Continuous machinery murmur under left clavicle

PDA (esp older children, may be more systolic in younger children)

PDA Management

1. Indomethacin (prostaglandin synthetase inhibitor) 2. NSAID 3. If fails --> Fluid restrict & diuretics + surgery (coil impaction)

Wide, fixed splitting of S2 + mid-systolic/ejection systolic murmur at L sternal edge

ASD (NB: larger ASD = louder murmur)

Atrial septal defect features

Usu asymptomatic, mid-systolic/ ejection systolic murmur at L sternal edge on routine exam

Baby with Down Syndrome has poor feeding with difficulty breathing and sweating. He has a systolic murmur

AVSD (NB: may have cyanotic component)

Apical pansystolic murmur

AVSD (murmur due to AV valve regurg)

Most common congenital HD

VSD (~30%)

A 3 or 4 month old patient presents with poor weight gain, poor feeding, tachypnoea, and a loud systolic murmur heard across the entire praecordium

VSD

Sx of HF in infant

Failure to thrive, tachypnoea, tachycardia, difficulty feeding, excessive sweating, fatigue, SOB, enlarged liver, frequent chest infections, irritability, gallop murmur

Harsh apical pansystolic murmur + parasternal heave

VSD (NB: VSD murmur may spontaneously disappear) | --> louder murmur = smaller VSD (more turbulence)

Sx HF + pansystolic murmur

VSD

Patent foramen ovale

Failure of the foramen ovale to close after birth (normally closes w first breath), mostly asymptomatic

PFO risks

ischaemic stroke secondary to paradoxical embolism

Sudden change from acyanotic HD (ie ASD, VSD, PDA) to cyanotic HD

Eisenmenger's syndrome (due to pulmonary HTN leading to reversal of L to R shunt, very poor prognosis, requires heart/lung transplant)

Prevention of Eisenmenger's syndrome

Fix hole (VSD, ASD, PDA) before pulmonary HTN develops

Benign, musical/humming systolic murmur at left sternal border

Still's murmur

Coartication of aorta

a congenital condition where the aorta narrows in the area where the ductus arteriosus inserts (--> severe obstruction to LV outflow), duct dependent

Coartication of aorta RFs

Turner's syndrome

Asymptomatic at birth, cyanosis & shock at Day 2-3, absent femoral pulses, radio-femoral delay, higher BP in arms>legs, EJS murmur radiating to back (posterior left scapulae), severe HF

Coartication of aorta

Rib notching on CXR

Coartication of aorta

Congenital pulmonary stenosis RFs

Noonan syndrome

Alagille syndrome associations

TOF, pulmonary stenosis

Classic congenital HD associations

Down syndrome: AVSD (most common), Tetralogy of Fallot, VSD Turner’s syndrome: Coarctation of aorta (pretty classic), Aortic stenosis (but coarctation more common) Noonan syndrome: Pulmonary stenosis Alagille syndrome: Pulmonary stenosis, TOF Congenital rubella syndrome: PDA