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Finals > Paeds: Cardio > Flashcards

Paeds: Cardio Flashcards

1
Q

fetal shunts

what are the 3 fetal shunts

A
  1. ductus arteriosus
  2. foramen ovale
  3. ductus venosus
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2
Q

fetal shunts

what does the ductus venosus connect

A

the umbilical vein to the IVC

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3
Q

fetal shunts

what does the foramen ovale connect

A

the RA with the LA

allows blood to bypass the RV and pulmonary circulation

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4
Q

fetal shunts

what does the ductus arteriosus connect

A

the pulmonary artery with the aorta and allows blood to bypass the pulmonary circulation

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5
Q

fetal shunts

how does the foramen ovale close

A

baby’s 1st breath –> pulmonary vascular resistance decreases –> RA pressure decreases –> LA pressure is greater than RA –> squashes atrial septum

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6
Q

fetal shunts

what does the foramen ovale become

A

the fossa ovalis

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7
Q

fetal shunts

how does the ductus arteriosus close

A

increased blood oxygenation –> drop in circulating prostaglandins –> closure

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8
Q

fetal shunts

what does the ductus arteriosus become

A

the ligamentum arteriosum

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9
Q

fetal shunts

how does the ductus venosus close

A

umbilical cord is clamped and there is no flow in the umbilical veins

so structurally closes a few days later

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10
Q

fetal shunts

what does the ductus venosus become

A

ligamentum venosum

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11
Q

Murmurs

what are innocent murmurs aka

A

flow murmurs

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12
Q

Murmurs

what are the typical features of innocent murmurs

A
  • soft
  • short
  • systolic
  • symptomless
  • situation dependent
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13
Q

Murmurs

what features would prompt further investigations and referral to a paediatric cardiologist

A
  • Murmur louder than 2/6
  • Diastolic murmurs
  • Louder on standing
  • Other symptoms: failure to thrive, feeding difficulty, cyanosis or SOB
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14
Q

Murmurs

what are the differentials of a pan-systolic murmur

A
  1. mitral regurg
  2. tricuspid regurg
  3. ventricular septal defect
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15
Q

Murmurs

describe a mitral regurg murmur

A

pan-systolic

heard at the 5th ICS, mid-clavicular line

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16
Q

Murmurs

describe a tricuspid regurg murmur

A

pan-systolic

heard loudest at the 5th ICS, L sternal border

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17
Q

Murmurs

describe a ventricular septal defect murmur

A

pan-systolic

heard loudest at the L lower sternal border

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18
Q

Murmurs

differentials of an ejection-systolic murmur

A
  • aortic stenosis
  • pulmonary stenosis
  • hypertrophic obstructive cardiomyopathy
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19
Q

Murmurs

describe an aortic stenosis murmur

A

ejection systolic

heart at 2nd ICS, R sternal border

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20
Q

Murmurs

describe a pulmonary stenosis murmur

A

ejection-systolic murmur

heard at the 2nd ICS, L sternal border

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21
Q

Murmurs

describe a hypertrophic obstructive cardiomyopathy murmur

A

ejection-systolic murmur

heard at the 4th ICS on the L sternal border

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22
Q

Murmurs

what causes the 2nd heart sound to be ‘split’

A

inspiration: chest wall
+ diaphragm pull the lungs and heart open.
This is called negative intra-thoracic pressure.

R heart fills faster as it pulls in blood from the venous system.

The increased volume in RV causes it to take longer for the RV to empty during systole, causing a delay in the pulmonary valve closing.

When the pulmonary valve closes slightly later than the aortic valve, this causes the 2nd heart sound to be ‘split’

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23
Q

Cyanotic Heart Disease

what kind of shunt is it

A

right to left shunt

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24
Q

Cyanotic Heart Disease

what heart defects can cause it

A
  • VSD
  • ASD
  • PDA
  • transposition of the great arteries
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25
Q

Cyanotic Heart Disease

what is Eisenmenger syndrome

A

left to right shunt becomes a right to left shunt , causing cyanosis

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26
Q

Patent Ductus Arteriosus

reason for it not to close

A
  • may be genetic
  • or rubella
  • prematurity is a key RF
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27
Q

Patent Ductus Arteriosus

why is there RV hypertrophy

A

pressure aorta > pulmonary vessels, so blood flows from aorta to pulmonary artery.

This creates a L to R shunt

This increases the pressure in the pulmonary vessels causing pulmonary hypertension

leading to R sided heart strain as the RV struggles to contract against the increased resistance.

Pulmonary hypertension and right sided heart strain lead to RV hypertrophy

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28
Q

Patent Ductus Arteriosus

why is there LV hypertrophy

A

increased blood flowing through the pulmonary vessels and returning to the L side of the heart

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29
Q

Patent Ductus Arteriosus

murmur

A

normal first heart sound

with a continuous crescendo-decrescendo “machinery” murmur

that may continue during the second heart sound

making the second heart sound difficult to hear.

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30
Q

Patent Ductus Arteriosus

presentation

A
  • SOB
  • difficulty feeding
  • poor weight gain
  • LRTI
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31
Q

Patent Ductus Arteriosus

diagnostic inx

A

echocardiogram

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32
Q

Patent Ductus Arteriosus

monitoring

A

Patients are typically monitored until 1 year of age using echocardiograms.

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33
Q

Patent Ductus Arteriosus

After 1 year of age it is highly unlikely that the PDA will close spontaneously so what is the mnx

A

trans-catheter or surgical closure can be performed

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34
Q

Atrial Septal Defect

how can it cause Eisenmenger syndrome

A

eventually, the pulmonary pressure > systemic pressure

the shunt reverses and forms a R to L shunt across the ASD

blood bypasses the lungs and the patient becomes cyanotic.

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35
Q

Atrial Septal Defect

types of ASDs from most to least common

A
  1. Ostium secondum
  2. Patent foramen ovale (not strictly classified as an ASD)
  3. Ostium primum
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36
Q

Atrial Septal Defect

what is Ostium secondum

A

where the septum secondum fails to fully close, leaving a hole in the wall

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37
Q

Atrial Septal Defect

what is Ostium primum

A

the septum primum fails to fully close, leaving a hole in the wall.

This tends to lead to atrioventricular valve defects making it an atrioventricular septal defect.

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38
Q

Atrial Septal Defect

why are ASDs a cause of stroke in pts with a DVT

A

the clot is able to travel from the RA to the LA

to LV to aorta and up the brain, causing a large stroke

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39
Q

Atrial Septal Defect

describe the murmur

A

mid-systolic

crescendo-decrescendo murmur

loudest at the upper L sternal border

w/ a fixed split 2nd heart sound

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40
Q

Atrial Septal Defect

what is a fixed split 2nd heart sound

A

closure of the aortic and pulmonary valves at slightly different times

but the split does not change with inspiration or expiration

increased volume of blood in RV which mean pulmonary valve closes later

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41
Q

Atrial Septal Defect

typical sx in childhood

A
  • SOB
  • Difficulty feeding
  • Poor weight gain
  • LRTI
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42
Q

Atrial Septal Defect

mnx

A
  • refer to paed cardiologist
  • transvenous catheter closure (via the femoral vein)
  • or open heart surgery
  • Anticoagulants (aspirin, warfarin + NOACS) to reduce risk of clots
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43
Q

Ventricular Septal Defects

which conditions are they commonly associated with

A

Down’s and Turner’s Syndrome

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44
Q

Ventricular Septal Defects

what kind of shunt is it

A

begins with L –> R (acyanotic) but can lead to R –>L when there is pulmonary hyptertension (Eisenmenger)

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45
Q

Ventricular Septal Defects

presentaion

A

initially symptomless

  • poor feeding
  • dyspnoea
  • tachypnoea
  • failure to thrive
46
Q

Ventricular Septal Defects

describe the murmur

A

pan-systolic

heard at the L lower sternal border

in the 3rd and 4th ICS

may be a systolic thrill on palpation

‘holo-systolic murmur’

47
Q

Ventricular Septal Defects

trx

A
  • watchful waiting if small as they often close spontaneously
  • transvenous catheter closure via femoral vein
  • open heart surgery
48
Q

Ventricular Septal Defects

what is there an increased risk of developing

A

infective endocarditis

abx prophylaxis should be considered during surgical procedures

49
Q

what is Ebstein’s anomaly

A

mother taking lithium so child has large right atrium and small right ventricle, usually due to low insertion of the tricuspid valve, which also causes tricuspid incompetence

pan-systolic murmur

50
Q

Coarctation of the Aorta

what is it

A

congenital condition where there is narrowing of the aortic arch, usually around the ductus arteriosus

51
Q

Coarctation of the Aorta

what underlying genetic condition is it associated with

A

Turner’s syndrome

52
Q

Coarctation of the Aorta

presentation

A
  • weak femoral pulses
  • tachypnoea
  • poor feeding
  • grey + floppy baby
53
Q

Coarctation of the Aorta

what would a 4 limb BP reveal

A
  • high BP in limbs supplied from arteries that come before the narrowing
  • lower BP in limbs that come after the narrowing
54
Q

Coarctation of the Aorta

what may the murmur be like

A
  • systolic

- heard below the L clavicle (L infraclavicular area) and below the L scapula

55
Q

Coarctation of the Aorta

what additional signs may develop over time

A
  • L ventricular heave due to LV hypertrophy
  • underdeveloped L arm (reduced flow to L subclavian artery
  • underdevelopment of the legs
56
Q

Coarctation of the Aorta

mnx in cases of critical coarctation where there is a risk of HF and death shortly after birth

A

Prostaglandin E is used keep the ductus arteriosus open while waiting for surgery to allow some blood flow into the systemic circulation distal to the coarctation

57
Q

Ebstein’s Anomaly

what is it

A

a congenital heart condition where the tricuspid valve is set lower in the right side of the heart (towards the apex), causing a bigger right atrium and a smaller right ventricle.

58
Q

Ebstein’s Anomaly

what is it associated with

A
  • ASD

- WPW syndrome

59
Q

Ebstein’s Anomaly

presentation

A
  • HF (oedema)
  • cyanosis
  • SOB + tachypnoea
  • poor feeding
  • collapse or cardiac arrest
60
Q

Ebstein’s Anomaly

what is heard on auscultation

A

gallop rhythm

3rd and 4th heart sound

61
Q

Ebstein’s Anomaly

diagnosis

A

echocardiogram

62
Q

Ebstein’s Anomaly

definitive mnx

A

surgical correction of the underlying defect.

63
Q

Ebstein’s Anomaly

medical mnx

A
  • treating arrhythmias and heart failure

- Prophylactic antibiotics may be used to prevent infective endocarditis

64
Q

what is the most common congenital heart defect if mother is diabetic

A

Transposition of the great vessels

65
Q

Transposition of the Great Arteries

what is it

A

the attachments of the aorta and the pulmonary trunk to the heart are swapped (“transposed”).

the right ventricle pumps blood into the aorta and the left ventricle pumps blood into the pulmonary vessels

66
Q

Transposition of the Great Arteries

why will the baby be immediately cyanosed

A

2 separate circulations that don’t mix: one travelling through the systemic system and right side of the heart

and the other traveling through the pulmonary system and left side of the heart

67
Q

Transposition of the Great Arteries

why is it associated with ASD, VSD and PDA

A

Immediate survival depends on a shunt between the systemic circulation and pulmonary circulation

68
Q

Transposition of the Great Arteries

how is it diagnosed

A

during pregnancy with antenatal USS

69
Q

Transposition of the Great Arteries

presentation at birth if not detected during pregnancy

A
  • cyanosis within few days of birth

- resp distress, tachycardia, poor feeding, poor weight gain and sweating

70
Q

Transposition of the Great Arteries

definitive mnx

A

open heart surgery:
cardiopulmonary bypass machine is used to perform an “arterial switch” procedure within a few days of birth.

If present, a VSD or ASD can be corrected at the same time.

71
Q

Transposition of the Great Arteries

what is a balloon septostomy

A

inserting a catheter into the foramen ovale via the umbilicus, and inflating a balloon to create a large ASD

72
Q

Transposition of the Great Arteries

why may a prostaglandin infusion be useful before defintive mnx

A

to maintain the patency of the PDA

73
Q

Tetralogy of Fallot

the 4 coexisting pathologies

A
  1. overriding aorta
  2. pulmonary valve stenosis
  3. RV hypertrophy
  4. VSD
74
Q

Tetralogy of Fallot

what does overriding aorta mean

A

the aortic valve is placed further to the right than normal, above the VSD.

RV contracts and blood can travel through VSD up into aorta carrying deoxygenated blood

75
Q

Tetralogy of Fallot

what encourages blood to be shunted from right to left

A

pulmonary stenosis and overriding aorta

76
Q

Tetralogy of Fallot

RFs

A
  • rubella
  • increased age of mother
  • alcohol consumption in pregnancy
  • diabetic mother
77
Q

Tetralogy of Fallot

diagnostic inx

A

echo

78
Q

Tetralogy of Fallot

what inx is useful in assessing the severity of the abnormality and shunt

A

doppler flow studies

79
Q

Tetralogy of Fallot

what may a chest x-ray show

A

‘boot shaped’ heart due to RV thickening

80
Q

Tetralogy of Fallot

what murmur may be heard

A

ejection systolic (pulmonary stenosis)

81
Q

Tetralogy of Fallot

severe case presentation

A

HF before 1y

82
Q

Tetralogy of Fallot

signs and sx

A
  • cyanosis
  • clubbing
  • poor feeding
  • poor weight gain
  • ejection systolic murmur heard loudest in the pulmonary area
  • ‘tet spells’
83
Q

Tetralogy of Fallot

what are tet spells

A

intermittent symptomatic periods where the R->L shunt becomes temporarily worsened, precipitating a cyanotic episode

84
Q

Tetralogy of Fallot

when does a tet spell occur

A

when the pulmonary vascular resistance increases or the systemic resistance decreases

e.g. child physically exerting

85
Q

Tetralogy of Fallot

why may a tet spell occur after a child physically exerts themselves

A

CO2 is a vasodilator that causes systemic vasodilation and therefore reduces the systemic vascular resistance

Blood flow will choose the path of least resistance, so blood will be pumped from the RV to the aorta rather than the pulmonary vessels, bypassing the lungs.

86
Q

Tetralogy of Fallot

what may older children do when a tet spell occurs

A

squat

it increases the systemic vascular resistance which encourages blood to enter the pulmonary vessels

87
Q

Tetralogy of Fallot

what may younger children do when a tet spell occurs

A

positioned with their knees to their chest

88
Q

Tetralogy of Fallot

tet spell mnx

A
  • O2
  • BB
  • IV fluids
  • morphine
  • sodium bicarb
  • phenylephrine
89
Q

Tetralogy of Fallot

how may morphine help in a tet spell

A

can decrease resp drive, resulting in more effective breathing

90
Q

Tetralogy of Fallot

how may sodium bicarb help in a tet spell

A

can buffer any metabolic acidosis that occurs.

91
Q

Tetralogy of Fallot

how may Phenylephrine infusion help in a tet spell

A

increase systemic vascular resistance

92
Q

Tetralogy of Fallot

definitive trx

A

total surgery repair by open heart surgery

93
Q

Tetralogy of Fallot

what is used to maintain the ductus arteriosus in nenoates to allow blood to flow from the aorta back to the pulmonary arteries

A

prostaglandin infusion

94
Q

Paediatric Aortic Stenosis

how many leaflets is the aortic valve made up of

A

3, called the aortic sinuses of Valsalva

95
Q

Paediatric Aortic Stenosis

presentation

A
  • can be asymptomatic
  • fatigue
  • SOB
  • dizziness
  • fainting
  • worse on exertion
96
Q

Paediatric Aortic Stenosis

describe the murmur

A
  • ejection systolic
  • heard loudest at the aortic area (R sternal border 2nd ICS)
  • crescendo-decrescendo
  • radiates to the carotids
97
Q

Paediatric Aortic Stenosis

other signs on examination

A
  • ejection click just before the murmur
  • palpable thrill during systole
  • slow rising pulse and narrow pulse pressure
98
Q

Paediatric Aortic Stenosis

gold standard inx

A

echo

99
Q

Paediatric Aortic Stenosis

how to monitor it

A
  • echos
  • ECG
  • exercise testing
100
Q

Paediatric Aortic Stenosis

options for trx

A
  • percutaneous balloon aortic valvoplasty
  • surgical aortic valvotomy
  • valve replacement
101
Q

Paediatric Aortic Stenosis

complications

A
  • LV outflow tract obstruction
  • HF
  • ventricular arrhythmia
  • bacterial endocarditis
  • sudden death, often on exertion
102
Q

Congenital Pulmonary Valve Stenosis

how many leaflets does the pulmonary valve have

A

3

103
Q

Congenital Pulmonary Valve Stenosis

what causes it

A

abnormally developed pulmonary leaflets –> thickened + fused

resulting in a narrow opening

104
Q

Congenital Pulmonary Valve Stenosis

which conditions is it associated with

A
  • ToF
  • William syndrome
  • Noonan syndrome
  • Congenital rubella syndrome
105
Q

Congenital Pulmonary Valve Stenosis

sx

A

often asymptomatic

  • fatigue on exertion
  • SOB
  • dizziness
  • fainting
106
Q

Congenital Pulmonary Valve Stenosis

describe the murmur

A
  • ejection systolic murmur heard loudest at the 2nd ICS, left sternal border
107
Q

Congenital Pulmonary Valve Stenosis

is there a thrill

A

palpable thrill in the pulmonary area

108
Q

Congenital Pulmonary Valve Stenosis

why is there a R ventricular heave

A

due to RV hypertrophy

109
Q

Congenital Pulmonary Valve Stenosis

is there a raised JVP

A

yes with giant a waves

110
Q

Congenital Pulmonary Valve Stenosis

gold standard inx for establishing a dx

A

echo

111
Q

Congenital Pulmonary Valve Stenosis

mnx for mild asymptomatic pts

A
  • none

- follow up with cardiologist with a watch + wait approach

112
Q

Congenital Pulmonary Valve Stenosis

trx if symptomatic or valve significantly stenosed

A

balloon valvuloplasty via a venous catheter

last line: open heart surgery

Finals (47 decks)

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