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Paeds CARDIO Flashcards

1
Q

What is Acrocyanosis?

A

peripheral cyanosis around the mouth + extremities
Often seen in healthy newborns, occurs immediately after birth

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2
Q

What causes acrocyanosis?

A

benign vasomotor changes resulting in peripheral vasoconstriction + increased tissue O2 extraction

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3
Q

What are the 6 features of innocent cardiac murmurs?

A

Sensitive to changes in position + breathing
Short duration (not pansystolic)
Single (no associated clicks/ gallops)
Small (in limited area + doesn’t radiate)
Soft (low amplitude)
Systolic

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4
Q

What is a ‘breathless baby’ presentation indicative of?

A

L-R shunt
Acyanotic heart defect

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5
Q

Recall the 3 types of L-R shunt from most frequent to least frequent

A

VSD
ASD
PDA

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6
Q

Give 3 risk factors for VSD

A

Maternal diabetes
Downs, Edwards, Patau syndrome
IUI- TORCH

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7
Q

Give 2 risk factors for ASD

A

Down syndrome
Fetal alcohol syndrome

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8
Q

Give 3 risk factors for PDA

A

Fetal alcohol syndrome
Congenital RUBELLA
Down syndrome

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9
Q

What murmur is heard in VSD?

A

Harsh pansystolic at lower LSB
Louder in smaller defects

MDM over cardiac apex

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10
Q

When can VSD be detected?

A

20w scan

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11
Q

What are the signs and symptoms of VSD?

A

Small: Asymptomatic

Med-large:
Heart failure by 2-3 months
failure to thrive
recurrent bronchopulmonary infections
Exercise intolerance

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12
Q

How are VSDs classified?

A

By size:
small <3mm
large >3mm

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13
Q

How should small VSDs be managed?

A

Self-limiting: they close over time

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14
Q

What is the medical management for large VSDs?

A

Diuretics for HF
ACEi to reduce afterload e.g. Captopril
High-energy feeds

(CDC: Calories, diuretics, Captopril)

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15
Q

What is the surgical management for large VSDs?

A

Patch repair

At 3-6 months to prevent permanent lung damage from pulmonary HTN + high blood flow

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16
Q

List 5 complications of VSD

A

Aortic regurgitation
Infective endocarditis
Eisenmenger’s complex
RHF
Pulmonary HTN

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17
Q

What is Eisenmenger syndrome?

A

Where a long-standing L-R shunt causes pulmonary HTN + eventual reversal of the shunt into a cyanotic R-L shunt

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18
Q

How should Eisenmenger be managed?

A

Early intervention for pulmonary blood flow
Heart transplantation not easy but can be done

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19
Q

What murmur is heard in ASD?

A

Ejection systolic
ULSE: 2nd ICS LSB
Widely split S2 (fixed- no change with respiration)

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20
Q

What are the types of ASD and which is more common?

A

Secundum (more common): defect in atrial septum (failure of closure of foramen ovale)

Primum/ Partial (AVSD): defect of AV septum

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21
Q

What are 3 signs and symptoms of ASD?

A

Asymptomatic (small)
Exertional dyspnoea
Recurrent bronchopulmonary infections

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22
Q

How will the different types of ASD appear on ECG?

A

Secundum: RBBB + RAD
Partial: superior QRS axis

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23
Q

How quickly after birth does AVSD present?

A

Typically 4-8w
May be earlier

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24
Q

How should the different types of ASD be managed?

A

Secundum: transcatheter device closure at 3-5y
Partial: surgical correction at 3-5y

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25
What investigation is diagnostic of ASD or VSD?
Echo
26
Where is the ductus arteriosus?
Between the aorta + pulmonary artery
27
What connection allows underdeveloped lungs to be bypassed by the fetal circulation? What keeps this patent in utero?
Ductus Arteriosis (R-L shunt) Kept patent by PGE + low O2 tension
28
What happens to the ductus arteriosus after birth?
Pulmonary vascular resistance decreases + allows reversal of shunt from R-L to L-R
29
Give 5 features of PDA on examination
Continuous 'machinery' murmur Left subclavicular thrill Large volume, bounding, collapsing pulse Wide pulse pressure Heaving apex beat
30
What is the management of PDA in premature infants?
Indomethacin/ Ibuprofen infusion Inhibits prostaglandin synthesis, induces closure Surgical: Transcatheter closure or surgical ligation
31
If PDA associated with another CHD, what is the management?
Prostaglandin E1 infusion to keep the PDA open
32
When do cyanotic and acyanotic heart defects present generally?
Left-to-Right shunts = LateR cyanosis Right-to-Left shunts = eaRLy cyanosis
33
Give 3 features of heart failure
Hepatomegaly Tachypnoea Pallor (low CO, low BP)
34
What is a 'blue baby' presentation a red flag for?
R-L shunt Cyanotic heart defect
35
What are 5 causes of cyanotic congenital heart disease?
Tetralogy of Fallot (most common) Transposition of the great vessels Tricuspid valve atresia Total anomalous pulmonary venous return persistent Truncus arteriosis
36
What is the tetralogy of fallot?
VSD Overarching aorta Right outflow tract obstruction: pulmonary stenosis RV hypertrophy
37
When does Tetralogy of fallot present?
~1-2 months, May be later e.g. 6m
38
How does ToF present?
Tet spells: hypercyanotic hypoxic episodes (peak 2-4m) a/w stress: crying, feeding, defecation
39
When does the ductus arteriosus close?
Functional closure within 24-48h if born at term Complete by 2-3w
40
What would be heard on auscultation in tetralogy of fallot?
ESM at ULSE due to pulmonary stenosis
41
What investigations should be done in suspected tetralogy of fallot?
Echo: confirmatory CXR: Boot shaped heart
42
How is tetralogy of fallot managed?
Medical: PGE1 infusion until surgery to maintain PDA Surgical by 6m: VSD repair- patch closure
43
How are acute tet spells managed in ToF?
100% FiO2 via NRB Knee to chest position, squatting
44
What palliative procedure may be performed for severe ToF in the first week of life?
Blalock Thomas Taussig shunt
45
What determines the degree of cyanosis and clinical severity in ToF?
Severity of right outflow tract obstruction
46
What is the basic anatomical pathology in ToGA?
Aorta leaves the right ventricle Pulmonary trunk leaves the left ventricle
47
When does ToGA present?
When ductus arteriosus closes at 2-4 days old
48
Give 2 signs of ToGA
Tachypnoea Postnatal cyanosis- not affected by supplemental O2
49
What is heard upon auscultation in ToGA?
Single loud S2 Often NO MURMUR Diminished femoral pulses
50
What investigations are used for ToGA?
Echo: confirmatory CXR: Egg on a string
51
How can ToGA be managed?
PGE1 infusion to keep DA open Balloon atrial septostomy Urgent surgery (within 2w)
52
What surgical procedures may be used for ToGA?
Arterial switch procedure or Rastelli procedure
53
When do aortic problems (coarctation or stenosis) present?
First few weeks of life depending on presence of other abnormalities + patency of DA
54
What test is used to diagnose heart disease in a cyanosed neonate, and how is it done?
Nitrogen washout test Give 100% oxygen for 10 mins Measure right radial artery blood gas oxygen If it stays low (<15kPa) = positive for CHD
55
What are the differentials for cardiac outflow obstruction and how can you clinically differentiate between them
If child is otherwise well: P or A stenosis If child is also in CV collapse + shock: coarctation
56
Recall the medical and surgical management of PDA
Medical: Indomethacin (NSAID): to prompt duct closure Surgical: at 1 year
57
How can cyanosis be tested for?
Hyperoxia nitrogen washout test
58
How should cyanosis be immediately managed?
ABCs Prostaglandin infusion (to maintain PDA patency)
59
Recall the timeline of presentation of the different types of cyanotic heart disease after birth
<10 mins: Tricuspid atresia Few hours: ToGA Up to 3w: AVSD Any age (at a few days, often): ToF 10-15y: Eisenmenger
60
What is Ebstein's abnormality?
Malformation of tricuspid valve leading to severe tricuspid regurgitation
61
What maternal medication is associated with Ebstein's abnormality?
Lithium
62
What would be heard on auscultation in Ebstein's abnormality?
split 1st + 2nd heart sounds
63
What is Ebstein's abnormality also referred to?
atrialisation of the right ventricle.
64
How should Ebstein's be managed?
Prostaglandin infusion Tricuspid valve repair
65
What is tricuspid atresia?
Complete absence of tricuspid valve: No blood flow between RA + RV
66
Describe the presentation of tricuspid atresia
Cyanosis + SOB within first 10 mins of life
67
What is the murmur in tricuspid atresia?
ESM at LSE due to VSD
68
Recall the management of tricuspid atresia
IV PGE1 infusion Balloon atrial septostomy Stage 1: to maintain a secure supply of blood to the lungs Blalock-Taussig shunt insertion or pulmonary banding to reduce pulmonary blood flow Stage 2: Bidirectional Glenn procedure Stage 3: Fontan procedure
69
Why is ToGA not instantly fatal?
Usually found alongside ASDs/ VSDs/ PDAs which aid mixing
70
What is the most common association with AVSD?
Down's syndrome
71
How should AVSD be managed?
Treat heart failure medically + surgery at 3 months
72
What is the cause of congenital aortic/ pulmonary stenosis?
Aortic: fusion of valve leaflets (2 instead of 3) Pulmonary: fusion of valve leaflets
73
What are the most likely co-existent conditions with aortic/ pulmonary stenosis?
Coarctation of aorta
74
What are the signs and symptoms of aortic/ pulmonary stenosis?
NO CYANOSIS AS: ESM. Palpable thrill. Ejection click PS: ESM, split S2
75
How should a/p stenosis be managed?
Transcatheter balloon dilatation
76
When does coarctation of the aorta present?
3 days - a few weeks of life Depends on severity
77
Recall signs and symptoms of coarctation of the aorta depending on severity
Critical: shock + heart failure- dyspnoea, pale, irritable, poor femoral pulses, hepatomegaly Less severe: Asymptomatic, weak femoral pulses, High BP in arms, low BP in legs Ejection systolic murmur
78
How should coarctation be managed?
Critical: ABC, PGE1 infusion + inotropes. Once stabilised surgical repair Non-critical: surgical repair OR balloon angioplasty + stenting
79
Recall 4 signs and symptoms of hypoplastic left heart syndrome
Cyanosis Tachypnnoea NO murmur
80
How should hypoplastic left heart syndrome be managed?
1st = ABCs + PGE1 2nd = Blalock-Taussig (BK) shunt or Norwood Stage 1 3rd = BK shunt removal --> Glenn/ hemi-Fontan --> Fontan/ Total Cavo-Pulmonary Connection
81
What is a BK shunt?
Arterficial ductus arteriosus
82
What HR is expected in SVT?
250-300bpm
83
Recall the main symptom of SVT in neonates
Hydrops fetalis
84
What would be seen on an ECG in SVT?
Narrow complex tachycardia + T wave inversion due to ischaemia
85
How should SVT be managed?
1. Circulatory + respiratory support (correct any tissue acidosis) 2. Vagal stimulating manoevres - 80% success 3. IV adenosine 4. Electrical cardioversion with synchronised DC shock if adenosine fails
86
What is the common cause of rheumatic fever?
Group A beta-haemolytic streptococcal throat infection Acute rheumatic fever presents 2-4w after
87
What age child can get rheumatic fever?
5-17y
88
What is the long term risk of rheumatic fever?
Mitral stenosis
89
What are the 5 major Jones criterion for rheumatic fever?
CASES Carditis Arthritis (Polyarthritis) Subcutaneous nodules Erythema marginatum (map-like outlines) Sydenham's chorea
90
What are the 5 minor criteria for rheumatic fever?
FRAPP: Fever Raised ESR >30 / CRP >3 Arthralgia Prolonged PR Previous RF
91
What criteria are necessary to diagnose acute rheumatic fever?
2 Major or 1 Major + 2 minor With evidence of preceding streptococcal infection e.g. elevated ASOT or +ve throat culture
92
How should rheumatic fever be managed?
Bed rest IV Benzylpenicillin STAT PO Penicillin V for >,10d High dose aspirin (suppresses inflammatory responses in heart + joints) Corticosteroids (if not resolved rapidly/ signs of mod-severe carditis)
93
What should be done following resolution of rheumatic fever?
Prophylatic monthly IM benzylpenicillin until age 21 May need surgical valve repair
94
Recall the signs and symptoms of infective endocarditis in a child
Necrotic skin lesions: from infected emboli Splinter haemorrhages Changing cardiac signs Fever, aneamia, pallor Splenomegaly Arthritis/ arthralgia Clubbing
95
How is infective endocarditis diagnosed in children?
Multiple blood cultures (before ABx) + echocardiography to identify vegetations
96
What is the most common pathogen implicated in paediatric IE?
Streptococcus viridians
97
How should infective endocarditis be managed in children?
6 weeks IV Abx Strep viridians (native/prosthetic valve) = amoxicillin + gentamicin/vancomycin Staph aureus (native valve): Amoxicillin/ vancomycin/ daptomycin Staph aureus (prosthetic valve): nafcillin/ oxacillin
98
How is the liver affected by cardiac failure?
May see hepatomegaly
99
How is the respiratory system affected by cardiac failure?
Increased RR Recurrent chest infections
100
What basic investigations are necessary in cardiac failure?
O2 sats BP FBC U+Es calcium BNP/ANP
101
Recall systematically the management of paediatric cardiac failure
Decrease preload: diuretics (furosemide)/ GTN Enhance contractility: eg digoxin, dopamine, dobutamine Reduce afterload: ACE inhibitors Improve oxygen delivery: B-blockers (eg carvedilol)
102
How should cyanosis be managed?
Prostaglandin infusion

YR5 Specialties (27 decks)

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