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Phase 3a > Paeds -Cardio > Flashcards

Paeds -Cardio Flashcards

1
Q

What criteria is required to diagnose rheumatic fever?

A

Jones criteria: 2 major OR 1 major + 2 minor AND evidence of preceding strep A infection

Major:

  • pancarditis
  • polyarthritis
  • syndenham chorea
  • erythema marginatum
  • subcutaneous nodules (rare)

Minor:

  • polyarthralgia
  • FEVER
  • Hx of rheumatic fever
  • raised acute phase proteins
  • PROLONGED PR INTERVAL
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2
Q

What puts kids at risk of infective endocarditis

A

Congenital heart defects esp if prosthetic martial inserted

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3
Q

Clinical signs of infective endocarditis

A
  • FEVER
  • Anaemia
  • Peripheral stigmata esp SPLINTER HAEMORRHAGE (don’t rely on this being present)
  • Necrotic skin lesions
  • changing cardiac signs
  • Splenomegaly
  • neuro signs from cerebral infarcts
  • retinal infarcts
  • arthritis
  • microscopic haematuria
  • CLUBBING (Late)
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4
Q

Management of IE

A
  • Take many blood cultures before giving antibiotics
  • can do ECHO
  • Usually give high dose penicillins AND aminoglycoside (GENTEMICIN)
  • ESR RAISED in BLOODS

Give 6 WEEKS of IV ANTIBIOTICS

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5
Q

Main prophylaxis for IE

A

Good dental hygiene

( Also Antibiotic prophylaxis for any dental/surgical procedures in OTHER COUNTRIES, NOT IN THE UK)

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6
Q

Fetal circulation

A

Oxygen transfer from placenta via UMBILICAL VEIN
- gets shunted through foramen ovale (bypasses lungs)
- Blood from vena cava gets shunted across ductus arterious

Ie fetal aorta has both oxygenated + deoxygenated blood (~50% saturation)

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7
Q

post birth cardiac changes

A

Breathing -> Decreased resistance in lungs so comparitively increased pressure in left side once cord is clamped so cannot be shunted to left anymore -> foramen ovale closes functionally
- Ductus arteriosus closes typically over next few days

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8
Q

Which is most common congenital defect

A

VSD (3-4 per 1000)

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9
Q

VSD pathophys

A
  • L to R shunt, increased flow to lungs
  • Sx occur when PVR falls
    • non-cyanotic but breathless due to pulm oedema
  • 75% close spontaneously
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10
Q

VSD murmur

A
  • Thrill, galloping
  • Pansystolic murmur at LEFT LOWER STERNAL EDGE
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11
Q

Common VSD Sx in babies

A

tachypnoae,
poor feeding,
failure to thrive

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12
Q

ASD types

A

Ostium Secundum

Ostium Primum

Sinus Venosus ASD

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13
Q

ASD Sx in babies

A

Typically asymp as atria are low pressure anyway

  • Non-cyanotic but breathless as more fluid in lungs so can get pulm oedema later on
  • R atria enlargement over time - can lead to arrhythmias in early adulthood
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14
Q

ASD Tx

A

Typically none required but if large , surgically close after age of 5 to reduce risk of arrhythmias in early adulthood

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15
Q

AVSD Sx

A
  • Pulm HTN; oedema
  • Breathless
  • Tachypnoea
  • Poor feeding; failure to thrive

Also hepatomegaly

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16
Q

AVSD murmur

A

Galloping thrill

Occurs from valvular regurgitation

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17
Q

AVSD is commonly associated with

A

Down’s syndrome (trisomy 21)

18
Q

PDA pathophys in preterms

A

All have PDA due to raised prostaglandin EE in circulation

19
Q

PDA Sx

A

Bounding pulse
Tachypnoea - too much blood in lungs -> pulm HTN + oedema
Diff feeding; failure to thrive

20
Q

PDA murmur

A

Machine-like continuous murmur

21
Q

PDA Tx

A

If failing to thrive:

  • Increase calories, nasogastric if needed
  • Diuretics (to reduce oedema)
  • Prostaglanding synthetase inhib can sometimes close by itself (INDOMETHACIN or IBUPROFEN)
  • Surgical closure
22
Q

Congenital AS Px

A
  • Shock collapse in neonates

If severe:
- reduced exercise tolerance
- fatiuige
- poor feeding
- syncope/collapse

Signs:

  • REduced lower limb pulses
  • Ejection systolic murmer in aortic area, radiating to carotids + thrill if severe
23
Q

Congenital Pulm stenosis Sx

A

If severe: SOB, poor feeding, can be cyanotic

Ejectionsystolic murmuer in Left Upper sternal edge, radiating to back esp if pulm branches also stenosed

24
Q

Aortic coarctation Sx

A

Acute:
- newborn collapse/shock
- typically when Ductus Arteriosus closes

  • Floopy, grey
  • Poor feeding
  • Tachypnoae
  • Reduced femoral pulses, esp compared to brachial pulses (+ radio-radial delay)

Older kids get murmur over back once collaterals develop

25
Q

Aorctic coarcation Tx

A

Prostaglandin E to keep PDA open

SURGERY - stent/balloon valvuloplasty

26
Q

Transposition of great arteries Tx

A

Baby will die if not surgically fixed
- can survive until PDA + foramen ovale closes

EMERGANCY SEPTOSTOMY (opens hole) + PROSTIN for duct
-> Refer for surgery

27
Q

Most common cyanotic heart defect

A

Tetralogy of fallot (VSD, pulm stenosis, RVH, overriding aorta)

28
Q

Tetrallogy of fallot

A
29
Q

Tetralogy of fallot Tx

A

RVOT/ductal stent or primary surgical repair

30
Q

Tetrology of fallot complication + Tx

A

Cyanotic spell - caused by muscle spasm at infundibulum around pulm valve

Give propanolol

31
Q

TAPVD

A

Critical cardiac defect - VERY CYANOSED

right atria to lungs but then oxygenated blood goes back to right heart
- not compatible with life
- can survive until shunts close

Only Tx = SURGERY

32
Q

Defects associated with Down’s

A

AVSD, TOF, VSD

33
Q

Defects associated with Turners

A

Aortic problems:

  • coarctation (all girls with aortic arch coarctation are given genetic tests)
  • AS
  • Bicuspid
  • Dissection risk later in life
34
Q

Defects associated with Di George syndrome

A

INterrupted aortic arch
Truncus arteriosus
TOF
VSD
PDA

35
Q

Defects associated with Noonan’s syndrom

A

PS
LVH

36
Q

Normal observations in 8 week old baby

A
  • HR 90-160
  • RR 30-60
  • Sats > 94%
  • BP: Systolic 80-100; Diastolic 55-65
  • Temp: 36.5 - 37.4
37
Q

sepsis vs sinus arrhytmias

A
  • sepsis is constant
  • svt waries
38
Q
A
39
Q

Treatment for SVT

A

ADENOSINE of increasing doses through catheter in big central vein

40
Q

Syncope Cardiac Red Flags

A
  • During exertion
  • When supine
  • Immediately following papitations
  • Exertional chest pain prior to syncope
  • In swimming pool
  • Secondary to auditory stimuli (these 2 are linked to long QT which also tends to have FHx)
  • Without warning
  • Structural heart disease
  • FHx of sudden death under 40
41
Q

Main differentials for very high HR in infants

A
  • Sepsis
  • SVT (or other arrhythmias)
  • Rarely myocarditis
42
Q
A

Phase 3a (26 decks)

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