Paeds -Cardio Flashcards
What criteria is required to diagnose rheumatic fever?
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
What puts kids at risk of infective endocarditis
Congenital heart defects esp if prosthetic martial inserted
Clinical signs of infective endocarditis
- 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)
Management of IE
- 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
Main prophylaxis for IE
Good dental hygiene
( Also Antibiotic prophylaxis for any dental/surgical procedures in OTHER COUNTRIES, NOT IN THE UK)
Fetal circulation
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)
post birth cardiac changes
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
Which is most common congenital defect
VSD (3-4 per 1000)
VSD pathophys
- L to R shunt, increased flow to lungs
- Sx occur when PVR falls
- non-cyanotic but breathless due to pulm oedema
- 75% close spontaneously
VSD murmur
- Thrill, galloping
- Pansystolic murmur at LEFT LOWER STERNAL EDGE
Common VSD Sx in babies
tachypnoae,
poor feeding,
failure to thrive
ASD types
Ostium Secundum
Ostium Primum
Sinus Venosus ASD
ASD Sx in babies
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
ASD Tx
Typically none required but if large , surgically close after age of 5 to reduce risk of arrhythmias in early adulthood
AVSD Sx
- Pulm HTN; oedema
- Breathless
- Tachypnoea
- Poor feeding; failure to thrive
Also hepatomegaly
AVSD murmur
Galloping thrill
Occurs from valvular regurgitation
AVSD is commonly associated with
Down’s syndrome (trisomy 21)
PDA pathophys in preterms
All have PDA due to raised prostaglandin EE in circulation
PDA Sx
Bounding pulse
Tachypnoea - too much blood in lungs -> pulm HTN + oedema
Diff feeding; failure to thrive
PDA murmur
Machine-like continuous murmur
PDA Tx
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
Congenital AS Px
- 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
Congenital Pulm stenosis Sx
If severe: SOB, poor feeding, can be cyanotic
Ejectionsystolic murmuer in Left Upper sternal edge, radiating to back esp if pulm branches also stenosed
Aortic coarctation Sx
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
Aorctic coarcation Tx
Prostaglandin E to keep PDA open
SURGERY - stent/balloon valvuloplasty
Transposition of great arteries Tx
Baby will die if not surgically fixed
- can survive until PDA + foramen ovale closes
EMERGANCY SEPTOSTOMY (opens hole) + PROSTIN for duct
-> Refer for surgery
Most common cyanotic heart defect
Tetralogy of fallot (VSD, pulm stenosis, RVH, overriding aorta)
Tetrallogy of fallot
Tetralogy of fallot Tx
RVOT/ductal stent or primary surgical repair
Tetrology of fallot complication + Tx
Cyanotic spell - caused by muscle spasm at infundibulum around pulm valve
Give propanolol
TAPVD
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
Defects associated with Down’s
AVSD, TOF, VSD
Defects associated with Turners
Aortic problems:
- coarctation (all girls with aortic arch coarctation are given genetic tests)
- AS
- Bicuspid
- Dissection risk later in life
Defects associated with Di George syndrome
INterrupted aortic arch
Truncus arteriosus
TOF
VSD
PDA
Defects associated with Noonan’s syndrom
PS
LVH
Normal observations in 8 week old baby
- HR 90-160
- RR 30-60
- Sats > 94%
- BP: Systolic 80-100; Diastolic 55-65
- Temp: 36.5 - 37.4
sepsis vs sinus arrhytmias
- sepsis is constant
- svt waries
Treatment for SVT
ADENOSINE of increasing doses through catheter in big central vein
Syncope Cardiac Red Flags
- 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
Main differentials for very high HR in infants
- Sepsis
- SVT (or other arrhythmias)
- Rarely myocarditis
