Paeds Cardio Flashcards
What are the three types of paediatric cardiac conditions?
- Congenital anomaly
- Cardiomyopathy
- Acquired heart disease
What are the features of a congenital anomaly of cardiac in paeds?
Commonest congenital defect
Various severity
Tend to be structural
Present <1yrs if problematic
What are the key features of a cardiomyopathy as a heart problems in paeds?
Structure of heart is normal
Muscle is diseased
HOCM - teenager - sudden cardiac death
Dilated - any age - HF risk
Genetic element
What are the key features of acquired heart disease as a problem in paeds?
Typically caused by infection or inflammation
Such as Kawasaki or Rheumatic HD
Heart formed normally structure and muscle at birth then changed.
What are the three key shunts in foetal circulation?
What do they do?
Ductus arteriosum -> oxygenated blood from umbilical veins to IVC
Foramen ovale -> RA to LA bypass lungs
Truncus arteriosus -> PA to Aorta - bypass lungs
At what time does the ductus arteriosus close?
Slower closing - norm 48-72hrs but can take up to 2 weeks in term babies -> longer in premature -> at this point duct dependent lesions may become symptomatic
At what time does the foramen ovale close?
Within first few occurs
In the postnatal circulation, what is the direction of flow through a patent foramen ovale?
Left atrium to right atrium
Due to pressure gradient
What way is the shunt direction in non-cyanotic conditions?
Left to right
Hence blood leaving the left ventricle is still oxygenated (although lower volume)
What are the key features of non-cyanotic cardiac conditions?
Sats < 95%
Defect in structure of heart or great vessels -> abnormal blood flow
Blood contains enough oxygen but is pumped through the heart abnormally
But still receives amount of oxygen and blood to body
Typically left to right shunts
What are some examples of acyanotic heart conditions?
Aortic stenosis
Atrial septal defect
Atrioventricular septal defect
Bicuspid aortic valve
Coarctation of the aorta
Patent Ductus Arteriosus
Pulmonary stenosis
Ventricular septal defect
What is the direction of the shunt in a cyanotic heart condition?
Right to left
Hence blood does not go to the lungs so is not sufficiently oxygenated -> leads to less oxygen going to the systemic circulation
For example tetrology of fallot
What are the key features of the pathology of a cyanotic heart condition?
Complete mixing of deoxygenated and oxygenated blood prior to entering systemic circulation
AND/OR
Deoxygenated blood bypasses the lung to go to the systemic circulation
What is a truncus arteriosus?
One main outflow tract from heart - rather than aorta and pulmonary arteries both the left and right ventricle leave via the same shunt and go into either aorta or PA.
Single large arterial trunk with VSD.
What are the 5 Ts of cyanotic heart disease?
Truncus arteriosus
Transposition of the Great Arteries
Tricuspid atresia
Tetralogy of fallot
Total anomalous Pulmonary Venous Connection
What is meant by transposition of the great arteries?
Two switched vessels
The right ventricle -> aorta
The left ventricle -> pulmonary arteries
The ductus arteriosus will remain open as long as possible
ASD may also be present due to PFO
What are the defects in tricuspide atresia?
Missing tricupsid valve -> no connection between the right atrium and right ventricle
leads to formation of ASD and VSD
In some cases have a PDA
What are the four key anomalies in the tetralogy of fallot?
VSD
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
What are the features in total anomalous pulmonary venous return?
4 pulmonary veins drain abnormally to RA
ASD presents
Can be supracardiac or infracardiac for region of drainge.
What are two key examples of a duct dependent lesion in neonatal cardiology?
Aortic coarctation
Pulmonary atresia with VSD
What are the four key classification of types of cardiac conditions in the neonate?
When do we screen for congential heart disease?
Antenatal - 50% missed - ultrasound and foetal echoes around 20w
NIPE - murmur and femoral pulses
6w check - murmur, pulses, stigmata
How does a four-limb saturation work to screen for an aortic coarctation/cardiac abnormality?
<90% in right hand or foot = failed screen -> defect
If between 90-95% or 3% different between the right hand and foot repeat after 1hr for max of 2hrs -> then fail if lower or no change
If greater than 95% and <3% difference between right hand and foot then passed screen - no concerns
What in the family history can indicate an increased risk of congenital heart disease?
Sudden cardiac death
Congenital heart disease history
What intrauterine infection can increase the risk of congenital heart disease?
Rubella
What toxins/drugs can increase the risk of congenital cardiac abnormalities?
Alcohol
Smoking
Cocaine
Lithium
Anti-epileptics
ACEi
Statins
What genetic conditions can increase the risk of congenital cardiac conditions?
Down syndrome
Noonan syndrome
DiGeorge syndrome
Turner Syndrome
What is the gestational and perinatal history may indicate an increased risk of cardiac disease?
Maternal diabetes - TGA/VSD./PDA> cardiomyopathy
Maternal lupus erythematous - congenital heart block
Maternal congenital heart disease
Foetal alcohol syndrome - VSD, PDA, ASD< TOF
Warfarin - ASD, PDA
Lithium - Ebstein anomaly
Valproic acid/pheyton - VSD
Retinoic acid
Rubella - brain, eyes, heart
What are the key gestational and perinatal history factors that may increase the risk of a cardiac disease?
Maternal diabetes - TGA, VSD<PDA, cardiomyopathy
Lithium - Ebstein anomaly
Rubella - effects brain, eyes and heart
What on general inspection may indicate an underlying cardiac condition in a child?
Pallor
Cyanosis
Nutritional state
Sweatiness
Dysmorphic features
What in the preacordium may indicate a cardiovascular congenital abnormality?
Hyperactive
Thrill
Dextrocardia
How does the location of scars on the chest relate to the surgery happened?
Cardiovascular abnormalities
What are the causes of an abnormal S2 heart sound?
What is an S3 heart sound?
When can it be heard?
Physiological in children/adults <30yrs
Can indicate cardiomyopathy, aortic or mitral regurg
Caused by rapid ventricular filling in early diastole
Heard best with bell at apex - ventricular gallop
What is the cause of an S4 heart sounds?
Always abnormal
Indicate hypertrophic cardiomyopathy or
Systemic HTN
Occurs in late diastole - when atrial systole forces blood into non compliant ventricles
Atrial gallop
What is a gallop rhythm associated with?
A dilated cardiomyopathy
Where might different murmurs be auscultated on the chest wall?
What are the different grades of murmur?
Grade 1 - very faint, may only be heard by an expert, no thrill, not in all positions
Grade 2 - soft, all positions, no thrill
Grade 3 - moderately loud, no thrill
Grade 4 - loud and associated with a palpable thrill
Grade 5 - very loud, thrill, heard with stethoscope partly off the chest
Grade 6 - loudest, with thrill, heard with stethoscope entirely off the chest
When is a patent ductus arteriosus murmur heard?
Continuous - throughout the cycle
What is a atrial or ventricular septal defect murmur head in the cardiac cycle?
Systole
