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Paediatrics > Paeds Cardio > Flashcards

Paeds Cardio Flashcards

1
Q

What is the most common congenital heart defect?

A

Ventricular Septal Defect (VSD)

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2
Q

The majority of VSDs are caused by a defect in which part of the ventricular septum?

A

membranous top bit

as opposed to muscular bottom bit

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3
Q

Which way do most VSDs shunt?

A

left to right

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4
Q

Which are the three types of CHD which shunt left-to-right? (breathless)

A

VSD, ASD, PDA

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5
Q

Which are the two types of CHD which shunt right-to-left? (blue)

A

Tranposition of Great Arteries

Tetralogy of Fallot

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6
Q

What is main symptom of left-to-right shunts?

A

breathless

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7
Q

What is main symptom of right-to-left shunts?

A

blue

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8
Q

Auscultation of VSD?

A

pansystolic murmur @LLSE

radiating to axilla

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9
Q

What proportion of VSDs close spontaneously?

A

50%

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10
Q

In later childhood, some VSDs can start shunting right-to-left instead, causing deoxygenated blood from the right heart to flow around the body, causing cyanosis. What’s this called?

A

Eisenmenger’s

happens due to gradual increase in pulmonary vascular resistance

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11
Q

Name 4 risk factors for VSD.

A

foetal alcohol
Down’s
maternal diabetes
rubella

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12
Q

Why does VSD cause an increased risk of endocarditis?

A

turbulent flow

advise good oral hygeine!

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13
Q

What might ECG show in VSD?

A

LV hypertrophy (left-to-right shunt)

or biventricular

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14
Q

CXR can normal in small VSD. What would CXR show in large VSD?

A

cardiomegaly

pulm oedema

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15
Q

What is the medical management of VSD? (x3)

buy time and reduce symptoms

A

diuretics + ACE inhibitors + extra calories

furosemide, captopril

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16
Q

What drug is used when a child has congestive HF?

A

digoxin

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17
Q

What is the surgical management of VSD?

A

surgical or catheter repair

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18
Q

Why is it important to remain good dental hygeine if you’re a child with a VSD (repaired or not)?

A

risk of infective endocarditis

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19
Q

7 week old infant presents with poor weight gain, shortness of breath, and poor feeding. On auscultation, pansystolic murmur on lower left sternal edge, radiating to axilla. What investigations?

A

suspect VSD:

  • ECG
  • Echo
  • consider CXR

also septic screen (bloods)

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20
Q

What is the gold standard investigation for diagnosis of VSD?

A

Echo

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21
Q

The main causes of heart problems in neonates are to do with obstructed systemic circulation. For example (x2)

A

coarctation of the aorta

hypoplastic left heart syndrome

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22
Q

The main causes of heart problems in infants are to do with high pulmonary blood flow. For example (x3)

A

VSD, ASD, PDA

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23
Q

The main causes of heart problems in older children are to do with actual heart failure. :( For example (x3)

A

Eisenmengers
Cardiomyopathy
Rheumatic heart disease

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24
Q

We can split congenital heart defects into left-to-right (VSD, ASD, PDA) or right-to-left (ToF, TGA) shunts….
But in which defect is there “common mixing”?

A

AVSD

atrioventriuclar septal defect

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25
Q

2 causes of outflow obstruction in well child.

A

aortic stenosis

pulmonary stenosis

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26
Q

What is cause of outflow obstruction in collapsed neonate?

A

coarctation of the aorta

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27
Q

Most ASDs are as a result of which bit of atrial septum failing to close?

A

ostium secundum

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28
Q

Ausculation of ASD.

A

ejection systolic murmur @ULSE
radiating to back
+ fixed second heart sound

(extra flow thru pulm valve + pulm valve can’t close)

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29
Q

What is the risky complication of ASD?

A 
paradoxical embolism
(crosses from pulm to systemic circ via ASD)  --> stroke
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30
Q

Most ASDs are ASYMP. But some ASDs present late with breathlessness, big right heart and palpitations. True or false?

A

true

most ASDs are asymp tho

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31
Q

Apart from ASD, what else can cause hole in atrial septum?

A

patent foramen ovale

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32
Q

When is the foramen ovale usually meant to close?

A

when baby takes her first breath

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33
Q

Where is the foramen ovale and why is it a thing?

A

hole in atrial septum

allow oxygenated blood from placenta to go from right to left
bypassing the fetal lungs, which don’t work until first breath

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34
Q

Where is the ductus arteriosus?

A

pulm artery to aorta

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35
Q

Why is the ductus arteriosus a thing?

A

bypassing the foetal lungs

catches any right to left that the foramen ovale has missed

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36
Q

What is management of ASD?

A

surgical or catheter repair

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37
Q

Auscultation of PDA.

A

continuous machinery murmur @ULSE

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38
Q

Which babies does PDA usually affect?

A

preterms

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39
Q

A preterm baby has cyanosis only in the lower extremities. What do you suspect?

A

PDA

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40
Q

Why does PDA only cause cyanosis in lower extremities?

A

ductus arteriosus is downstream from subclavian arteries (which supply head and upper limbs)

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41
Q

Which hormone keeps ductus arteriosus patent? :(

A

prostaglandin E2

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42
Q

Which drug can do pharmacalogic closure of a PDA?

A

IV indomethacin

or ibuprofen

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43
Q

What is a AVSD (atrioventricular septal defect)?

A

the centre of the heart is missing :(

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44
Q

Which kids are affected by AVSD?

A

those with Down’s syndrome

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45
Q

In which congenital heart defect would they be breathless AND blue, with rapid symptoms?

A

AVSD

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46
Q

In general, what is the management for left-to-right shunts?

A

stabilise
increase calorie intake (NG feeds?)
diuretics + ACE inhibitors
…surgical or catheter repair

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47
Q

The aorta swaps places with the pulmonary artery. What’s this called?

A

Transposition of Great Arteries

48
Q

What happens in Transposition of the Great Arteries?

A

Aorta swaps places with the pulmonary artery

(blood from right heart goes out to body via aorta, never oxygenated)

(blood from left heart goes out to lungs via pulm artery, never deoxygenated)

:/

49
Q

Where is ductus venosus?

A

umbilical vein to IVC

50
Q

In which congenital heart defects do the pulmonary and systemic circulations stay separate? :(

A

Transposition of the Great Arteries

(blood from right heart goes out to body via aorta, never oxygenated)

(blood from left heart goes out to lungs via pulm artery, never deoxygenated)

51
Q

What is the cause of death in Transposition of the Great Arteries

A

deep hypoxia and lactic acidosis

52
Q

What is the most common CYANOTIC congenial heart defect?

A

Tetralogy of Fallot

53
Q

What is the definitive investigation for Transposition of the Great Arteries?

A

Echo

shows aorta and pulm artery wrong way round

54
Q

What sign might CXR show in Transposition of the Great Arteries?

A

“egg on a string”

narrowed superior mediastinum

55
Q

Describe the management of Transposition of the Great Arteries.

A 
Balloon Sepostomy (to allow emergency mixing)
then surgical correction

(long term complications of dodgy heart and neuro-dev abnormalities)

56
Q

Within the first 24hrs of birth, a baby boy is cyanosed and has really low sats. ABG shows resp acidosis. He then collapses. What is the likely cause and how would you confirm this?

A

Transposition of the Great Arteries
Echo

(hypoxia and lactic acidosis)

57
Q

What are the four abnormalities in Tetralogy of Fallot?

A
  1. Pulm stenosis
  2. RV hypertrophy
  3. VSD
  4. Aorta overriding VSD
58
Q

Which chromosomal abnormality is associated with Tetralogy of Fallot?

A

DiGeorge syndrome

also CHARGE syndome
(also foetal alcohol syndrome)

59
Q

What is the chromosome deletion in DiGeorge syndrome?

A

22q11 deletion

60
Q

A 5 week old presents with clubbing, feeding difficulty and weight faltering. He deteriorates and starts going blue. You hear a pansystolic murmur at the lower left sternal edge, and an ejection systolic murmur at the upper left sternal edge. What do you suspect?

A

Tetralogy of Fallot

pansystolic LLSE = VSD
ejection systolic ULSE = pulm stenosis

61
Q

Sepsis should be on the differential for any infant with resp distress and hypoxia. True or false?

A

true

62
Q

What causes “Tet spells” in Tetralogy of Fallot? (this is when they become hypercyanotic when active)

A

hypoxia

they squat down to kink femoral arteries, change pressure and reverse shunt.

63
Q

What are the symptoms of a “tet spell”?

A

sudden breathlessness
increasing cyanosis
lots of crying

64
Q

What bloods might you do if you suspect genetic abnormality causing Tetralogy of Fallot?

A

chromosomal microarray

65
Q

What would ECG show in Tetralogy of Fallot?

A

RV hypertrophy (right-to-left shunt)

66
Q

What would CXR show in Tetralogy of Fallot?

A

boot-shaped heart

67
Q

What causes the boot shaped heart sign on CXR in Tetralogy of Fallot?

A

RV hypertrophy

68
Q

What is gold standard for confirming diagnosis of Tetralogy of Fallot?

A

Echo

69
Q

What drug can be given in “tet spells” ?

A

Propanolol

70
Q

What is the management of Tetralogy of Fallot?

A

manage tet spells (propanolol, squatting, BT shunt)

then perhaps definitive surgical repair

71
Q

BT shunt can help reduce tet spells from hypoxia before definitive repair of Tetralogy of Fallot. What does it stand for?

A

Blalock-Taussig

72
Q

85% children with surgically repaired Tetralogy of Fallot now survive to adulthood. How long do they need follow up?

A

lifelong

73
Q

What are the three main causes of outflow obstruction in kids?

A

aortic stenosis
pulm stenosis
coarctation of the aorta

74
Q

Blood gets to top half of body but not bottom half, causing radio-femoral delay. What is this?

A

coarctation of aorta

75
Q

What does coarctation mean?

A

narrowing

76
Q

A newborn has weak femoral pulses. What should FLASH across your mind?

A

coarctation of the aorta

narrowing is usually downstream of subclavians

77
Q

Which congenital heart defect is associated with Turner’s syndrome?

A

coarctation of aorta

78
Q

Asymptomatic murmurs in otherwise well neonates. What outflow obstructions do you think of?

A

aortic stenosis

pulm stenosis

79
Q

What kind of pulse would you feel in a child with aortic stenosis?

A

slow rising pulse (parvus + tardus)

80
Q

What would an ECG/Echo show in aortic stenosis?

A

LV hypertrophy

81
Q

Ausculation in aortic stenosis.

A

ejection systolic murmur in upper right sternal edge

radiating to carotids

82
Q

Ausculation in pulm stenosis.

A

ejection systolic murmur in upper left sternal edge

radiating to back

83
Q

What would an ECG/Echo show in pulm stenosis?

A

RV hypertrophy

sometimes felt as heave in pulm stenosis

84
Q

Which other congenital heart defects can result in pulm stenosis?

A

ASD

Tetralogy of Fallot

85
Q

Pulmonary stenosis is associated with which genetic disorder?

A

Noonan syndrome

86
Q

Noonan syndrome can be a cause of pulmonary stenosis. Which chromosome is usually the problem?

A

chromosome 12

87
Q

As well as Tetralogy of Fallot, DiGeorge syndrome can also cause Truncus Arteriosus. What is this?

A

aorta and pulm artery don’t properly separate

88
Q

Which congenital heart defects are most strongly associated with foetal alcohol syndrome?

A

ASD

VSD

89
Q

Which congenital heart defect is most strongly associated with Down’s syndrome?

A

AVSD

also Tet Fallot, VSD

90
Q

Which congenital heart defect is most strongly associated with Turner’s syndrome (45,X)?

A

Coarctation of the aorta

91
Q

What is a thrill?

A

THIS REVISION! JOKE.

A palpable murmur

92
Q

What is a heave?

A

hypertrophy

93
Q

There is ejection systolic murmur at the upper left sternal edge, radiating to the back, and parasternal heave. Suspect?

A

pulm stenosis

heave is from RV hypertrophy

94
Q

Pulmonary stenosis might be a defect on its own, or a part of which other congenital heart defects?

A

ASD

Tetralogy of Fallot

95
Q

Aortic stenosis is ejection systolic murmur at upper right sternal edge. Where might this radiate to?

A

carotids

96
Q

Slow rising pulse in….

A

aortic stenosis

97
Q

You feel a thrill over the carotids. What FLASHES across your mind?

A

aortic stenosis

98
Q

Pansystolic murmur at lower left sternal edge. What might this be and where might it radiate?

A

VSD

radiating to axilla

99
Q

Ejection systolic murmur at upper left sternal edge. What might this be and where might it radiate?

A

pulm stenosis
radiating to back

(+ parasternal heave: RV hypertrophy)

100
Q

Differentials for strawberry tongue?

A

KAWASAKI
SCARLET FEVER

(oral allergy syndrome!)
(toxic shock)

101
Q

What are the criteria called for diagnosing Kawasaki?

A

Crash and Burn!

102
Q

Tell me the Crash and Burn criteria for diagnosing Kawasaki.

A 
Conjunctivitis
Rash
Adenopathy (lymph)
Strawberry tongue (+red throat, cracked lips)
Hands and feet

Burn = fever (lasting >5ds)

103
Q

Describe me the conjunctivitis in Kawasaki.

A

Bloodshot eyes with limbus sparing

104
Q

Describe me the ‘hands and feet’ in Kawasaki.

A

red and swollen palms + soles

peeling of fingers + toes

105
Q

Does the fever in Kawasaki typically resolve with anti-pyretics?

A

Nope.

106
Q

To get a diagnosis of Kawasaki, how many of the Crash and Burn criteria do you need?

A

4 symptoms + fever lasting >5ds

doesn’t meet all criteria = ‘incomplete Kawasaki’

107
Q

What would urine show in Kawasaki?

A

sterile pyuria

increased WCC but no obv infection

108
Q

Tell me what Kawasaki disease actually is please thank you :)

A

Vasculitis
of coronary arteries
but also large/medium size arteries throughout body

immune system attacks artery endothelial cells

109
Q

Which age group does Kawasaki disease affect?

A

under 5s

esp 1yr olds

110
Q

Kawasaki disease is one of the few indications for the use of aspirin in children. Why is aspirin not normally used?

A

risk of Reye’s syndrome
(brain and liver injury)
(after viral illness during which aspirin was administered)

111
Q

In Kawasaki disease, kids often have raised WCC, with ‘shift to the left’. What does this mean?

A

more immature WBCs than normal

112
Q

What is the investigation to diagnose Kawasaki?

A

clinical diagnosis only!

raised WCC, ESR/CRP, liver enzymes, plts

113
Q

You’ve diagnosed Kawasaki clinically. What investigations would you want to check out?

A

bloods - (raised WCC, ESR/CRP, liver enzymes, plts)
urine - (sterile pyuria)
echo - (coronary artery involvement?)

114
Q

What is the management of Kawasaki?

A

IV immunoglobulin

aspirin

115
Q

Why do you follow up Echo of Kawasaki six wks later?

A

check for coronary artery aneurysm/clots, may need warfarin

116
Q

Kawasaki may resolve untreated. But 25% of children get…

A

coronary artery aneurysms

Paediatrics (14 decks)

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