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3a Paediatrics > Paeds cardio (ILA 3) > Flashcards

Paeds cardio (ILA 3) Flashcards

1
Q

Describe the circulation in the foetus

A
  1. umbilicus supplies oxygen to the foetus
  2. umbilical cord goes into liver and empties into portal vein
  3. portal vein -> IVC -> R atrium
  4. R atrium has higher pressure than L atrium as gets all the systemic venous return
  5. blood flows through foramen ovale across the atrial septum into L atrium
  6. L atrium blood flows into L ventricles and pumped to upper body
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2
Q

What is the role of the ductus arertiosus?

A

connects pulmonary artery to the aorta

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3
Q

What circulatory changes occur with the foetus’s first breath?

A
  1. resistance to pulmonary blood falls and volume of blood flowing through lungs increases -> rise in L atrial pressure
  2. foramen ovale closes
  3. ductus arteriosus closes within first few hours
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4
Q

Outline the possible causes of congenital heart disease?

A

MATERNAL DISORDERS - rubella, SLE, diabetes mellitus

MATERNAL DRUGS - warfarin, fetal alcohol syndrome

CHROMOSOMAL ABNORMALITY - downs syndrome, Edwards syndrome, Palau syndrome, Turners syndrome, Williams syndrome

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5
Q

Describe the 5 ways in which congenital heart disease presents?

A
  1. antenatal diagnosis
  2. heart murmur
  3. heart failure
  4. cyanosis
  5. shock
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6
Q

How are congenital heart defects detected in the foetus ?

A

fetal anomaly scan at 18-20 weeks gestation

checks anatomy of fetal heart

if abnormality detected, do a detailed fetal ECHO

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7
Q

How do “innocent murmurs” present?

A 
4 S's...
aSymptomatic
Soft blowing murmur 
Systolic murmur only
left Sternal edge
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8
Q

List the possible neonatal causes of heart failure?

A

neonatal heart failure is caused by obstructed systemic circulation

L->R shunts
severe coarction of the aorta
interruption of the aortic arch
hypoplastic L heart syndrome

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9
Q

List the possible infantile causes of heart failure?

A

heart failure in young children is caused by high pulmonary blood flow

VSD
atrioventricular septal defect
persistent ductus arteriosus

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10
Q

List the causes of heart failure in older children?

A

caused by right to left heart failure

Eisenmenger syndrome
rheumatic heart disease
cardiomyopathy 
myocarditis 
pericardial effusions
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11
Q

List the signs of left sided heart failure

A 
breathlessness - on exertion, feeding
sweating
poor feeding
recurrent chest infections
palpitations
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12
Q

List the signs of right sided heart failure

A

ankle oedema
hepatomegaly
raised JVP
ascites

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13
Q

State the 3 types of cyanosis

A
  1. peripheral cyanosis
  2. central cyanosis
  3. persistent cyanosis
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14
Q

Describe peripheral cyanosis

A

“blue hands and feet”

occurs when a child is cold or unwell or with polycythaemia

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15
Q

Describe central cyanosis

A

“blue tongue”

haemoglobin in blood >50g/L
seen in bronchiolitis, sepsis, resp infection

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16
Q

How are congenital heart defects detected?

A

ECHOCARDIOGRAM

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17
Q

List the 3 left to right shunts causing breathlessness

A
  1. atrial septal defect
  2. ventricular septal defect
  3. patent ductus arteriosus
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18
Q

What is the most common atrial septal defect

A

secundum ASD in 80% = defect in centre of atrial septum involving foramen ovale

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19
Q

How does an atrial septal defect present?

A

asymptomatic
breathlessness
recurrent chest infections

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20
Q

What murmur is heard with an atrial septal defect?

A

ejection systolic murmur at L sternal edge

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21
Q

How is atrial septal defect managed?

A

if small - closes spontaneously

if large - surgical correction

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22
Q

How might a large ventricular septal defect present?

A

breathlessness
faltering growth
recurrent chest infectons
failure to thrive

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23
Q

Which murmur is heard with ventricular septal defect?

A

pan systolic murmur

heard loudest with a small VSD
softer with a larger VSD

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24
Q

List the signs on examination of a patient with a VSD

A 
tachycardia
tachypnoea
pan systolic murmur 
apical mid diastolic murmur 
loud pulmonary second sound
enlarged liver
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25
Q

Outline the findings on a chest x-ray of someone with a large VSD

A

cardiomegaly
enlarged pulmonary arteries
increased pulmonary vascular markings
pulmonary oedema

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26
Q

How is VSD managed?

A

small - close spontaneously

large - surgery at 3-6 months of age

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27
Q

What is patent ductus arteriosus?

A

when the ductus arteriosus fails to close by 1 month after expected date of delivery due to defect in the constrictor mechanism of the duct

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28
Q

Which murmur is heard in patent ductus arteriosus?

A

continuous murmur beneath the left clavicle

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29
Q

What are the signs of patent ductus arteriosus?

A 
continuous murmur 
collapsing or bounding pulse 
pulmonary hypertension
tachypnoea
failure to thrive
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30
Q

How is patent ductus arteriosus diagnosed?

A

echo

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31
Q

How is patent ductus arteriosus managed?

A

NSAIDs e.g. indomethacin

surgical closure with coil/ occlusion device at 1 y/o

32
Q

List the right to left shunts? “cyanotic”

A
  1. tetralogy of ballot

2. transposition of great arteries

33
Q

which test is done to determine heart disease in a cyanosed neonate?

A

hyperoxia (nitrogen washout) test

infant placed in 100% oxygen for 10 mins and if right radial arterial press still low= cyanotic congenital heart disease

34
Q

outline the management for a cyanosed neonate

A
  1. stabilise ABC

2. prostaglandin infusion - keeps duct open so blood can travel to lungs

35
Q

What are the side effects of a prostaglandin infusion?

A 
apnoea
seizures
flushing
vasodilation
hypotension
36
Q

What are the 4 features of tetralogy of fallot?

A
  1. pulmonary stenosis
  2. right ventricular hypertrophy
  3. overriding of the aorta
  4. ventricular septal defect
37
Q

how does tetralogy of fallot present?

A

severe cyanosis
hyper cyanotic events on exercise, crying, defacating
squatting on exercise

38
Q

which murmur is heard with tetralogy of fallot?

A

loud ejection systolic murmur at left sternal edge

39
Q

How are hyper cyanotic events managed?

A

usually self limiting but if >15 mins…

  1. pain relief
  2. IV propanol
  3. bicarbonate
  4. artificial ventilation
40
Q

What are the causes of cyanotic heart disease? (5 T’s)

A 
Tricuspid atresia
Tetralogy of fallot
Transposition of the great arteries
Truncus arteriosus
Total anomalous pulmonary venous connection
41
Q

What is transposition of the great arteries?

A

pulmonary artery and aorta swap!!

aorta connected to right ventricle so blue blood returned to body

pulmonary artery connected to L ventricle so pink blood returned to lungs

42
Q

How does transposition of the great arteries present?

A

CYANOSIS - on day 2 of life
no murmur
2nd heart sound loud

43
Q

Which imaging is diagnostic for translation of the great arteries?

A

ECHO- shows abnormal connections

44
Q

How is transposition of the great arteries managed?

A
  1. prostaglandin infusion
  2. balloon atrial septosomy
  3. surgery to switch arterial supply!! (surgery when around 6kg)
45
Q

When does Eisenmengers syndrome occur?

A

it is the reversal of a left to right shunt

if not treated at an early age, the shunt causes pulmonary arteries to have thick walls and causes PULMONARY HYPERTENSION leading to R sided heart failure and death

46
Q

What are the 2 common mixing CHD?

A
  1. atrioventricular septal defect

2. tricuspid atresia

47
Q

Describe the presentation of atrioventricular septal defect

A

commonly associated with Downs syndrome
cyanosis at birth
heart failure at 2-3 weeks
pulmonary hypertension

48
Q

Describe tricuspid atresia

A

obstructed tricuspid valve causing a right to left shunt

only the left ventricle is effective, the right ventricle is small and nonfunctional

49
Q

How does tricuspid atresia present?

A

CYANOSIS!

50
Q

How is tricuspid atresia managed?

A

aim is to maintain a secure supply of blood to the lungs at low pressure by…

  1. Blalock Traussig shunt insertion
  2. pulmonary artery banding operation
  3. Glenn and Fontan operation
51
Q

List the 3 causes of outflow obstruction in the well child

A
  1. aortic stenosis
  2. pulmonary stenosis
  3. coarction of the aorta
52
Q

What is aortic stenosis?

A

aortic valve leaflets are partly fused together so there is restrictive exit of the blood from the left ventricle

53
Q

What are the symptoms of severe aortic stenosis?

A
  1. reduced exercise tolerance Causing SOB
  2. chest pain on exertion
  3. syncope
54
Q

List the signs seen in aortic stenosis

A

carotid thrill
narrow pulse pressure
ejection systolic murmur
small rising pulse

55
Q

How would you investigate aortic stenosis?

A
  1. Chest X-ray - Left ventricular hypertrophy with post-stenotic dilatation of the ascending aorta
  2. ECHO
56
Q

What is pulmonary stenosis?

A

pulmonary valve leaflets partly fused together so there is restrictive exit from the right ventricle

57
Q

List the signs of pulmonary stenosis

A
  1. ejection systolic murmur
  2. palpable thrill
  3. ejection click
  4. R ventricular heave
58
Q

Describe the findings on investigations of pulmonary stenosis

A
  1. Chest radiography - normal or post stenotic dilatation of the pulmonary artery
  2. ECG- R ventricular hypertrophy
59
Q

List the causes of outflow obstruction in the sick infant

A
  1. coarction of the aorta
  2. interruption of the aortic arch
  3. hypo plastic left heart syndrome
60
Q

What is coarction of the aorta?

A

narrowing of the descending aorta - usually at the ductus arteriosus

61
Q

What is coarction of the aorta associated with?

A

males
Turners syndrome
neurofibromatosis
bicuspid aortic valve

62
Q

How does coarction of the aorta present?

A
  1. peripheral cyanosis, SOB
  2. systemic hypertension
  3. ejection systolic murmur
  4. radio-femoral delay
  5. intermittent claudication
63
Q

How is coarction of the aorta investigated?

A

chest radiograph = rib notching, 3 sign

ECG= left ventricular hypertrophy

64
Q

What are the symptoms and signs of supra ventricular tachycardia?

A

heart rate rapid: 250-300 beats/min
narrow complex tachycardia
ECG: T wave inversion

65
Q

how is supra ventricular tachycardia managed in the severely ill child?

A
  1. circulatory and respiratory support
  2. vagal stimulating manoeuvres e.g. carotid sinus massage
  3. IV adenosine
66
Q

What is the maintenance therapy for supra ventricular tachycardia?

A

flecainide or sotalol +/- propanol

67
Q

What are the most common causative pathogens of infective endocarditis?

A

streptococcus viridian’s

Staph. aureus

68
Q

Outline the risk factors of infective endocarditis

A

bad dental hygiene
prosthetic material in surgery
congenital heart disease
rheumatic valve disease

69
Q

How does infective endocarditis present?

A 
fever
malaise
anaemia
splenomegaly
splinter haemorrhages
Janeway lesions
clubbing
retinal infarcts
70
Q

How is infective endocarditis diagnosed?

A
  1. blood cultures
  2. ECHO - detect vegetations, fibrin and platelets
  3. raised ESR
71
Q

How is infective endocarditis managed?

A

high dose IV penicillin + amino glycoside for 6 weeks

72
Q

How is dilated cardiomyopathy managed?

A 
ABCD
A- ACE-inhibitors
B- beta adrenoreceptor blocking agent
C- carvedilol
D- diuretics
73
Q

List the causes of an ejection systolic murmur

A 
innocent murmur
coarction of the aorta 
aortic stenosis 
pulmonary stenosis
tetralogy of fallot
74
Q

List the causes of a pan systolic murmur

A

ventricular septal defect
tricuspid regurgitation
mitral regurgitation

75
Q

List the causes of a continuous murmur

A

patent ductus arteriosus

collateral circulation

76
Q

List the causes of a diastolic murmur

A

aortic regurgitation
mitral stenosis
tricuspid stenosis

3a Paediatrics (9 decks)

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