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a to revise - phase 3a > PAEDS CARDIOLOGY TO DO > Flashcards

PAEDS CARDIOLOGY TO DO Flashcards

1
Q

ATRIAL SEPTAL DEFECT
What signs would you find on clinical examination in ASD?

A
  • Fixed + widely split S2 (split does not change with inspiration/expiration)
  • ES murmur at upper L sternal edge (pulmonary) as increased flow across pulmonary valve by L>R shunt
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2
Q

VSD
What are some conditions associated to VSD?

A
  • Trisomy 13, 18 + 21
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3
Q

VSD
What are the features of the pansystolic murmur in VSD?

A
  • Left lower sternal edge
  • Loud murmur = smaller VSD (larger = quieter)
  • May have systolic thrill on palpation
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4
Q

HEART FAILURE
What are the causes of heart failure in neonates?

A

Obstructed or duct-dependent systemic circulation (HLHS, severe coarctation)

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5
Q

HEART FAILURE
What is the management of heart failure?

A
  • Furosemide (loop diuretic)
  • Captopril (ACEi)
  • Increased calories
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6
Q

PDA
What are the signs of PDA?

A
  • Collapsing or bounding pulse as increased pulse pressure
  • Continuous ‘machinery’ murmur heard loudest beneath the L clavicle
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7
Q

TOF
What abnormalities are described in tetralogy of fallot (TOF)?

A
  • Large VSD
  • Pulmonary stenosis (RV outflow obstruction)
  • RVH
  • Overriding aorta
    (If ASD present too = pentad of Fallot)
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8
Q

TOF
What is TOF associated with?

A
  • Trisomy 21 + 22q deletions
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9
Q

TOF
What is the management of a hyper-cyanotic tet spell in TOF?

A
  • Morphine for sedation + pain relief
  • IV propranolol as peripheral vasoconstrictor
  • IV fluids, sodium bicarbonate if acidotic
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10
Q

TGA
What are the investigations for TGA?

A
  • May be Dx antenatally, pre (R arm) + post duct (foot) sats
  • CXR may show narrow mediastinum with ‘egg on its side’ appearance
  • ECHO confirms Dx
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11
Q

TRICUSPID ATRESIA
How does tricuspid atresia present?

A
  • ‘Common mixing’ of systemic + pulmonary venous return in LA = cyanosis + dyspnoea
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12
Q

COARCTATION OF AORTA
What is a consequence of coarctation of aorta?

A
  • Collateral circulation forms to increase flow to the lower part of the body leading to the intercostal arteries becoming dilated + tortuous
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13
Q

COARCTATION OF AORTA
What is the clinical presentation of coarctation of aorta?
How may it present if severe?

A
  • Weak femoral pulses + radiofemoral delay
  • Systolic murmur between scapulas or below L clavicle
  • Heart failure, tachypnoea, poor feeding, floppy
  • LV heave (LVH)
  • Acute circulatory collapse at 2d as duct closes (duct dependent)
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14
Q

COARCTATION OF AORTA
What are the investigations for coarctation of the aorta?

A
  • 4 limb BP (R arm > L arm), pre + post-duct sats
  • CXR may show cardiomegaly + rib notching (often teens + adults)
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15
Q

HYPOPLASTIC LEFT HEART
What is the clinical presentation of HLHS?

A
  • Sickest neonates with duct-dependent circulation
  • No L side flow so ductal constriction > profound acidosis + rapid CV collapse
  • Weakness or absence of all peripheral pulses
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16
Q

EBSTEIN’S ANOMALY
What is Ebstein’s anomaly associated with?

A
  • Wolff-Parkinson-White syndrome + lithium in pregnancy
17
Q

EBSTEIN’S ANOMALY
What is the clinical presentation of Ebstein’s anomaly?

A
  • Evidence of heart failure
  • SOB, tachypnoea, poor feeding, collapse or cardiac arrest
  • Gallop rhythm with S3 + S4
  • Cyanosis few days after birth if ASD when ductus arteriosus closes
18
Q

AORTIC STENOSIS
What is aortic stenosis associated with?

A
  • Bicuspid aortic valve + William’s syndrome (supravalvular)
  • Also may be mitral stenosis + coarctation of aorta too
19
Q

AORTIC STENOSIS
What is the normal clinical presentation of aortic stenosis?

A
  • Most asymptomatic with ejection-systolic murmur at upper right sternal edge (aortic area) radiating to neck (carotid thrill)
  • Ejection click before murmur
  • Palpable systolic thrill
  • Slow rising pulses + narrow pulse pressure
20
Q

PULMONARY STENOSIS
What is the clinical presentation of pulmonary stenosis?

A
  • Ejection systolic murmur at upper left sternal edge with ejection click
  • ?RV heave due to RVH
  • Critical PS = duct-dependent pulmonary circulation so cyanosis in first few days of life
21
Q

RHEUMATIC FEVER
What is the pathophysiology of rheumatic fever?

A
  • Multi-system disorder due to autoimmune response producing antibodies against group A beta-haemolytic strep pyogenes (after tonsillitis) that targets other tissues
  • T2 hypersensitivity reaction as immune system attacks cells throughout body
22
Q

RHEUMATIC FEVER
How is rheumatic fever diagnosed?

A

Jones criteria –
- Evidence of recent strep infection plus 2 major or 1 major + 2 minor criteria

23
Q

RHEUMATIC FEVER
What are the major criteria in rheumatic fever?

A

JONES –

  • Joint arthritis (migratory as affects different joints at different times)
  • Organ inflammation (pancarditis > pericardial friction rub)
  • Nodules (subcut over extensor surfaces)
  • Erythema marginatum rash (pink rings of varying sizes on torso + proximal limbs)
  • Sydenham chorea
24
Q

RHEUMATIC FEVER
What are the minor criteria in rheumatic fever?

A

FEAR –

  • Fever
  • ECG changes (prolonged PR interval) without carditis
  • Arthralgia without arthritis
  • Raised CRP/ESR
25
Q

RHEUMATIC FEVER
What are the investigations for rheumatic fever

A
  • Throat swab for MC&S
  • Anti-streptococcal antibodies (ASO) titres = anti-DNase B +ve indicates strep infection (repeat after 2w to check if negative)
  • Echo, ECG + CXR to check cardiac involvement
26
Q

RHEUMATIC FEVER
What is the management of rheumatic fever?

A
  • Prevention by treating strep infections with 10d phenoxymethylpenicillin
  • Specialist Mx (NSAIDs for joint pain, aspirin + steroids for carditis)
  • Prophylactic 1/12 IM benzathine penicillin most effective to prevent recurrence (if not daily PO penicillin)
27
Q

DILATED CARDIOMYOPATHY
What is the management of dilated cardiomyopathy?

A
  • Dx by ECHO
  • Sx treatment with diuretics, ACEi + carvedilol (beta blocker)
28
Q

SUPRAVENTRICLAR TACHYCARDIA
What is the management of a supraventricular tachycardia?

A
  • 1st line = Vagal stimulation (carotid sinus massage, cold ice pack to face)
  • 2nd line = IV adenosine
  • 3rd line = Electrical cardioversion
  • Long term = ablation of pathway or flecainide
29
Q

PDA
What are some risk factors of PDA?

A

Prematurity is key + association with maternal rubella

30
Q

INFECTIVE ENDOCARDITIS
What is the management?

A

High dose IV Abx (penicillin with aminoglycoside like vancomycin) for 6w

31
Q

HEART FAILURE
What are the causes of heart failure in infants?

A

High pulmonary blood flow (VSD, AVSD, large PDA)

32
Q

HEART FAILURE
What are the causes of heart failure in older children?

A

Eisenmenger’s syndrome (RHF),
rheumatic disease,
cardiomyopathy

33
Q

TOF
What are some risk factors?

A
  • Rubella,
  • maternal age >40,
  • alcohol in pregnancy,
  • maternal DM
34
Q

TGA
What is it associated with?

A

Duct dependent lesion, associated with PDA, ASD + VSD

35
Q

TRICUSPID ATRESIA
How is it managed?

A

Shunt between subclavian + pulmonary artery with surgery later

36
Q

COARCTATION OF AORTA
What is it associated with?

A

Turner’s syndrome

a to revise - phase 3a (16 decks)

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