PAEDS CARDIOLOGY TO DO Flashcards
ATRIAL SEPTAL DEFECT
What signs would you find on clinical examination in ASD?
- 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
VSD
What are some conditions associated to VSD?
- Trisomy 13, 18 + 21
VSD
What are the features of the pansystolic murmur in VSD?
- Left lower sternal edge
- Loud murmur = smaller VSD (larger = quieter)
- May have systolic thrill on palpation
HEART FAILURE
What are the causes of heart failure in neonates?
Obstructed or duct-dependent systemic circulation (HLHS, severe coarctation)
HEART FAILURE
What is the management of heart failure?
- Furosemide (loop diuretic)
- Captopril (ACEi)
- Increased calories
PDA
What are the signs of PDA?
- Collapsing or bounding pulse as increased pulse pressure
- Continuous ‘machinery’ murmur heard loudest beneath the L clavicle
TOF
What abnormalities are described in tetralogy of fallot (TOF)?
- Large VSD
- Pulmonary stenosis (RV outflow obstruction)
- RVH
- Overriding aorta
(If ASD present too = pentad of Fallot)
TOF
What is TOF associated with?
- Trisomy 21 + 22q deletions
TOF
What is the management of a hyper-cyanotic tet spell in TOF?
- Morphine for sedation + pain relief
- IV propranolol as peripheral vasoconstrictor
- IV fluids, sodium bicarbonate if acidotic
TGA
What are the investigations for TGA?
- 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
TRICUSPID ATRESIA
How does tricuspid atresia present?
- ‘Common mixing’ of systemic + pulmonary venous return in LA = cyanosis + dyspnoea
COARCTATION OF AORTA
What is a consequence of coarctation of aorta?
- Collateral circulation forms to increase flow to the lower part of the body leading to the intercostal arteries becoming dilated + tortuous
COARCTATION OF AORTA
What is the clinical presentation of coarctation of aorta?
How may it present if severe?
- 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)
COARCTATION OF AORTA
What are the investigations for coarctation of the aorta?
- 4 limb BP (R arm > L arm), pre + post-duct sats
- CXR may show cardiomegaly + rib notching (often teens + adults)
HYPOPLASTIC LEFT HEART
What is the clinical presentation of HLHS?
- 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
EBSTEIN’S ANOMALY
What is Ebstein’s anomaly associated with?
- Wolff-Parkinson-White syndrome + lithium in pregnancy
EBSTEIN’S ANOMALY
What is the clinical presentation of Ebstein’s anomaly?
- 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
AORTIC STENOSIS
What is aortic stenosis associated with?
- Bicuspid aortic valve + William’s syndrome (supravalvular)
- Also may be mitral stenosis + coarctation of aorta too
AORTIC STENOSIS
What is the normal clinical presentation of aortic stenosis?
- 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
PULMONARY STENOSIS
What is the clinical presentation of pulmonary stenosis?
- 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
RHEUMATIC FEVER
What is the pathophysiology of rheumatic fever?
- 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
RHEUMATIC FEVER
How is rheumatic fever diagnosed?
Jones criteria –
- Evidence of recent strep infection plus 2 major or 1 major + 2 minor criteria
RHEUMATIC FEVER
What are the major criteria in rheumatic fever?
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
RHEUMATIC FEVER
What are the minor criteria in rheumatic fever?
FEAR –
- Fever
- ECG changes (prolonged PR interval) without carditis
- Arthralgia without arthritis
- Raised CRP/ESR
