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
RHEUMATIC FEVER
What are the investigations for rheumatic fever
- 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
RHEUMATIC FEVER
What is the management of rheumatic fever?
- 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)
DILATED CARDIOMYOPATHY
What is the management of dilated cardiomyopathy?
- Dx by ECHO
- Sx treatment with diuretics, ACEi + carvedilol (beta blocker)
SUPRAVENTRICLAR TACHYCARDIA
What is the management of a supraventricular tachycardia?
- 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
PDA
What are some risk factors of PDA?
Prematurity is key + association with maternal rubella
INFECTIVE ENDOCARDITIS
What is the management?
High dose IV Abx (penicillin with aminoglycoside like vancomycin) for 6w
HEART FAILURE
What are the causes of heart failure in infants?
High pulmonary blood flow (VSD, AVSD, large PDA)
HEART FAILURE
What are the causes of heart failure in older children?
Eisenmenger’s syndrome (RHF),
rheumatic disease,
cardiomyopathy
TOF
What are some risk factors?
- Rubella,
- maternal age >40,
- alcohol in pregnancy,
- maternal DM
TGA
What is it associated with?
Duct dependent lesion, associated with PDA, ASD + VSD
TRICUSPID ATRESIA
How is it managed?
Shunt between subclavian + pulmonary artery with surgery later
COARCTATION OF AORTA
What is it associated with?
Turner’s syndrome
