Paeds Cynotic Heart Disease Flashcards
What is Transposition of the Great Arteries (TGA)?
Serious defect!
When the aorta is connected to the right ventricle and the pulmonary artery is attached to the left Ventricle - This will be a 2 complete separate circulation
they need to have some other defect such as VSD,ASD, PSD that would cause a mixing of the blood or a hole between the two sides otherwise the baby will die.
TGA
Males are more common
Become symptomatic in the first week of life
Become increasingly tachypnoeic with metabolic acidosis
Require fixing surgically
What is Trunchus Arteriosus?
Truncus arteriosus is a rare congenital heart defect where a single common blood vessel originates from the heart instead of the usual two vessels
Pt is cyanotic
What is Tetralogy of Fallot ?
There are 4 problems in here
What are the 4 problems the baby will have in Tetralogy of Fallot?
Overriding Aorta
Pulmonic Stenosis
Ventricular septal defect
Right Ventricular Hypertrophy ( walls are often thicker and got much greater resistance into the lungs ) complication of Trisomy 21
What is the classic appearance of Tetralogy of Fallot in chest x ray?
Boot shaped heart
What is Tricuspid Atresia?
When the tricuspid have not been formed
In tricuspid atresia, you have solid tissue instead of the tricuspid valve. This sheet of tissue blocks blood flow from the right atrium to the right ventricle, where blood would normally go. Because of this blockage, the right ventricle usually is small and underdeveloped. The other valve on the right side between the right ventricle and the lungs can also be underdeveloped (pulmonary valve).
What are the Cyanotic Heart Diseases?
Transposition of the great arteries (TGA)
Truncus Arteriosus (TA)
Total Anomalous Pulmonary Venous Return (TAPVR)
Tetralogy of Fallot (TOF)
Tricuspid Atresia
Clue - if it begins with the T, it’s cyanotic
What is HF in children?
When the heart is unable to pump blood sufficiently to maintain the blood slow to meet the body’s needs.
What are the clinical features in infants/young children of HF?
Tachypnoea and sweating during feeds
Easy fatigability (takes longer time to feed the baby)
Excessive sleepiness or tiredness
irritability
decreased volume of feeds
poor weight gain
failure to thrive may result in delayed motor milestones
What are the symptoms/clinical features in older children?
Exercise intolerance
Anorexia
Dyspnoea
Oedema
Palpitations
Chest pain or syncope
What are the exam findings of the baby with HF?
Grey/blue
cold peripheries
Raised JVP
tachycardia
heart murmur- crepitations
oedema
low bp
effort in breathing
prolonged CRP
What is the test you could do to differentiate between cardiac and pulmonary causes ?
Hyperoxia test where you put 100% oxygen for 10 minutes and if they’re still cyanotic after that period then the cause may be due to heart disease
What is the management for babies if they’re cyanotic?
Airway -make sure the airway is clear
Breathing - use oxygen carefully
C- Consider prostaglandin if needed, restrict fluid, in small volumes of 5ml/kg is generally advised
Consider diuretics such as furosemide, spironolactone and other cardiac meds such as inotrope, ACEi, Antiarrhythmics
D- Do not forget glucose - is this sepsis then consider abx
T- Transfer quickly
What is the definitive management strategies?
Medically supportive
oxygen
fluid/electrolyte
nutrition (high-calorie feeds /less volume)
Surgical - corrective/palliative
Emergency – balloon atrial septostomy
Corrective –VSD, ASD closure
Cardiac Transplant
HTN in children ?
due to a secondary cause -coarctation of the aorta
BP of over >95
