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Paeds Written - CARDIO Flashcards

1
Q

How can Acyanotic defect cause cyanosis?

A

Cause pulmonnary HTN
If pulmonary pressure > systemic pressure –> reversal of blood flow ‘Eisenmenger syndrome’
Causes cyanosis

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2
Q

How does cyanosis occur in cyanotic heart defects?

A

Deoxygenated blood bypasses lungs & returns to body

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3
Q

Cyanotic heart conditions

A

Tetralogy of Fallot

Transposition of great vessels/arteries

Tricuspid atresia

(+ Truncus arteriosus, Total anomalous pulmonary venous return, Hypoplastic left heart)

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4
Q

Acyanotic heart conditions

A

Ventricular septal defect

Atrial septal defect

Patient ductus arteriosus

Coarctation (of aorta)

Aortic stenosis

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5
Q

Qualities of innocent murmurs

A 
Soft blowing - pulmonary area
Short buzzing - aortic area
Vary with posture
No radiation
No diastolic component
No thrill
No added heart sounds
Asymptomatic
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6
Q

What is Still’s murmur?

A

Innocent murmur
low pitched sound
heart at lower left sternal edge

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7
Q

Pathophysiology of PDA

A

Failure of ductus arteriosus to close as normal with first breaths

Remains patent –> too much blood delivered to lungs

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8
Q

Risk factors for PDA

A

Premature
Birth at high altitude
Maternal rubella (in 1st trimester)

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9
Q

Signs O/E with PDA

A 
Left supraclavicular thrill?
Continuous machinery murur
Large volume bounding collapsing pulse
Wide pulse pressure
Heaving apex beat
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10
Q

Tx for PDA

A 
Indomethacin or Ibuprofen
2nd line (or large duct) = open or keyhole surgery

EXCEPTION: if associated with another (duct-dependent) congenital cardiac defect, prostaglandin E1 given to keep open until after surgery

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11
Q

Main features of Tetralogy of Fallot

A

Ventricular septal defect
Right ventricular hypertrophy
Right ventricular outflow obstruction (pulmonary stenosis)
Overriding aorta

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12
Q

Associations with Tetralogy of Fallot

A

22q11.1 deletion syndrome (Di George)

Down’s syndrome

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13
Q

Presentation of Tetralogy of Fallot

A

Hypercyanotic ‘tet’ spells

  • in 1st month of life
  • may cause LOC
  • Triggered by crying, breathing deeply/rapidly
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14
Q

Signs O/E in Tetralogy of Fallot

A

Mid systolic ejection murmur (from pulmonary stenosis)

Right parasternal heave (RV hypertrophy)

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15
Q

Ix findings in Tetralogy of Fallot

A

CXR –> boot shaped heart

ECG –> RV hypertrophy

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16
Q

Management of Tetralogy of Fallot

A

Prolonged hyper cyanotic spells:

  • Propanolol
  • Morphine
  • Fluids

Definitive = surgical repair
- 2 stage repair if small pulmonary artery

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17
Q

Presentation of atrial septal defect

A

Mostly asymptomatic - many found in adulthood

SOB
Lethargy
Poor appetite & growth
Increases respiratory infections

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18
Q

Signs O/E in Atrial Septal Defect

A

Ejection systolic murmur over pulmonary area

Fixed (wide) splitting of 2nd heart sound

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19
Q

Signs O/E in ventricular septal defect

A

Mild = none

Larger:
Holosystolic (pansystolic) murmur at lower left sternal edge
Palpable thrill
Mid-diastolic low pitched rumble at apex
Parasternal heave
Displaced apex beat

Signs of Heart failure

  • peripheral oedema
  • ascites
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20
Q

Complications/risks in child with VSD

A

Infective endocarditis
Pulmonary HTN
Aneurysm of ventricular septum

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21
Q

Tx required for VSD

A

No intervention UNLESS haemodynamic instability –> surgical correction

+/- Infective endocarditis prophylaxis if high risk

22
Q

Most common heart condition seen in children with Down syndrome?

A

Atrioventricular septal defect (AVSD) aka Endocardial cushion defect

23
Q

Presentation of ATRIOVENTRICULAR SEPTAL DEFECT (AVSD)

A

Cyanosis
Heart failure after few weeks of life
Usually no murmur

24
Q

Presentation / signs of Transposition of Great Arteries

A

Severe cyanosis within first days of life (as ductus arteriosus closes)

Loud S2

No murmur

25
Diagnostic Ix for Transposition of Great Arteries
Nitrogen washout / hyperoxia test - pO2 < 15kPa after 10 mins of 100% O2 = cyanotic congenital heart disease CXR --> egg on string appearance (narrow upper mediastinum), increased pulmonary markings
26
Management of Transposition of Great Arteries
Alprostadil (prostaglandin E1) - maintain ductus arteriosus Balloon atrial septoplasty - pulls atrial septum down to allow mixing Definitive surgical correction - arterial switch
27
Side effect of Prostaglandin E1 Tx in neonates?
Apnoea | - may need intubation
28
Tricuspid atresia signs & symptoms
``` Cyanosis SOB Shortly after birth --> over weeks Prominent first heart sound Pansystolic murmur - from VSD ``` +/- ejection systolic from pulmonary stenosis, continuous from PDA
29
Risk factor/association with Epstein's anomaly
Lithium use in pregnancy
30
Signs O/E for Ebstein's anomaly
Split 1st and 2nd heart sound | Cardiomegaly
31
(Isolated) pulmonary & aortic stenosis key signs/symptoms
Both = ejection systolic murmur + NO cyanosis ``` Aortic = carotid thrill Pulmonary = no thrill, harsh murmur at left sternal edge ```
32
Treatment of aortic/pulmonary stenosis
Trans-catheter balloon dilatation
33
Signs/symptoms of coarctation of aorta
Asymptomatic OR Ejection systolic murmur High BP in arms, low BP in legs Absent femoral pulses - other pulses normal Rib notching (from large collateral intercostal arteries forming)
34
Management of coarctation of aorta
Relies on ductus arteriosus so unwell infant --> A-E + prostaglandin E1 Well infant --> surgical repair OR balloon angioplasty +/- stenting
35
Key features of Hypoplastic left heart
Mitral and/or aortic valve narrowing or complete block Left ventricle very underdeveloped Aorta small & underdeveloped Atrial septal defect
36
Presentation of Hypoplastic left heart
Well at birth THEN | breathless & ill soon after
37
Management of hypoplastic left heart
Keep ductus arteriosus open - prostaglandin E1 Multiple operations - improve QOL but no curative surgery
38
Most common childhood arrhythmia?
Supraventricular tachycardia
39
Treatment of SVT in children
Cardio-resp support - correct tissue acidosis - positive pressure ventilation if needed Vagal stimulating manoeuvre e.g. ice pack to face IV adenosine Electrical cardioversion + maintenance therapy (flecainamide, sotalol) once sinus rhythm restored
40
Treatment options for recurrent SVT
Percutaneous Radiofrequency ablation (RFA) | Cryoablation of accessory pathway
41
Presentation of rheumatic fever
Latent interval 2-6 weeks after pharyngeal infection PPE Sx - polyarthritis - pericarditis - erythema marginatum (map-link outlines) Sydenham's chorea 2-6 months later
42
Criteria for diagnosis rheumatic fever
Jones' Criteria Evidence of recent strep throat - raised ISO titre - other strep Ab - group A strep on throat culture AND - 2 majors - 1 major +2 minors
43
Major criteria for rheumatic fever
CASES ``` Carditis Arthritis Subcutaneous nodules Erythema marginatum Sydenham's chorea ```
44
Minor criteria for Rheumatic fever
FRAPP ``` Fever Raised ESR/CRP Arthralgia Prolonged PR interval Previous RF ```
45
Treatment of rheumatic fever
Bed rest + anti-inflammatories High dose aspirin Abx (if evidence of persistent infection) - amoxicillin Corticosteroids (if fever + inflammation does not resolve rapidly)
46
Long term /prophylactic Tx of rheumatic fever
monthly benzathine penicillin injections - until 10 years after last episode OR 21yo - lifelong if severe valve disease +/- Surgical Tx - valve repair, replacement
47
Signs/Sx of Infective Endocarditis
Fever, anaemia, pallor Thrombotic: - Necrotic skin lesions - infected emboli - Splenomegaly - Retinal infarcts - Microscopic haematuria - Splinter haemorrhages - Neuro signs (from cerebral infarct) ``` Janeway lesions Osler nodes Clubbing New heart murmur Arthritis or arthralgia ```
48
Management of infective endocarditis
IV Abx - beta lactam + aminoglycoside - e.g. amoxicillin + gentamicin - 6 weeks +/- Surgical removal of prosthetic material
49
Features of heart failure in child
Poor feeding, faltering growth Recurrent chest infections Fatigue Sweating Tachypnoea Gallop rhythm Cardiomegaly Hepatomegaly
50
Principles of managing heart failure
Reduce preload - diuretics Enhance cardiac contractility - dopamine OR digoxin, adrenaline, dobutamine Reduce after load - ACEi, hydralazine Improve oxygen delivery - beta blocker e.g. carvedilol Enhance nutrition

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