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Pediatric cardiology > Pediatric cardiology > Flashcards

Pediatric cardiology Flashcards

1
Q

Left to right shunt lesion:

A

extra blood is displaced through a communication from the left to the right side of the heart; increased pulmonary blood flow; increased pulmonary pressures.

  • Atrial Septal Defect (ASD)
  • Ventricular Septal Defect (VSD)
  • Patent Ductus Arteriosus (PDA)
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2
Q

What is the shunt volume is dependent upon three factors:

Left to right shunt lesion

A

(1) size of defect
(2) pressure gradient between chambers or vessels
(3) peripheral outflow resistance

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3
Q

What happens to untreated left to right shunt lesion?

A

untreated shunts can result in pulmonary vascular disease, left ventricular dilatation and dysfunction, right ventricular hypertension and hypertrophy (RVH), and ultimately R to L
Shunts

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4
Q

ASD =

A

Atrial Septal Defect

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5
Q

3 types of atrial septal defect:

A
  1. ostium primum (common in Down syndrome)
  2. ostium secundum (most common type, 50-70%)
  3. sinus venosus (defect located at entry of superior vena cava into right atrium)
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6
Q

Ostium primum:

ASD

A

common in Down syndrome

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7
Q

Ostium secundum:

ASD

A

most common type, 50-70%

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8
Q

Sinus venosus:

ASD

A

defect located at entry of superior vena cava into right atrium

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9
Q

ASD - epidemiology:

A

6-8% of congenital heart lesions

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10
Q

ASD - Natural history:

A
  • 80-100% spontaneous closure rate if ASD diameter <8 mm if remains patent
  • congestive heart failure (CHF) and pulmonary hypertension can develop in adult life
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11
Q

ASD - linical presentation:

A
  • History: often asymptomatic in childhood

- Physical exam: grade 2 3/6 pulmonic outflow murmur, widely split and fixed S2

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12
Q

ASD - Investigation:

A
  • ECG: right axis deviation (RAD), mild RVH, right bundle branch block (RBBB)
  • CXR: increased pulmonary vasculature
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13
Q

ASD - Management:

A

elective surgical or catheter closure between 2-5 yr of age

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14
Q

VSD =

A

Ventricular Septal Defect

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15
Q

What is the frequency of ventricular septal defect?

A

most common congenital heart defect (30-50%)

- small VSD (majority)

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16
Q

Small VSD - History:

A

history: asymptomatic, normal growth, and development

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17
Q

Small VSD: Physical exam:

A

early systolic to holosystolic murmur, best heard at LLSB, thrill

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18
Q

Small VSD - Investigation:

A

ECG and CXR are normal

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19
Q

Small VSD - management:

A

most close spontaneously

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20
Q

moderate-to-large VSD - Epidemiology:

A

CHF by 2 mo; late secondary pulmonary hypertension if left untreated

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21
Q

moderate-to-large VSD - History:

A

delayed growth, decreased exercise tolerance, recurrent URTIs or “asthma” episodes

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22
Q

moderate-to-large VSD - Physical exam:

A

holosystolic murmur at LLSB, mid-diastolic rumble at apex, size of VSD is inversely related to intensity of murmur

23
Q

moderate-to-large VSD - Investigations:

A
  • ECG: left ventricular hypertrophy (LVH), left atrial hypertrophy (LAH), RVH
  • CXR: increased pulmonary vasculature, cardiomegaly, CHF
24
Q

moderate-to-large VSD - Management:

A

treatment of CHF and surgical closure by 1 yr old

25
Q

moderate-to-large VSD - Management:

A

treatment of CHF and surgical closure by 1 yr old

26
Q

PDA=

A

Patent Ductus Arteriosus

27
Q

Patent Ductus Arteriosus

A

patent vessel between descending aorta and left pulmonary artery (normally, functional closure within first 15 h of life, anatomical closure within first days of life)

28
Q

PDA - Epidemiology:

A

5-10% of all congenital heart defects delayed closure of ductus is common in premature infants (1/3 of infants <1750g); this is different from PDA in term infants

29
Q

PDA - Natural history:

A

spontaneous closure common in premature infants, less common in term infants

30
Q

PDA - History:

A

asymptomatic, or have apneic or bradycardic spells, poor feeding, accessory muscle use, CHF

31
Q

PDA - Physical exam:

A
  • tachycardia
  • bounding pulses
  • hyperactive precordium
  • wide pulse pressure
  • continuous “machinery” murmur best heard at left infraclavicular area
32
Q

PDA - Investigations:

A
  • ECG: may show LAE, LVH, RVH
  • CXR: normal to mildly enlarged heart, increased pulmonary vasculature, prominent pulmonary artery
  • ECHO: diagnostic
33
Q

PDA - Management:

A 
- indomethacin (Indocid®): 
PGE2 antagonist (PGE2 maintains ductus arteriosus patency) is only effective in premature infants
- catheter or surgical closure if PDA causes respiratory compromise, FTT, or persists beyond 3 months of life.
34
Q

PDA - Obstructive lesions:

A

present with decreased urine output, pallor, cool extremities and poor pulses, shock or sudden collapse

  • Coarctation of the Aorta
  • Aortic Stenosis
  • Pulmonary Stenosis
35
Q

Coarctation of the Aorta:

A

narrowing of aorta (almost always at the level of the ductus arteriosus)

36
Q

Coarctation of the Aorta - Epidemiology:

A

commonly associated with bicuspid aortic valve (50%); Turner syndrome (35%)

37
Q

Coarctation of the Aorta - History:

A

often asymptomatic

38
Q

Coarctation of the Aorta - Physical exam:

A
  • upper extremity systolic pressures of 140-145 mmHg
  • few have high BP in infancy (160-200 mmHg systolic), but this decreases as collaterals develop
  • decreased blood pressure and weak/absent pulses in lower extremities radial-femoral delay
  • absent or systolic murmur with late peak at apex, left axilla, and left back
  • if severe, presents with shock in the neonatal period when the ductus closes
39
Q

Coarctation of the Aorta - Investigations:

A

ECG shows RVH early in infancy, LVH later in childhood

40
Q

Coarctation of the Aorta - Prognosis:

A
  • can be complicated by hypertension; if associated with other lesions (e.g. PDA, VSD)
  • can lead to CHF
41
Q

Coarctation of the Aorta - Management:

A
  • give prostaglandins to keep ductus arteriosus patent for stabilization and perform surgical correction in neonates.
  • For older infants and children balloon arterioplasty may be an alternative to surgical correction.
42
Q

Aortic Stenosis - 4 Types:

A
  • valvular (75%)
  • subvalvular (20%)
  • supravalvular and idiopathic hypertrophic subaortic stenosis (IHSS) (5%)
43
Q

Aortic Stenosis - History:

A
  • often asymptomatic

- but may be associated with CHF, exertional chest pain, syncope or sudden death

44
Q

Aortic Stenosis - Physical exam:

A

systolic ejection murmur (SEM) at RUSB with aortic ejection click at the apex (only for valvar stenosis)

45
Q

Aortic Stenosis - Management:

A

valvular stenosis is usually treated with balloon valvuloplasty patients with subvalular or supravalvular stenosis require surgical repair, exercise restriction required

46
Q

Pulmonary Stenosis - 3 Types:

A
  • Valvular (90%)
  • Subvalvular
  • Supravalvular
47
Q

Pulmonary Stenosis - Definition of critical pulmonic stenosis:

A

inadequate pulmonary blood flow, dependent on ductus for oxygenation, progressive hypoxia and cyanosis

48
Q

Pulmonary Stenosis - natural history:

A

may be part of other congenital heart lesions (e.g. Tetralogy of Fallot) or in association with syndromes (e.g. congenital rubella, Noonan syndrome)

49
Q

Pulmonary Stenosis - History:

A

spectrum from asymptomatic to CHF

50
Q

Pulmonary Stenosis - Physical examination:

A
  • wide split S2 on expiration
  • SEM at LUSB
  • pulmonary ejection click (for valvular lesions)
51
Q

Pulmonary Stenosis - Investigation:

A
  • ECG: RVH

- CXR: post-stenotic dilation of the main pulmonary artery

52
Q

Pulmonary Stenosis - Management:

A

surgical repair if critically ill, or if symptomatic in older infants/children

53
Q

Right to left shunt lesions:

A
  • Tetralogy of Fallot

-

Pediatric cardiology (1 decks)

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