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Paediatrics > Zero to finals- Cardio > Flashcards

Zero to finals- Cardio Flashcards

1
Q

What are the 3 foetal shunts?

A

Ductus venosus
Foramen ovale
Ductus arteriosus

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2
Q

What is the ductus venosus

A

Shunt connects umbiliacal vein to IVC and allows bypass of liver

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3
Q

What is the foramen ovale?

A

Shunt connects RA to LA and allows blood to bypass the RV and pulmonary circulation

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4
Q

What is the ductus arteriosus

A

Connects pulmonary artery with aorta and allows blood to bypass the pulmonary circulation

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5
Q

How does the foramen ovale close?

A

First breath baby takes expans alveoli. Decreases pulmonary vascular resistance
This decrease causes a fall in pressure in RA
At this point LA pressure is greater than RA which squashes atrial septum to cause functional closure of foramen ovale

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6
Q

What does the foramen ovale become?

A

Fossa ovalis

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7
Q

What keeps the ductus arteriosus open?

A

Prostaglandins

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8
Q

What causes the closure of the ductus arteriosus?

A

Increased blood oxygenation causes a drop in circulating prostaglands. This causes closure of the ductus arteriosus which becomes the ligamentum arteriosum

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9
Q

What does the ductus venosus become?

A

Ligamentum venosum

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10
Q

What are innocent murmurs also called? What are they caused by?

A

Flow murmurs

Fast blow flow through various areas of the heart during systole

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11
Q

What are the features of innocent murmurs?

A 
Soft
Short
Systolic
Symptomless
Situation dependent
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12
Q

What investigations can rule out abnormalities in murmurs in children?

A

ECG
CXR
Echocardiography

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13
Q

What causes negative intra thoracic pressure?

A

During inspiration the chest wall and the diaphragm pull the lungs open. Also pulls the heart open

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14
Q

What does an atrial septal defect sound like?

A

Mid systolic, crescendo-decresendo murmur. Loudest at the upper left sternal border, with a fixed split second heart sound

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15
Q

What does fixed split mean?

A

Heart sound does not change with inspiration and expiration

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16
Q

What sound may be heard in PDA?

A

Small PDA may not cause any abnormal heart sounds
More significant PDAs cause a normal first heart sound with a continuous crescendo decresendo machine murmur that may continue during the second heart sound, making the second heart sound more difficult to hear

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17
Q

What does the murmur in teratology of the fallout sound like?

A

It arises from pulmonary stenosis giving an ejection systolic murmur loudest at the pulmonary area

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18
Q

What is cyanosis?

A

When deoxygenated blood enters the systemic circulation

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19
Q

When does cyantoic heart disease occur?

A

When blood is able to bypass the pulmonary circulation and the lungs
Allows a right to left shunt

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20
Q

Heart defects that can cause a right to left shunt:

A

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
Transposition of the great vessels

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21
Q

What is Eisenmenger syndrome?

A

If the pulmonary pressure increases beyond the systemic pressure, blood will start to flow from right to left across the defect causing cyanosis

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22
Q

What can having an asymptomatic PDA throguh childhood present with as in adulthood?

A

HF

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23
Q

PDA presenting symptoms

A 
Murmur may be pciked up
SOB
Difficulty feeding
Poor weight gain
LRTI
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24
Q

How can a diagnosis of PDA be confirmed

A

Echocardiogram

Doppler flow during ECHO can assess size and characteristics of left to right shunt

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25
Q

What is the management of PDA?

A

Monitored until 1 year of age using echocardiograms

After 1 it is highly likely close spontaneously and transcatheter or surgical closure can be performed

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26
Q

What is an atrial septal defect?

A

A hole in the septum between the two atria

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27
Q

In ASD what way does the blood move?

A

From LA to RA as pressure higher in LA

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28
Q

What can ASD lead to?

A

Blood flows to lungs to patient not cyantoiv but increased flow and pressure in right side of heart leads to right sided overload and heart strain
RHF and pulmonary hypertension

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29
Q

What is Eisenmenger syndrome?

A

Pulmonary pressure is greater than systemic. Shunt reverses and becomes right to left shunt. Blood bypasses lungs and becomes cyanotic

30
Q

Examples of Atrial septal defects?

A

Ostium secundum
Patent foramen ovale
Ostium primum

31
Q

Complications of ASD?

A

Stroke
AF
Pulmonary hypertension and RHF
Eisenmenger syndrome

32
Q

What is important to think about in relation to atrial septal defects and DVT?

A

Clot goes to RA then LA due to ASD instead of being a PE!

33
Q

What are symptoms of ASD?

A

SOB
Difficulty feeding
Poor weight gain
LRTI

34
Q

What is the management of PDA?

A

Refered to paediatric cardiologist
When it is small and asymptomatic watch and wait
Corrected surgically using a transvenous catheter colusure. Anticoagulants such as aspirin, warfarin and NOACs reduce risk of clots and stroke in adults

35
Q

what is VSD

A

Congeital hole in the septum between ventricles

Can occur by themselves but commonly associated with Down’s syndrome and Turner’s syndrome

36
Q

What are symptoms of VSD>

A

Poor feeding
Dysponea
Tachynponea
Failure to thirve

37
Q

What is found in examination of a VSD

A

Pan systolic murmur more prominent over left lower sternal border in the third and fourth intercostal spaces
Systolic thrill on palpation

38
Q

What is the treatment of a VSD?

A

Watched if small
Corrected surgically using a transvenous catheter closure via femoral vein or open heart surgery
Risk of IE in patients with VSD. Abx prophylaxis should be considered during surgery to reduce risk of IE

39
Q

What is Eisenmenger syndrome?

A

Blood flows from right tp left side of heart cross a structural lesion bypassing the lungs
ASF, VSD, PDA
Can develop 1-2 years with large shunts or in adulthood with small shunts

40
Q

What is cyanosis?

A

Blue discolouration of skin relating to a low level of oxygen in blood

41
Q

How does bone marrow respond to low oxygen saturation?

A

Produces more red cells and hameoglobin to increased oxygen carrying capacity in the blood
Leads to polycythaemia which is a high concentration of haemoglobin in blood
Gives patients a plethoric complexion
High concentration of RBCs and haemoglobin make the blood more viscous making patients more prone to thrombus formation

42
Q

Examinatin findings in pulmonary hypertension

A

Right ventricular heave
Loud P2
Raised JVP
Peripheral oedema

43
Q

What are the findings related to right to left shunt and chronic hypoxia?

A

Cyanosis
Clubbing
Dysponea
Plethroic complexion

44
Q

What is the management of eisenmengers syndrome?

A

Once the pulmomnary pressure is high enough to cause the syndrome it cant be medically reversed. Only definitive treatment is a heart lung transplant
Closely followed by a specialist
Medical manegemtn involves: Oxygen can help manage symptoms
Pulmonary hypertension: sildendail
Arrhythmia treatment
Treatment of polycythemia with venesection
Prevention and treatment of thrombosis with anticoagulation
Prevention of IE using prophylactic abx

45
Q

What is coarctation of the aorta?

A

Congenitral condition where there is a narrowing of the aortic arch

46
Q

What is the presentation of coarctation of the aorta?

A

Often the only indication is a weak femoral pulse
Four limb bp- high bp in ones before narrowing and low bp in ones after
May be a systolic murmur below the left clavicle and below the left scapula
Tachyponea and increased work of breathing
Poor feeding
Grey and floppy baby
Left ventricular heave
Underdeveloped left arm where there is reduced flow to the subclavian artery
Underdevelopment of the legs

47
Q

What is the management of coarctation of the aorta

A

Mild- Ca live symtpom free until adulthood without requiring surgical input
Severe-Patients will require emergency surgery shortly after birth
Critical- Risk of HF and death. Prostanglandin E is used to keep ductus arteriosus opem while awaiting surgery. Then surgery asap

48
Q

What is the presentation of aortic stenosis?

A

Mild- Asymptomatic. Incidental discovery
More severe- Fatigue, SOB, dizziness and fainting
Symptoms worse on exertion
Severe- Present with HF within months of birth

49
Q

Signs of aortic stenosis

A 
Ejection systolic mumur in aortic area
Crescendo-decrescendo
Radiates to carotids
Ejection click just before the murmure
Palpable thrill during systole
Slow rising pulse and narrow pulse pressure
50
Q

Management of aortic stenosis?

A

Percutaneous baloon aortic valvoplasty
Surgical aortic valvotomy
Valve replacement

51
Q

What are the complications of aortic stenosis?

A 
Left ventricular outflow tract obstruction
HF
Ventricalr arrhythmias
Bacterial endocarditis
Sudden death
52
Q

Congenital pulmonary valve stenosis is associated with what?

A

Teratology of fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome

53
Q

What is the presentation of pulmonary valve stenosis

A

Asymptomatic
More significant- Pulmonary valve stenosis
Can present with symptoms of fatigue on exertion, SOB, dizziness and fainting

54
Q

What is the management of pulmonary valve stenosis?

A

ECHO to investigate
Mild- Symptoms patients generally do not require any interventions
Symptomatic or significantly stenosed, balloon valvulopasty via a venous catheter
Open heart surgery

55
Q

What are the 4 coexisting patholgies of the teratology of fallout?

A

VSD
Overriding aorta
Pulmonary valve stenosis
RVH

56
Q

What are the risks factors of teratology of fallout?

A

Rubella infection
Increased age of the mother
Alcohol consumption in pregnancy
Diabetic mother

57
Q

Investigation of teratology of fallot?

A

ECHO
Doppler flow study
CXR- Boot shaped heart due to RV thickening

58
Q

What is the presentation of teratology of the fallout?

A

Most cases are picked up before the child is born during the antenatal scans
Ejection systolic murmur caused by the pulmonary stenosis may be heard on newborn check
Severe cases will present with HF before one year of age
In milder cases they can present as older children once they start to develop signs and symptoms of HF

59
Q

What are signs and symptoms of HF?

A 
Cyanosis
Clubbing
Poor feeding and poor weight gain
Tet spells
Ejection systolic murmur loudest in pulmonary area
60
Q

What are Tet spells?

A

Intermittent symptomatic periods where the right to left shunt becomes temporarily worsened precipitating a cyanotic episode

Pulmonary vascular resistant increases or systemic resistance decreases for example If child exerting get more CO2
CO2 is a vasodilatorand therefore reduces systemic vascular resistance

Blood goes from RV to aorta rather than pulmonary vessels

Episodes percipitated by waking, physical exertion or crying
Child will become irritable, cyanotic and SOB

Severe spells can lead to reduced consciousness, seizures and potentially death

61
Q

Tet spell treatment options

A

Older children may squat
Younger children can be positioned with their knees to chest
These increase systemic vascular resistance

Any medical management should involve an experience paediatrician as they can be potentially life threatening: Supplementary oxygen, beta blockers, IV fluid, morphine, sodium bicarbonate and phenylephrine infusion

62
Q

What is the management of teratology of fallout?

A

In neonates, a prostaglandin infusion can be used to maintain the ductus arteriosus. Allows blood to flow from the aorta back to the pulmonary arteries

Total surgical repair by open heart surgery is the definitive treatment however mortality from surgery is around 5%

Prognosis depends on the severity, however it is poor without treatment. With corrective surgery 90% of patients will live into adulthood

63
Q

What is ebstein’s anomaly?

A

Congenital heart condition where the tricuspid valve is set lower in the right side of the heart causing a bigger RA and a smaller RV
Leads to poor flow from RA to RV
Poor flow to pulmonary vessels
Often associated with a right to left shunt via an atrial septal defect
Also associated with WPW

64
Q

What is the presentation of Ebsteins anomaly

A 
Evidence of hearth failure
Gallop rhythm heard on auscultation
Cyanosis
SOB and tachyponea
Poor feeding
Collapse or cardiac arrest
65
Q

What are the investigations for ebstein’s anomaly?

A

ECG: Arrhythmias, right atrial enlargement, right bundle branch block, left axis deviation

CXR: Cardiomegaly and right atrial enlargement

Echocardiogram: Investigation of choice for confirming the diagnosis and assessing the severity

66
Q

What is the management of ebstein’s anomaly?

A

Treat arrhytmias and HF
Prophylatic ABX may be used to prevent IE
Defintive management is by surgical correction of the underlying defect

67
Q

What is the transposition of great vessels?

A

Where the attachments of the aorta and the pulmonary trunk to the heart are swapped
RV pumps blood into the aorta and LV pumps blood into the pulmonary vessels

2 separate circulations do not mix: one travelling through the systemic systems and right side of the heart and other travelling through the pulmonary system and left side of the heart

68
Q

What is transposition of the great vessels associated with?

A

VSD
Coarctation of the aorta
Pulmonary stenosis

69
Q

What is the presentation of transposition of the great vessels?

A

Often diagnosed during pregnancy with antenatal US scans
If not detected in pregnancy it will present with cyanosis at or within a few days of birth
ASD or VSD can initially compensated by allowing blood to mix between circulation but within a few weeks of the life they will develop respiratory distress, tachycardia, poor feeding, poor weight gain and sweating

70
Q

What is the management of transposition of the great vessels?

A

When there is a VSD this will allow some mixing of blood
Prostanglandin infusion can be used to maintain the ductus arteriosus. This allow blood from the aorta to flow to the pulmonary arteries for oxygenation
Balloon septostomy involves inserting a catheter into the foramen ovale via the umbilicus and inflating a balloon to create a large ASD. Allows blood returning from the lungs to flow to the right side of the heart and out through to the aorta to the body
Open heart surgery-Definitive management. Cardiopulmonary bypass machine is used to perform an arterial switch procedure within a few days of birth

Paediatrics (142 decks)

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