1
Q
cyanotic heart disease (R->L shunt)
A
- transposition of great arteries
2.critical pulmonary stenosis - total anomalous venous return
- tetralogy of fallot ** (most common)
- tricuspid atresia
- hypoplastic L heart
2
Q
acyanotic L -> R shunts heart disease
A
- VSD
- ASD
- PDA
3
Q
acyanotic ostructive heart disease
A
coarctation of aorta
aortic stenosis
pulmonary stenosis
4
Q
features of tetralogy of fallot
A
- VSD
- overriding aorta
- pulmonary stenosis
- R ventricular hypertrophy
5
Q
presentation of tetralogy of fallot
A
- antenatal diagnosis
- collapsed neonate in first few days of life
- cyanotic
- murmur - systolic with thrill (Pulmonary stenosis)
- tet spells at 4-6 months old
6
Q
management of ‘tet spells’
A
- squatting/ raising knees to chest
- oxygen
- morphine
- fluid bolus
7
Q
diagnosis of tetralogy of fallot
A
- CXR - boot shaped heart
- ECHO **
- ecg - R axis deviation, R ventricular hypertrophy
8
Q
Management of tetralogy of fallot
A
- prostaglandin. 5-10 nanograms/kg/min
- surgical intervention at 4-6 months old
- full closure when VSD closed or 2 stage (Blalcok taussig shunt and then definitive repair)
9
Q
presentation of total anomalous pulmonary venous drainage
A
cyanotic
1st few hours of life
Increased WOB
increased lactate
10
Q
presentation of transposition of great arteries
A
- antenatal
- collapsed cyanotic neonate in day 1-5 of life
- unable to correct with 100% oxygen
11
Q
investigations for transposition of great arteries
A
- CXR - ‘egg on side’
- ECHO **
12
Q
management of transposition of great arteries
A
- intubate and ventilate
- prostaglandin iV
- interventional balloon atrial septostomy (enlarges foramen ovale for mixing of blood) OR pulmonary artery banding (if have VSD)
- arterial switch procedure *
13
Q
features of ebstains anomlay
A
abnormal displacement of abnormal tricuspid valve…
- older child
- fatigue
- palpitations
4.gallop rhythm with multiple clicks
14
Q
presentation of VSD
A
- pansystolic murmur - heard at baby check
- present with heart failure 6-8 weeks - resp distress, tiring on feeding, reduced exercise tolerance, faltering growth, displaced apex beat
15
Q
investigations for VSD
A
- CXR - Normal or cardiomegaly + pulmonary oedema
- ECG - L ventricular hypertrophy
- ECHO **
16
Q
Management of VSD
A
- depends on size of VSD if need surgical closure / patch (early closure indicated by heart failure/ faltering growth/ pulmonary HTN)
- diuretics - to reduce volume overload
- ACE-I - to reduce L ventricular afterload
17
Q
cause of ASD
A
failure of endocardial cushion development
most common ASD is secundum ASD = defect in atrial septum involving fossa ovalis
18
Q
presentation of ASD
A
- ejection systolic murmur over left sternal edge
- fixed wide split second heart sound
- heart failure / increased risk fo chest infections
19
Q
management of ASD
A
interventional cardiac catheterisation at 3-5 y/o
20
Q
murmur in pulmonary stenosis
A
systolic murmur
click heard
thrill
radiates to back
21
Q
murmur in PDA
A
machinery continuous murmur
heard best at L infraclavicular border
22
Q
murmur in aortic regurgiation
A
diastolic murmur at left sternal border
radiate to apex of heart
23
Q
murmur in aortic stenosis
A
ejection systolic murmur heard over right upper sternal border
24
Q
describe an innocent murmur
A
systolic
grade 2/6
well child
murmur changes with movement
25
mitral regurgitation murmur
pansystolic heard over cardiac apex
radiate to axilla
displaced apex beat
splitting of heart sounds
26
define PDA
presence of ductus arteriosus beyond 1 month of corrected gestation (usually closes by day 7) causing L->R shunt
27
risk factors for pDA
- females
- premature babies
- trisomy 21
- congenital rubella
- fetal alcohol syndrome
28
presentation of PDA
- asymtomatic
- can develop heart failure, faltering growth
- preterm : dependence on resp support, swinging oxygen sats
- continuous machinery murmur at upper l sternal edge (can have systolic and diastolic murmur)
29
management of pDA
1. fluid restriction
2. high calorie milk
3. diuretics - furosemide and spiro
4. paracetamol ** (COX inhibitor) or ibuprofen or indomethacin for 3 days - pharmacological closure
5. transcatheter surgical closure - if heart failure and term
30
associations with coarctation of the aorta
- 85% have bicuspid aortic valve
- boys
- turner syndrome
31
presentation of critical coarctation of the aorta
1. collapsed neonate day 2-7
2. weak/ absent femoral pulses
3. tachypnoea/ poor feeding
4. poor perfusion
32
presentation of non critical (post ductal) coarctation of the aorta
1. present when older
2. asymptomatic
3. hypertension of upper limbs - resistant to medications, causes headaches/ nephropathy
4. BP in lower limbs < upper limbs
5. ejection systolic murmur at upper r sternal edge radiating to back
33
investigations for suspected coarctation of the aorta
1. ECHO
2. high lactate
3. CXR - normal.
34
management of critical coarctation of the aorta
1. iV prostaglandin
2. inotropes
3. subclavian flap repair / if unstable, balloon dilatation of the aorta
35
complications post surgical repair of coarctation of the aorta
- ischaemia of spinal cord
- systemic hypertension
- re-coarctation
- aortic aneurysm
36
presentation of hypoplastic L heart syndrome
1. collapsed neonate in first few day of life
2. maternal obesity prevents detection antenatally
3. metabolic acidosis
4. difficult to feel pulses
37
management of hypoplastic L heart syndrome
1. target sats 75-85%
2. prostaglandin
3. surgery...
1st stage = norwood
2nd stage= glenn provedure
3rd stage = fontan procedure
38
bacterial causes of infective endocarditis
1. staph aureus **
2. streptococus viridans
3. haemophilus
4. staph epidermidis (prosthetic valve)
5. kingella
39
risk factors for infective endocarditis
- congenital heart disease
- long term venous catheters
- immunosuppression
- previous IE
- IVDU/ tattoos/ dental procedures
40
presentation of infective endocarditis
FEVER + NEW MURMUR
- malaise/ rashes/ hepatosplenomegaly
- Janeway lesions
- Roth spots
- osler nodes
41
criteria for diagnosis of infective endocarditis
DUKES CRITERIA
2 x major or 1 x major + 3 x minor
MAJOR CRITERIA
1. 2 x positive blood culture
2. ECHO findings e.g. mass/ vegetation. abscess
MINOR CRITERIA
1. predisposing criteria
2. fever
3. vascular phenomena e.g. janeway lesions, septic pulmonary infarct, intracranial haemorrhage
4. immunological phenomena e.g. roth spots, oslers node, glomerulonephritis
42
management of infective endocarditis
4-6 weeks of IV antibiotics (ceftriaxone and gentamicin)
43
cause of rheumatic fever
group A strep
normally 2-3 weeks post sore throat/ URTI
44
criteria/ diagnosis of rheumatic fever
DUCKETT JONES CRITERIA
2 x major or 1 x major + 2 x minor
MAJOR
C- carditis - fever,murmur
A- arthritis
S - subcutaneous nodules
E - erythema marginatum - macular lesions with pale centres
S - sydenhams chorea - rapid involuntary movements
MINOR
F - fever
R - raised CRP/ ESR
A - arthritis
P - prolonged pR interval
P - previous RF
45
management of rheumatic fever
1. ECG - prolonged PR interval (1st degree heart block)
2. anti streptolysin o titre +ve
3. bed rest
4. treat with penicillin
46
causes of myocarditis
1. viral ** - adenovirus *, coxsackie, parvovirus
2. autoimmune
3. toxic
47
presentation of myocarditis
1. new/ acute onset of heart failure (dilated cardiomyopathy) in well child
2. recent viral illness
3. new murmurs - gallop rhythm
48
investigations for myocarditis
1. raised troponin
2. ECHO - secondary pericardial effusions
49
presentation of pericarditis
1. chest pain - radiates to shoulder, sharp, movement/ inspiration worsens pain
2. pericardial rub
3. R sided heart failure e.g. raised JVP, pedal oedema, hepatomegaly
4. muffled heart sounds
5. fever
50
ECG in pericarditis
wide spread saddle ST elevation
51
ECG of SVT
narrow complex tachycardia (< 120ms QRS)
no p waves
regular
HR >200 bpm
52
types of SVT
1. AV re-entry tachycardia (80%) = re-enterant loop due to accessory conduction pathway e.g. WPW
2. AV nodal re-entry tachycardia (15%) = re-enterant circuit within AVN causing rapid conduction from AVN e.g. atrial tachycardias post surgery, spontaneous SVTs, lead to cardiomyopathy
53
investigations for SVT
1. ECG - >200 bpm, no p waves, regular, narrow complex
2. ECHO - look for structural disease
3. 24 hour holter
4. EP studies
54
management of haemodynamically SVT
1. vagal manoeuvres e.g. ice dunk, valsalva, carotid massage
2. IV adenosine 0.1mg/kg - 3mg -> 6mg -> 12mg
3. synchronous cardioversion 0.5-2 J/kg
55
management of shocked SVT
1. synchronised (at R wave) Dc cardioversion 1J/kg
56
describe wolff parkinson white syndrome
accessory conduction pathway between atria and ventricles (AVRT)
- accessory pathway called bundle of kent
- orthodromic AVRT
57
associations with wolff parkinson white syndrome
1. first degree relatives 3%
2. ASD
3. ebstains anomaly
4. cardiomyopathy
58
ECG in wolff parkinson white syndrome
shortened PR interval
delta wave (slurred upstroke of QRS)
widened QRS
VF !!!!
59
management of wolff parkinson white syndrome
1. beta blockers
2. amiodarone
3. flecainide
4. radio frequency ablation
AVOID ADENOSINE OR DIGOXIN as can induce AF or VF
60
congenital causes of long QT syndrome
1. ROMANO WARD SYNDROME
- most common
- autosomal dominant
2. JERVELL AND LANGE NEILSEN SYNDROME
- sensorineural deafness
- autosomal recessive
- defect in potassium channel
61
acquired causes of long QT syndrome
1. drugs e.g. azithromycin, olanzapine, quetiapine, quinine
2. electrolyte - hypokalaemia, hypocalcaemia, hypomagnesiumaemia
3. cocaine
4. mI
5. hypothermia
62
ECG of long QT syndrome
QTc >480 msec
use bazetts formula
63
management of long QT syndrome
1. beta blockers
2. ICD
3. avoid strenuous exercise
64
cause of hypertrophic cardiomopathy
usually autosomal dominant
due to beta cardiac myosin heavy chain
mild hypertrophy - mutation in troponin T
65
presentation of hypertrophic cardiomyopathy
- sudden death
- fatigue
- palpitations
- syncope
- apex displaced
-- flow murmur
66
management of hypertrophic cardiomyopathy
1. ECG
2. ECHO/ cardiac MRI
3. light excercise
4. beta blockers
5. calcium channel blockers
6. ACE-I
7. ICD
67
criteria/ presentation of kawasakis disease
fever for >5 days :
C - conjunctivitis, non purulent
R - Rash - maculopapular, urticarial
A - adenopathy - cervical, unilateral
S - strawberry tongue, cracked lips, red throat
H - hands and feet - desquamation, erythematous
68
cardiovascular complications of kawasakis disease
1. carditis e.g. myocarditis, pericarditis
2. valve disease
3. coronary artery dilatation and aneurysm
69
management of kawasakis disease
1. IV immunoglobulin - given first 7-10 days of illness, reduces aneurysms
2. aspirin (SE= reye syndrome_
3. steroids
70
side effects of digoxin
- yellow vision
- nausea and vomiting
- av block
71
management of VT
1. IV amiodarone
2. DC cardioversion - synchronous, 1J/KG
72
management of VF
DC shock 4J/kg
73
causes of prolonged PR interval (0.12-0.22ms)
- viral myocarditis
- ebsteins
- hyperkalaemia
74
causes of shortened PR interval
- wolff parkinson white
- glycogen storage disease
75
ECG of R ventricular hypertrophy
r axis deviation (V1)
tall R waves in V1 + V4
upright T waves in V1 + V4
deep S waves in V5 + V6
76
ECG of L ventricular hypertrophy
L axis deviation
tall R waves in V5 + V6
deep S waves in V1 + V4
inverted T waves in 1 and AVL
77
ECG in hyperkalaemia
PEAKED T waves
prolonged PR interval
flattened P waves
78
ECG in hypokalaemia
St depression
T wave inversion
prominent U waves
79
duct dependent lesions
1. critical pulmonary stenosis
2. hypoplastic L heart
3. critical aortic stenosis
4. coarctation of aorta
80
AKP
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