common congenital cardiac lesions
- ventricular septal defect
- patent ductus arteriosus
- atrial septal defect
- pulmonary stenosis
- aortic stenosis
- coarctation of aorta
- transposition of great arteries
- tetralogy of fallot
drug factors affecting baby heart
- alcohol
- amphetamines
- cocaine
- ecstasy
- phenytoin
- lithium
infection factors affecting baby heart
Toxoplasma
Rubella
CMV
herpes
maternal factors affecting baby heart
DM
systemic lupus erythematosus
describe presence of congenital heart defects in downs syndrome
- trisomy 21
- AVSD
history taking congenital heart defect
- feeding
- weight
- development
- cyanosis
- tachypnoea
- dyspnoea
- exercise tolerance
- chest pain
- syncope
- palpitations
- joint problems
CHD examination
- weight and height
- dysmorphic features
- cyanosis
- clubbing
- tacky/dyspnoea
- pulses/ apex
- heart sounds
- murmurs
CHD investigations
- blood pressure
- O2 stats
- arterial BGA
- ECG
- CXR
- echo
- catheter
- angiography
- MRI
- exercise testing
methods for improving CHD if you can’t fix it
- medication
- paliative procedure e.g. BT, balloon valvoplasty, prostaglandin infusion, pulmonary banding
common features of innocent murmurs
- systolic murmur
- no other signs of cardiac disease
- soft murmur (grade 1-2/6)
- vibratory, musical
- localised
- varies with position, respiration, exercise
describe stills murder
- LV outflow murmur
- age 2-7
- soft systolic, twangy
- apex @ left sternal border
- increases in supine position and with exercise
describe pulmonary outflow murmur
- age 8-10
- soft systolic
- vibratory
- upper left sternal border (well localised, not radiating to back)
- increases in supine position and with exercise
- often children with narrow chest
describe carotid/ brachiocephal IC arterial bruits
- age 2-10
- 1-2/6 systolic
- harsh
- supraclavicular
- radiates to neck
- increases with exercise, decreases on turning head or extending neck
describe venous hum
- age 3-8
- soft indistinct
- continuous murmur, sometimes with diastolic accentuation
- supraclavicular
- only in upright position, disappears when lying down or turning head
3 main types of ventricle septal defects
- subaortic
- perimembranous
- muscular
clinical presentation ventricle septal defects
- pansystolic murmur lower left sternal edge, sometimes with thrill
- signs of cardiac failure if large
eventually leads to biventricular hypertrophy and pulmonary hypertension
methods for VSD closure
- amplatzer or other occlusion device, trans-catheter
- patch closure (open heart surgery)
clinical presentation of atrial septal defects
- few clinical signs in early childhood
- sometimes detected in adulthood with AF, HF or pulmonary hypertension
- wide fixed splitting of 2nd heart sound, pulmonary flow murmur
presentation mild pulmonary stenosis
asymptomatic
presentation moderate and severe pulmonary stenosis
exertion dysponoea and fatigue
presentation of severe aortic stenosis
- reduced exercise tolerance
- exertional chest pain
- syncope
- ejection systolic murmur upper right sternal border, radiation into carotids
changes to fetal circulation at birth
- pulmonary vascular resistance falls
- pulmonary blood flow rises
- systemic vascular resistance is increased
- ductus arteriosus closes
- foramen ovale closes
- ductus venosus closes
management of patent ductus arteriosus in newborns
- fluid restriction + diuretics
- prostaglandin inhibitors
- surgical ligation
what CHD is common in pre-term infants
patent ductus arteriosus
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Children with Special Needs30
-
Vomiting and Malabsorption in Childhood29
-
Resp Paediatrics28
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infectious diseases part 114
-
intro to neonatology16
-
neonatal physiology20
-
A Childs Journey23
-
paediatric nephrology68
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Child Protection9
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endocrine and diabetes29
-
dermatology49
-
rheumatology17
-
urology21
-
Intro to Paeds Surgery30
-
the injured child17
-
liver and infant nutrition23
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acute paeds approach5
-
paediatric oncology29
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infectious disease part 2+331
-
neurology56
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cardio25
-
adolescent health12
-
paeds pharmacology26
