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paeds cardiac
.
35
Medical
Undergraduate 4
04/17/2017

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Cards

Term
hallmarks of innocent murmurs
Definition
asymptomatic pt
soft blowing murmur
systolic murmur
left sternal edge
Term
what are the left to right shunts?
Definition
ASD
VSD
PDA
Term
a fixed widely split S2 implies what?
Definition
ASD
Term
features of small VSD
Definition
pansystolic murmur at LLSE
loud murmur implies smaller defect
no pulmonary HTN
lesions close spontaneously
Term
ejection systolic murmur best heard at upper left sternal edge
fixed splitting of s2
what is it?
Definition
ASD

if there is a pan systolic murmur at apex then this is partial AVSD

mx: catheter device closue for secundum ASD
surgery for partial AVSD. both done at 3years.
Term
continous murmur at upper left sternal edge with bounding pulses. what defect am i?
Definition
PDA
Term
describe the murmur of VSD
Definition
pansystolic murmur and left lower sternal edge
Term
what is different between a small and large VSD?
Definition
small VSD murmur louder and no pulmonary HTN
large VSD, quiete murmur and presence of pulmonary HTN.
Term
what is the hyperoxia nitrogen washout test?
Definition
used to determine the presence of heart disease in a cyanosed neonate
place infant in 100% for 10mins
if right radial artery PaO2 from ABG remains low <15kPa after this time then a diagnosis of cyanotic congenital heart disease is made.
Term
signs of tetralogy of fallout on CXR?
Definition
boot shaped heart and concave pulmonary artery bay on the left hand side.
Term
if CXR reveals a narrow upper mediastinum with an egg on the side appearance of the cardiac shadow what are you thinking?
Definition
transposition of the great arteries.
Term
name 3 cyanotic congenital heart disease
Definition
TOF
TGA
eisenmengers syndrome
Term
list the left to right shunts
Definition
ASD partial and secundum
VSD small and large
PDA
Term
name cyanotic congenital heart disease
Definition
TOF
EISENMENGERS
TGA

these are also call right to left shunts
Term
name common mixing heart conditions
Definition
AVSD
complex disease e.g. tricuspid atresia
Term
causes of outflow obstruction in a well child
Definition
aortic stenosis
pulmonary stenosis
adult type coarction of aorta
Term
left heart outflow obstruction in a sick child - duct dependent lesions
Definition
coarction of aorta
interruption of aortic arch
hypo plastic left heart syndrome
Term
what is important in duct dependent lesions?
Definition
prostaglandin infusion to keep the PDA open.
Term
how would you use the pulse to differentiate between hypo plastic left heart syndrome and correction of the aorta?
Definition
there is weakness or absence of all pulses in hypo plastic left heart syndrome

in coarction of aorta there are weak femoral pulses.
Term
mx of hypo plastic left heart syndrome?
Definition
neonatal Norwood procedure
followed by glenn or Hemi Fontan at ~6 months and
again Fontan at 3 years
Term
describe the cyclical change in heart rate with respiration
Definition
acceleration with inspiration
slowing on expiration
Term
rx of complete heart block
Definition
infants usually have anti-to and anti-la antibodies
all children with symptoms need endotracheal pacemaker
Term
features of long QT syndrome
Definition
AD inheritance with many phenotypes
has been associated with erythromycin therapy, electrolyte disorders and head injury
Term
jones criteria what is needed to diagnose endocarditis?
Definition
two major

or
one major and two minor
Term
major manifestations of endocarditis jones criteria
Definition
pancarditis
polyarthritis
sydenham chorea
erythema marginatum
subcutaneous nodules: mainly on extensor, painless
Term
describe the erythema marginatum rash
which condition is it found in?
Definition
rash on trunks and limbs
pink macules spread outwards causing pink border with fading centre
borders may unite to give a map like outline
Term
describe features of the minor jones criteria
Definition
fever
polyarthralgia
hx of rheumatic fever
raised acute phase reactant, ESR, CRP leucocytosis
prolonged PR interval on ECG
Term
what is the most common murmur in IE?
Definition
aortic regurgitation
Term
how should blood cultures be taken to ix IE?
Definition
3 sets of bloods from peripheral sites with at least 6 hours between them before Abx have been commenced

in those with acute presentation and septic shock take 2 sets of cultures within different times of the hour before starting ABx
Term
what is required from the modified DUKES criteria to diagnose IE?
Definition
two major or
one major 3 minor or
5 minor
Term
DUKE major criteria?
Definition
positive blood culture from 2 sets
evidence of endocardial involvement
positive echo for IE
Term
mx for native valve endocarditis?
Definition
amoxicillin and gentamicin
Term
mx for prosthetic valve endocarditis?
Definition
vancomycin, gentamicin and rifampicin
Term
carey coombs murmur
Definition
due to vegetations on mitral valve in IE
Term
austin flint murmur
Definition
due to severe aortic regurg
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