Paediatric Cardiology

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Paediatric Cardiology by Mind Map: Paediatric Cardiology

1. Presentation:

1.1. Murmurs

1.1.1. 70-80%- INNOCENT MURMURS Systolic No other signs of cardiac disease Soft murmur Vibratory/musical Localised Varies with position, respiration, excercise

1.1.2. Stills Murmur LV outflow murmur Ages 2-7yrs Apex, left sternal edge Soft, systolic, increases in supine position w excercise

1.1.3. Pulmonary outflow murmur Ages 8-10yrs Soft, systolic, vibratory Upper left sternal border, localised Increases in supine w excercise Child may have narrow chest

1.1.4. Carotid/Brachiocephalic arterial bruits Ages 2-10yrs 1/6-2/6 systolic- HARSH Supraclavicular and radiates to neck Increases w exercise and reduces when turning or extending neck

1.1.5. Venous Hum Ages-3-8yrs Soft, indistinct Continuous murmur sometimes w diastolic attenuation Supraclavicular Only present when upright in position

1.2. Cyanosis

1.3. Failure to thrive

1.4. Rhythm Disturbance/ Collapse/Syncope

2. History:

2.1. Tachyopnea

2.2. Chest Pain

2.3. Syncope

2.4. Palpitations

2.5. Reduced ETT

2.6. Poor eating/feeding, weight gain and development

2.7. Join Problems

3. Congenital Heart Defects

3.1. Aetilogy

3.1.1. Genetic Chromosomal anomalies account for 6-10% of CHD

3.1.2. Environmental Drugs Alcohol, Amphetamines, Illicit Infections Rubella, CMV, herpes, Toxoplasma Maternal DM, SLE

3.1.3. Teratogenic

3.2. 30% of live births

3.3. Trisomy 13- 90% ASD and VSD

3.4. Trisomy 18- 80% VSD and PDA

3.5. Trisomy 21- 40% AVSD- DOWN'S SYNDROME

4. Examination

4.1. Weight

4.2. Height

4.3. Cyanotic

4.3.1. Tetrology of Fallot

4.4. Clubbing

4.5. SOB

4.6. Pulses/Apex

4.6.1. Absent femoral pulse- Coarctation of Aorta

4.7. Heart Sounds

4.8. Murmurs

4.8.1. Timing- Systole/Diastole/Continuous

4.8.2. Duration- Early/Mid/Late or Ejection/Holo/Pansystolic

4.8.3. Pitch- Harsh/Soft

4.9. Dysmorphic Features-DOWNS

4.10. Oedema- Bilateral Pitting shows severe cardiac problems

4.10.1. Bi-ventricular failure

5. Invesitgations

5.1. BP

5.1.1. UL High or LL Low- Coarctation of Aorta

5.2. O2 Sats

5.3. ECG

5.4. CXR

5.4.1. Transposition of Great Vessels- EGG shaped appearance

5.4.2. Tetrology of Fallot- BOOT shaped appearance

5.5. Echo

5.6. Cath Lab

5.7. Angiography

5.8. MRI

5.9. ETT

6. Acyanotic Conditions

6.1. Coarctation of Aorta

6.1.1. Present With collapse (4-10days)

6.1.2. No murmurs

6.1.3. Fluids don't help

6.1.4. Conservative management normally but may need surgical resection

6.2. VSD

6.2.1. Two types- Muscular and Perimembranous

6.2.2. Muscular uually small and closes spontaneously

6.2.3. Noticed at about week 3

6.2.4. Consequent Pulmonary Hypertension- no treatment, bi-ventricular hypertrophy

6.2.5. PAN SYSTOLIC MURMUR, left lower sternal edge w a thrill

6.2.6. Unclosed Left to Right shunt

6.2.7. Surgery for closure if not spontaneous- Patch/Amplatzer device

6.3. ASD

6.3.1. Two types- Osteum Primum from Septum Primum  and Septum Secondum

6.3.2. Type 1- Mimics VSD in signs and consequences ECG shows- Superior axis- left axis deviation w RV hypertrophy

6.3.3. Type 2- Often no signs may be identified in adulthood as AF, Ejection systolic

6.3.4. Good chance of closure spontaneously unless large

6.4. PDA

6.4.1. Ibprufoen and Indomethacin within 24hrs for closure

6.4.2. Continuous Murmur

6.4.3. Duct dependent conditions are an exception- transposition, hypoplastic, coarctation- PROSTOGLANDINS to open duct

7. Cyanotic Conditions

7.1. Tetrology of Fallot

7.1.1. Systolic Murmur

7.1.2. Pulmonary Stenosis, VSD, Overriding Aorta, RVH

7.1.3. Admit, O2, B-blocker, BT shunt (Subclavian A->Pulmonary A

7.2. Transposition of Great Vessels

7.2.1. No Murmurs

7.2.2. Ventilate + Prostoglandins

7.2.3. Scan- 2 parallel vessels on echo

7.2.4. Acidosis/Hypoxia

7.2.5. Surgical Treatment