P year‎ > ‎Paediatrics‎ > ‎

12.09.13 Cardiology

VSD
  • Loud, pansystolic murmur, LLSB
    • NOT from flow through the defect; more from turbulent flow in the R ventricle
  • Loud S2 if pulmonary HTN
  • Potential for Eisenmenger Syndrome
    • Also caused by ASD, PDA
    • Left-to-right shunt => increased pulmonary flow => damage => pulmonary HTN => Right-to-left shunt => Cyanosis
    • Presents with cyanotic episodes in teenage years


Innocent murmur

  • Systolic
    • Except venous hum, which is innocent but systolic + diastolic
  • Soft
  • Normal heart sounds
  • Normal pulses
  • No thrill
  • No radiation
  • Position dependent
  • Asymptomatic
  • Normal CXR and ECG


Kawasaki syndrome

  • Autoimmune medium-vessel vasculitis
  • Diagnosis:
    • Fever of ≥5 days' duration plus 4 of:
      • Bilateral nonsuppurative conjunctivitis
      • One or more changes of the mucous membranes of the upper respiratory tract
        • Pharyngeal injection, dry fissured lips, injected lips, "strawberry" tongue
      • One or more changes of the extremities
        • Peripheral erythema, peripheral edema, periungual desquamation, generalized desquamation
      • Polymorphous rash
        • Pimarily truncal
      • Cervical lymphadenopathy
        • >1.5 cm in diameter
  • Can cause fatal coronary artery aneurysms
  • Treatment:
    • IVIG
    • Aspirin
      • One of the few conditions for which it's indicated in kids
      • cf Rey's syndrome
    • Plasma exchange
    • Corticosteroids?
      • Poor evidence and may increase risk of coronary artery aneurysms


IVIG therapy

  • Contains the pooled, polyvalent, IgG from the plasma of over one thousand blood donors
  • Effects last between 2 weeks and 3 months
  • Mechanism unclear
    • Activates inhibitory Fc receptors on dendritic cells
    • => anti-inflammatory effects
  • Indications
    • Immune deficiencies
      • X-linked agammaglobulinemia
      • Hypogammaglobulinemia
      • Acquired compromised immunity conditions featuring low antibody levels
    • Autoimmune disease
      • e.g. ITP
    • Inflammatory diseases
      • e.g. Kawasaki disease.
    • Acute infections


Tet spells

  • Problem
    • Not entirely clear
    • Sudden decrease in pulmonary blood flow and therefore oxygenation?
      • Increased pulmonary vascular resistance? (Crying)
      • Fall in systemic vascular resistance
    • Begins a cycle:
      • Acidosis => Hyperventilation
      • => More systemic venous return
      • => More R=>L shunt
      • => Even less pulmonary blood flow
    • Also spasm of pulmonary artery?
  • Place in a knee-chest position 
    • Increase systemic vascular resistance
  • Oxygen
  • IV morphine
    • Venoconstriction => More peripheral venous blood pooling => Less venous return => Less R=>L shunt
    • Sedative effect
  • IV propranolol
    • Relaxes the infundibular muscle spasm causing right ventricular (RV) outflow tract obstruction (RVOTO)

Coarctation of the aorta
  • HARD TO FIND PULSES
  • Ejection systolic murmur radiating to between the shoulder blades
  • Symptoms depend on where to coarctation is
    • Pre-dutal
    • Ductal
    • Post-ductal

  • See rib notching on CXR, due to collateral vessels


Transverse myelitis

  • Pathogenesis
    • Inflammatory process of the spinal cord
    • => axonal demyelination
  • Transverse implies that the inflammation is across the thickness of the spinal cord
  • Causes
    • Post infection
      • CMV?
    • MS
  • Progresses vary rapidly
    • Hours-days
  • Presentation
    • Depends on level
      • Upper cervical cord => Quadriplegia, Resp. paralysis
      • C5–T1 => Combination of upper and lower motor neuron signs in the upper limbs; exclusively upper motor neuron signs in the lower limbs
      • T1–12 => Upper motor neuron signs in the lower limbs, presenting as a spastic diplegia
      • L1–S5 => Combination of upper and lower motor neuron signs in the lower limbs
    • Motor impairment
    • Sometimes have some sensory impairment


Notes

  • AMPLE
    • Allergies
    • Medications
    • Past Medical History
    • Last Eaten
    • Events Leading
  • Breathlessness in a baby makes it hard for them to feed => FTT
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