-
What is the most common group of structural malformation in children?
Congenital heart disease
-
What kind of shunt is an acyanotic heart lesion? (which direction)
- L to R shunt
- ie baby does not have cyanosis
-
what are the 3 most common acyanotic heart lesions?
- VSD
- PDA
- ASD
- THEY ARE THE LEFT TO RIGHT SHUNT TYPES
-
What are the 3 types of outflow obstruction congenital heart lesion? (these are ACYANOTIC)
- Pulmonary stenosis
- Aortic stenosis
- Coarctation of the aorta
-
What are the 3 cyanotic congenital heart lesions?
- Tetralogy of fallot
- Transposition of the great arteries
- Atrioventricular septal defect (complete)
-
In the fetus, which atrium has higher pressure L or R and why?
- L has lower pressure as little blood returning from lungs
- R has higher pressure as it receives all the SYSTEMIC VR inc. blood from PLACENTA
- What happens to the circulation with the first breaths?
- Resistance to pulmonary blood flow falls
- vol of blood through the lungs increases x6
- so get rise in LA pressure
- at same time as placenta is excluded from circulation → less blood returning to RA
-
what causes the flap valve of the foramen ovale to close?
Change in pressure difference – now L>R
-
What does the DA connect and when does it close?
- Connects pulmonary artery to aorta in fetal life
- Normally closes in first few hours/days
-
When does a baby with a duct dependent circulation present?
1-2 days of age when duct closes their condition deteriorates dramatically
-
What are the 5 ways of congenital heart disease presenting?
- Antenatal cardiac US diagnosis
- Heart murmur
- Cyanosis
- Heart failure
- Shock
-
Which mothers have a detailed fetal echocardiogram done?
- Downs syndrome
- Parents have previous child with heart disease
- Mother has congenital heart disease
-
What is the most common presentation of a congenital heart disease?
Heart murmur
-
What is an innocent murmur?
- In a normal heart
- Turbulent flow in outflow tracts/vessels either side of heart
-
What are the 2 types of innocent murmur?
- Ejection murmur: turbulent blood flow in outflow tract, not assoc with structural abnormality. Soft blowing systolic
- Venous hum: turbulent flow in HEAD AND NECK VEINS.
-
Where do you hear a venous hum? What phase?
- CONTINUOUS
- Low pitch rumble heart beneath CLAVICLE
-
What increases a venous hum?
- Inspiration
- Louder after exercise
-
What can a venous hum be mistaken for and how do you distinguish the 2?
- Mistaken for PDA
- But venous hum disappears on lying flat or with compression of jugular veins on the same side
- What are the hallmarks of an innocent ejection murmur? (clue…)
- 5 s’s
- Soft
- Systolic murmur: diastolic murmur by itself is NEVER INNOCENT
- sternal edge – left (localised)
- no added sounds, no radiation
- aSymptomatic patient
-
Why are innocent murmurs often heard during febrile illness/anaemia?
Due to increased CO
-
Why do some infants with VSD or PDA present after several weeks of age?
As their pulmonary vascular resistance is still high for a few weeks then falls later
-
What are the causes of CYANOSIS in a newborn with respiratory distress (>60/min)
- Cardiac disorders – cyanotic congenital heart disease
- Resp disorders: surfactant deficiency, MAS, pulmonary hypoplasia
- Persistent Pulmonary Hypertension of the Newborn (PPHN): failure of the pulmonary vascular resistance to fall after birth
- Infection
- Inborn error of metabolism
- Polycythaemia
-
What level of DEOXYGENATED Hb gives rise to central cyanosis?
Deoxygenated blood exceeds 5g/dL
-
In the neonatal period, what are the 2 main categories, causes of cardiac cyanosis?
- 1. Reduced pulmonary blood flow: infants with duct-dependent pulm circ (relies on DA – so when it closes they become severely cyanosed. They have ROTO so depend on PDA. Severe cyanosis develops when duct closes. Also in Fallot’s get pulmonary stenosis so ROTO
- 2. Abnormal mixing of systemic venous and pulmonary venous blood: present with cyanosis first 2 days. TGA there must be some mixing.
-
On chest x-ray, how do you differentiate between the 2 main causes of cyanotic heart disease?
- Abnormal mixing: pulmonary vascularity is increased, pulmonary plethora is apparent
- Inadequate pulm blood flow: pulmonary vascularity decreased, oligaemic lung fields
-
If echo is unavailable, how is congenital cyanotic heart disease confirmed?
- HYPEROXIA TEST (nitrogen washout)
- Infant is placed in 100% oxygen for 10 minutes
- If the R radial arterial PaO2 remains low <15KPa then cyanotic congenital heart disease can be diagnosed if lung disease & PPHN
- If the PaO2 > 20 then it is NOT cyanotic heart disease
-
How is central cyanosis due to congenital heart disease distinguished from that due to respiratory disease?
Failure of R radial artery PO2 to rise above 15kPa after breathing 100% for 10 minutes
-
What sort of heart lesion do most infants with cyanotic heart disease presenting in first few days of life have? And so what is the Rx?
- Duct dependent (as closes in first few days)
- Rx = maintenance of the ductal patency with PGE
-
What are potential SE of PGE?
- Apnoea
- Jitterniess
- Seizures
- Flushing
- Vasodilation
- Hypotension
-
What are the most common symptoms of heart failure in children?
- Breathlessness – esp on feeding/exertion
- Sweating
- Poor feeding
- Recurrent chest infections
-
What are the signs of heart failure in an infant?
- Poor weight gain, failure to thrive
- Tachypnoea
- Tachycardia
- Murmur, Gallop rhythm
- Enlarged heart
- Hepatomegaly
- Cool peripheries
-
What is the main title and 4 causes of heart failure in the NEONATAL period?
- Obstructed (DUCT DEPENDENT) systemic circulation
- Hypoplastic left heart syndrome
- Critical aortic valve stenosis
- Severe coarctation of the aorta
- Interruption of the aortic arch
- (if the obstruction is very severe, then arterial perfusion may be predominantly by R to L flow of blood via the DA = duct dependent systemic circulation)
-
What are the main causes of heart failure in INFANCY? Which kind of shunt?
- L to R shunt – so volume overload to lungs!
- VSD
- AVSD
- Large PDA
-
In heart failure in infants, when may symptoms increase and then improve and why?
- Increase up to age of 3 months as the pulmonary vascular resistance FALLS initially
- Then improve as pulmonary vascular resistance rises in response to the L to R shunt!
-
If heart failure is untreated in infancy, what complication/syndrome can develop and why?
- L to R shunt, if untreated get EISENMENGER’S SYNDROME
- IRREVERSIBLY raised pulmonary vascular resistance due to chronically raised pulmonary artery pressure and flow
-
What is the treatment of Eisenmenger’s syndrome?
Heart-lung transplant
-
Which Ix do you do in suspected heart failure? And what would they show?
- CXR: enlarged heart, pulmonary congestion/plethora
- ECG: may be suggestive of heart defect
- Echo: shows defect and poor contractility of ventricles
-
What does differential cyanosis in the limbs indicate?
R to L shunting across the DA
-
What are the 2 types of ASD? Which is the more common type?
- Ostium Secundum ASD: 80% of ASDs (more common)
- Ostium primum ASD (also known as partial AVSD)
-
Where is the defect in the secundum ASD? And what causes it?
- High in the atrial septum
- Enlarged Foramen ovale, inadequate growth of septum secundum or xs absorption of septum primum
-
Which syndrome is affected by primum ASD /pAVSD?
Down’s syndrome
-
Which murmur is AVSD commonly associated with?
Mitral regurgitation
-
What are the symptoms of ASD?
- Asymptomatic commonly
- Recurrent chest infection/wheeze
- Heart failure
- Arrhythmia: 40s onwards
-
What is an ASD commonly mistaken for?
Patent foramen ovale
-
How do you distinguish between an ASD and a patent foramen ovale?
- PFO opens only in conditions of raised atrial pressure or volumes
- Whereas ASDs are LARGE and ALWAYS open
-
What % of people have a patent foramen ovale?
1/3
-
What are the 3 physical signs of ASD?
- 1. Fixed and widely SPLIT 2nd heart sound (as RVSV is equal in both insp and exp)
- 2. ESM best heard at upper left sternal edge – due to inc flow across RV outflow tract due to L-R shunt
- 3. With a partial AVSD – apical pansystolic murmur from the AV valve regurgitation
-
Is there a murmur generated by the flow across the ASD, why?
No because it is LOW VELOCITY
-
What does CXR of ASD show?
- Pulmonary plethora
- Cardiomegaly
-
What does ECG of ASD show?
- RV hypertrophy
- Incomplete RBBB
-
Which Ix is needed to diagnose ASD?
Echo
-
What is the Rx of ASD? And what is it trying to prevent?
- Surgical – for secundum insertion of an occlusion device
- Prevent cardiac failure, arrhythmia in later life
-
When is surgery for ASD best done? Where?
- 3-5 years of age
- 30% in cardiac catheter lab
-
Is endocarditis prophylaxis needed for ASD repair?
Not for secundum ASD
-
How are VSDs classified?
According to size
-
What are the symptoms of a small VSD?
Asymptomatic
-
What are the 2 main signs of a small VSD?
- LOUD Pansystolic murmur at lower left sternal edge
- Thrill at lower left sternal edge
- (quiet P2)
-
What do CXR, ECG and echo show in small VSD?
- CXR, ECG are normal
- Echo shows anatomy of defect.
-
What is the management of small VSD?
- Most close spontaneously
- Need antibiotic prophylaxis of bacterial endocarditis before dental extraction
-
What are the symptoms of a large VSD?
- Heart failure
- Breathlessness
- Failure to thrive after 1 week old
-
What are signs of large VSD?
- SOFT pansystolic murmur (because big hole!)
- Apical mid diastolic murmur – due to increased flow across mitral valve after blood has circulated through lungs
- Loud P2 due to raised pulm art DBP
- Tachypnoea
- Tachycardia
- Enlarged liver – due to heart failure
-
What does CXR of large VSD show?
- Cardiomegaly
- Enlarged pulm artery
- Increased pulm vasc markings
- Pulm oedema
-
What does ECG of large VSD show?
- LVH and RVH
- Signs of pulm HTN
-
What is the management of a large VSD – remember medical and surgical
- Drugs for heart failure: diuretics + captopril (ACEi)
- Additional calorie input
- Surgery: at 3-6 months of age to manage heart failure, prevent permanent lung damage from high pressures
-
What is a complication of a VSD – think about having such a big L to R shunt?
- Increased flow in pulm vessels → pulmonary hypertension → increased pressure on R heart → reversal of shunt → so then right to left → CYANOSIS!!!
- = Eisenmenger’s syndrome
-
What is the main complication of Eisenmengers syndrome, and when does E occur?
- Cyanosis
- E occurs in 2nd decade of life
-
What does the DA connect?
Aorta to L pulm artery
-
When does the DA usually close by?
Fourth day of life
-
When is a PDA diagnosed?
If duct does not close after 1 month POST TERM
-
Which direction is the flow of blood in a PDA?
- From aorta to pulmonary artery (L→ R)
- Following the fall in pulm vasc res after birth
-
Give 3 risk factors for PDA?
- Preterm infants
- Downs
- High altitude
-
Is the PDA in preterm infants the same as congenital PDA?
No!
-
What are the 2 main clinical features of a PDA?
- 1. Bounding pulse due to wide pulse pressure
- 2. Machinery murmur
- (if large duct then may get pulm HTN)
-
Describe the change in murmur type in PDA
- Initially SYSTOLIC
- Then as pulmonary vasc res falls – a continuous run off from the aorta to the pulm artery occurs with a continuous MACHINERY MURMUR
- Hear it beneath the clavicle
-
Why does the murmur in PDA continue into diastole?
Because the pressure in the pulm artery is lower than that in the aorta throughout the cardiac cycle
-
Normally the ECG and CXR features of PDA are normal but if large what are the features similar to?
Large VSD
-
What is the management of a PDA?
- If asymptomatic PDA – must close ALL to prevent bacterial endocarditis (higher risk of pulm vasc dis and BE from PDA than VSD! )
- Coil or occlusion device via cardiac catheter at 1yr age
- If large PDA may need surgical close at 1-3 months
-
Usually PDAs are asymptomatic, but if the duct is large what can happen?
- L→ R shunt as pulm vasc res falls
- Heart failure
-
What are the 3 types of outflow obstruction in the WELL child?
- Aortic stenosis
- Pulmonary stenosis
- Adult type coarctation of the aorta
-
If you see aortic stenosis, what other things do you have to exclude?
- Mitral valve stenosis
- Coarctation of aorta
-
How does mild aortic stenosis present?
Asymptomatic murmur
-
How does severe stenosis present?
- Reduced exercise tolerance
- Chest pain on exertion
- SYNCOPE
-
In the neonatal period how many AS present?
- Severe heart failure
- Duct dependent SYSTEMIC circulation leading to shock
-
What causes aortic stenosis?
Partial FUSION of the aortic valve leaflets – so restricted LV exit
-
What is the pulse like in aortic stenosis?
Small volume, slow rising pulses
-
What type of murmur do you get in aortic stenosis? And where do you hear it?
- Ejection systolic murmur radiating to neck
- Murmur in ‘A’ – upper right sternal edge
-
What 2 features do you get of the heart sounds in AS?
- Delayed and soft aortic S2
- Apical ejection click
-
What do you see on CXR of AS?
- Normal or prominent LV
- Post stenotic dilatation of aorta
-
What do you see on ECG of AS? (2 main things)
- LVH – deep S wave in V2 and tall R wave in V6 (>45mm)
- Downward T wave suggests LV strain and severe AS
-
What is the management of AS?
- If symptomatic or high resting pressure gradient across aortic valve need
- BALLOON VALVOTOMY
-
If there is significant AS what will the children eventually need?
Valve replacement
-
What is the pathology of pulmonary stenosis?
Pulmonary valve leaflets are partly fused together – restrictive RV exit
-
What type of pulmonary circulation may some neonates with pulmonary stenosis have?
- Duct dependent pulmonary circulation
- So they present in first few days of life
-
What type of murmur do you get in aortic stenosis? And where do you hear it?
- Ejection systolic murmur
- Murmur in ‘P’ – upper left sternal edge
-
Where do you hear an ejection click in pulm stenosis?
Upper left sternal edge
-
What happens to HS in pulm stenosis?
Soft or absent P2
-
What may you see on CXR of pulm stenosis?
- Normal
- Or post stenotic dilatation of pulm artery
-
What does ECG of pulm stenosis show?
RVH – upright T wave in V1 indicates RVH in children
-
Although most children with PS are asymptomatic, what will eventually occur to them?
- Progressive RVH
- Reduced exercise tolerance
-
What is management of pulm stenosis?
Transcatheter balloon dilatation
-
Why must you palpate for femoral pulses in cardiovascular examination of any child?
Detect coarctation of aorta
-
Which of the 3 outflow obstruction heart defects in a WELL child is not duct dependent?
coarctation of the aorta
-
how is coarctation of aorta classified?
- Preductal: symptomatic infants
- Postductal: asymptomatic chidren
-
What is the prognosis of coarctation of the aorta?
Gradually becomes more severe over many years
-
What are symptoms of coarctation of the aorta?
- Asymptomatic
- May have leg pains or headache
-
What do you find on cardiac examination in coarctation of the aorta? – think systematically
- Pulse: radiofemoral delay (due to blood bypassing the obstruction via collateral vessels in the chest wall – hence pulse in legs is delayed)
- BP: always systemic hypertension in the R arm
- Heart: ESM at upper sternal edge
-
What 2 things do you see on CXR of coarctation of aorta?
- Rib NOTCHING due to development of large collateral intercostal arteries under the ribs posteriorly to bypass obstruction
- 3 sign: aortic knob → notch where coarctation is →post stenotic dilatation
-
What does ECG of coarcation show?
LVH
-
What is management of coarctation, when does this happen?
- When the condition becomes severe (assess by echo), then STENT at cardiac catheter
- May need surgical repair
-
What is the other name for adult type coarctation of the aorta?
Post ductal coarctation
-
What is the other name for interruption of the aortic arch?
Pre ductal coarctation
-
What is the problem with pre ductal coarctation?
No connection between aorta PROXIMAL and DISTAL to the arterial DUCT
-
What other heart defect is commonly seen with preductal coarctation?
VSD
-
When does preductal coarctation present? With what features?
- Neonatal – when DA closes get heart failure!
- Features of duct dependent systemic circulation
-
On diagnosis of preductal coarctation what needs to be done?
PG infusion to maintain ductal patency and transfer to cardiac centre for surgery
-
What is the management of preductal coarctation?
Complete correction with closure of VSD and repair of aortic arch in first few days of life
-
What other conditions is preductal coarctation associated with?
- DiGeorge syndrome
- Palatal defects
- Immunodeficiency
- hypoCa
- 22q11.2 gene deletion
-
What are the 2 forms of outflow obstruction in the sick infant?
- Interruption of aortic arch (preductal coarctation)
- Hypoplastic left heart syndrome
- They are both DUCT DEPENDENT
-
What is hypoplastic left heart syndrome?
Underdevpt of entire L side of heart
-
What happens when the DA constricts in hypoplastic L heart syndrome?
- Profound acidosis and rapid cardiovascular collapse as it is a duct dependent systemic circulation with no L heart!
- Therefore need to give PG urgently!
-
On examination how do you tell between coarctation and hypoplastic left heart syndrome?
- Coarctation: weak FEMORAL pulses
- Hypoplastic L heart: ALL PERIPHERAL pulses are weak/absent
-
What is Rx of hypoplastic L heart syndrome?
Norwood procedure – difficult neonatal operation!
-
In congenital heart disease, what are the 2 causes of CYANOSIS?
- 1. Decreased pulmonary blood flow, with R to L shunt – FALLOTS
- 2. Abnormal mixing of systemic and pulmonary venous return – TRANSPOSITION OF GREAT ARTERIES & TRICUSPID ATRESIA
-
What is the most common cause of cyanotic congenital heart disease?
Tetralogy of fallot
-
What are the 4 main features of Fallot?
- Large VSD
- Overriding aorta
- Subpulmonary stenosis → RVOTO
- RVH as a result
-
When are most Fallots diagnosed?
- Antenatally
- Or after identifying MURMUR in few months of life
-
What is a HYPERCYANOTIC SPELL?
- Rapid increase in cyanosis
- Associated with irritability or inconsolable crying due to severe HYPOXIA and BREATHLESSNESS and PALLOR
- Due to tissue acidosis
-
What are signs of Fallots?
- Clubbing of fingers and toes – older children
- Cyanosis
- Loud single S2 (only A2)
- Loud ESM
-
What type of murmur do you get in Fallots? (remember one of the 4 features…valve one)
ESM at LSE
-
What happens to heart sound in Fallots?
Single 2nd HS – A2
-
What causes the murmur to become shorter and cyanosis to increase?
- Increased RVOTO
- Mainly muscular and BELOW the pulm valve
-
During a hypercyanotic spell what happens to the murmur in Fallots?
Very short or inaudible
-
Why is it important to recognise hypercyanotic spells?
They may lead to myocardial infarction, CVA, death if untreated
-
In fallots what happens on exercise?
Squatting – late in infancy
-
What is the ECG of Fallots at birth and later?
- Birth: normal
- Later: RAD, RVH – upright T wave in V1 with pure R wave (no S wave)
-
What is the characteristic feature on CXR of Fallots?
- Boot shaped (uptilted apex) heart caused by RVH
- As there is pulm stenosis – get decreased pulm blood flow – so dec pulm vasc markings
-
What is the initial management of Fallots? And when is corrective surgery done? What are the 2 main aspects of surgery
- Medical
- Surgery at 6 months age
- 1. Patch closure of VSD
- 2. Widening of RVOT
-
What needs to be done with neonates who are very cyanosed?
- SHUNT to increase pulm blood flow
- Artificial tube between subclavian artery and pulm artery – modified Blalock Taussig shunt
- Or balloon dilatation of RVOT
-
What is management of hypercyanotic spells?
- Morphine – relieve pain and abolish hyperpnoea
- Sodium bicarbonate – correct acidosis
- Propranolol – peripheral vasoconstriction to relieve subpulmonary muscular obstruction that is the cause of reduced pulm bld flw.
- Iv fluids
-
What can be done to prevent hypercyanotic spells?
Oral propranolol
-
What is the problem in transposition of the great arteries?
- Aorta is connected to the RV
- Pulmonary artery is connected to LV
- The blue blood us returned to the body
- Pink blood is returned to the lungs
-
Describe the 2 circulations in TGA? Is it compatible with life?
- 2 PARALLEL circulations
- Unless mixing of blood between the 2 circulations, the condition is incompatible with life
-
What is the main symptom of TGA?
- CYANOSIS!!
- Can be profound and life threatening
-
When does TGA usually present?
- Day 1-2 of life
- When ductal closure leads to a marked reduction in mixing of the desat and sat blood
-
What other anomalies would make the cyanosis less severe?
Mixing of blood from VSD
-
What is the heart sound in TGA?
Single
-
When may you see clubbing in TGA?
Rare child who presents after 1 yr of life
-
What does CXR of TGA look like?
- Narrow upper mediastinum with an egg on side appearance of heart shadow
- Increased pulmonary vasc markings
-
What is the main aspect of management of TGA?
- To improve mixing of saturated and desat blood
- So maintain PDA – PGE infusion
-
What is the life saving procedure for TGA?
- Balloon atrial septostomy
- Catheter with balloon at tip through umb/fem vein to RA and foramen ovale - balloon inflated when in LA then pulled through the atrial septum – tear the septum and makes the flap valve of the foramen ovale incompetent – allow mixing of systemic and pulm venous blood within the atrium
-
What is the definitive Rx of TGA and when is it done?
- Surgery – arterial switch procedure
- Done first few days of life
- Pulm artery and aorta transected above the valves and switched over
-
As well as the pulm and aorta which other arteries need to be transferred in surgery for TGA?
Coronary arteries transferred to the new aorta
-
Who is more likely to get AVSD?
Downs syndrome
-
What is a complication of AVSD?
Pulmonary hypertension
-
What are the different ways AVSD can present?
- Antenatal US screening
- Cyanosis at birth or HF at 2-3weeks
- Routine echo screening for Downs
-
What do you always see on ECG of AVSD?
Superior axis
-
What is the management of AVSD?
- Treat heart failure medically: diuretics, captopril, calories
- Surgical repair at 3-6months
-
What happens to the chambers in tricuspid atresia?
- Only LV is effective
- R is small and non functional
-
Where is there common MIXING of sys and pulm venous return?
LA
-
How does tricuspid atresia present?
- Cyanosis in newborn period if duct dependent
- May be well at birth then become cyanosed or breathless
-
What is management of tricuspid atresia?
- Blalock Taussig shunt – between subclavian and pulm artery
- Pulm artery banding to reduce pulm blood flow if breathless
-
Why is complete corrective surgery for tricuspid atresia not possible?
As there is only one effective functioning ventricle
-
What operation can be done to bypass the RA and RV?
- Glenn: Connecting the SVC to the pulm artery after 6 months
- Fontan: connect IVC to pulm artery
-
how is rheumatic fever diagnosed?
- Duckett Jones criteria
- 2 major
- or 1 major 2 minor
- as well as evidence of preceding strep infection eg ASOT
-
what are major criteria?
CASES
-
what are minor criteria?
- FLAPPP
- fever
- leucocytosis
- arthralgia
- positive acute phase protein
- previous rheumatic fever
- prolonged PR interval on ECG
-
what is Rx of rheumatic fever?
- bed rest
- high dose aspirin to suppress fever and arthritis
- steroids for severe carditis
- diuretics and ACEi for heart failure
- abx if still infection
-
how can recurrent attacks of rheumatic fever be prevented?
- prophylactic penicillin
- lifelong
-
what is main complication of rheumatic fever?
scarring and fibrosis of mitral valve
-
what are the 2 main cardiac infections?
- infective endocarditis
- myocarditis
-
what is main cause of infective endocarditis?
strep viridans (alpha haemolytic)
-
what Ix for IE?
- 3 separate blood cultures in first 24 hours
- echo
- CRP raised
-
what is treatment of infective endocarditis?
- high dose ampicillin
- gentamicin
- 4-6 weeks iv
-
which children need abx prophylaxis against IE?
all CHD except osteum secundum defects
-
what age children does myocarditis affect?
neonates and infants
-
what are the 3 main causes of myocarditis?
- coxsackie
- echovirus
- rubella
-
what are the 2 different presentations of myocarditis?
- acute: cardiovascular collapse
- gradual: congestive cardiac failure
-
what is Rx of myocarditis?
supportive
-
what is complication of myocarditis?
chronic dilated cardiomyopathy
-
what is the upper limit of normal sinus rhythm in children?
210bpm
-
what is the significance of premature atrial and ventricular contractions in children?
common and benign
-
what is heart rate in SVT?
> 220/min
-
what is the cause of SVT in 95% of children?
accessory connection
-
how do children and infants present with SVT?
- children - asymptomatic
- infants - heart failure: poor feed, sweat, irritable
- older children - palpitations
-
how is the diagnosis of SVT made?
- ECG
- narrow complex tachycardia
- P waves after QRS complex
-
which syndrome is related to SVT in children? what causes it?
- Wolff-Parkinson White syndrome
- accessory bundle of Kent - allows premature activation of the ventricles
-
when can you see features of WPW on ECG? what are they?
- when in sinus rhythm
- short PR
- wide QRS
- slurred upstroke - delta wave
-
how is an acute episode of SVT managed in children?
- need to terminate and restore SR by
- - vagal stimulation: ice cold compress to face or carotid sinus massage
- - iv adenosine
- - synchronised DC cardioversion if above fail
-
what is prognosis of SVT?
- good
- majority have no further episodes after infancy
-
if a child has persistent paroxysms of SVT what can be done?
radiofrequency ablation
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