Pediatric Cardiology Revision

Key Topics

• Congenital Heart Defects
• Rheumatic Fever
• Infective Endocarditis

Congenital Heart Defects

• Cyanotic vs Acyanotic Defects
  • Cyanotic Defects: Right to left shunt causing deoxygenated blood to enter circulation, leading to cyanosis.
  • Acyanotic Defects: Left to right shunt, mainly oxygenated blood in circulation.

Cyanotic Heart Diseases (1 to 5)

1. Truncus Arteriosis - One great vessel leaving the heart.
2. Transposition of the Great Arteries - Two great arteries in incorrect positions.
3. Tricuspid Atresia - Valve fails to form, mixed blood circulation.
4. Tetralogy of Fallot (ToF) - Four defects: pulmonary stenosis, right ventricular hypertrophy, VSD, overriding aorta.
5. Total Anomalous Pulmonary Venous Return - Pulmonary veins drain to right atrium, requires ASD for survival.

Acyanotic Heart Defects

• Ventricular Septal Defect (VSD)

  • Most common congenital heart defect.
  • Left to right shunt, can lead to Eisenmenger Syndrome if untreated.
  • Management: Patch closure.

• Atrial Septal Defect (ASD)

  • Often asymptomatic, may cause pulmonary hypertension in adulthood.
  • Management: Surgical correction.

• Atrioventricular Septal Defect (AVSD)

  • Risk factor: Trisomy 21.
  • Management: Surgical.

• Patent Ductus Arteriosus (PDA)

  • Connection fails to close postnatally, left to right shunt.
  • Can be necessary for survival in certain defects.
  • Management: NSAIDs in premature infants, surgical if large.

• Coarctation of the Aorta

  • Narrowing of aortic arch, leads to pressure difference between limbs.
  • Risk factor: Turner Syndrome.

Rheumatic Fever

• Occurs post Group A strep infection.
• Jones Criteria
  • Major: Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules.
  • Diagnosis: Culture or antibody testing + criteria.
• Management
  • IM Benzathine penicillin or oral penicillin.
  • Long-term antibiotic prophylaxis.

Infective Endocarditis

• Can be caused by staph, strep, or gram negatives.
• Symptoms: New murmur, fever, peripheral stigmata (rare in children).
• Management: Antibiotic regimen (Ben Pen, Flucloxacillin, Gentamicin).

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Study Tips

• Focus on understanding underlying physiology.
• Memorize buzzwords and key associations for defects.
• Consult provided slides for additional management details.

Exam Strategy

• Prioritize congenital heart defects.
• Understand cyanotic vs acyanotic classifications.
• Be aware of the Jones Criteria for rheumatic fever.