Paediatrics Matrix

Ventricular Septal Defect Ix (R1)

Simple Acyanotic CHD

RF: CHD

Sx: Cough, noisy breathing/breathing difficulties, swelling/oedema, failure to thrive/LOW, short stature, crying/irritable/unwell, dysmorphic features, newborn resp. distress

Ix:

First Line: Clinical Exam (pansystolic murmur), CXR (cardiomegaly, overload)

Gold Standard: Echocardiogram (size, location etc)

Ventricular Septal Defect Mx (R1)

Mx: nutrition, diuretics, ACEi, Surgical Closure

First Line:

Long Term: Surgery (VSD closure if sx)

Cx: pulmonary HTN, HF, cyanotic disease (TOF, truncus arteriosus)

Assoc. Conditions: pulmonary atresia, tetralogy of Fallot, Truncus Arteriosus

Atrial Septal Defect Ix (R1)

Simple Acyanotic CHD

RF: chromosomal assoc. (Downs Syndrome etc)

Sx: Cough, noisy breathing/breathing difficulties, swelling/oedema, failure to thrive/LOW, short stature, crying/irritable/unwell, dysmorphic features, newborn resp. distress

• Often minimal sx until adulthood (acyanotic)

Ix:

First Line: Clinical Exam, CXR (enlarged right heart/pulmonary artery)

Gold Standard: Echocardiograph (size, shunt volume, global cardiac function etc)

Atrial Septal Defect Mx (R1)

Mx: nutrition, diuretics, ACEi, Surgical Closure

First Line:

Long Term: surgery (atrial septosomy, ASD closure)

Cx: HF, pulmonary HTN (chronic left-to-tight shunt and AV valve regurg.)

Assoc. Conditions: pulmonary atresia, Total Anomalous Pulmonary Venous Return

Cardiac Failure Ix (R1)

RF: large left-to-right shunts/valve regurg. (ASD, VSD, PDA)

Sx: Tachypnoea, Cool Extremeties, Reduced Pulses, Cough, noisy breathing/breathing difficulties, swelling/oedema, failure to thrive/LOW, crying/irritable/unwell

Ix:

First Line: Clinical Exam, CXR (cardiomegaly, ↑ pulmonary markings), ECG

Gold Standard: Echocardiograph (ventricular function, valve lesions, shunts etc)

Cardiac Failure Mx (R1)

Mx:

First Line: Stabilize cardiopulmonary function (Diuretics, Dopamine, Ventilation, Correct Metabolic Acidosis)

Long Term: surgery

Cx: pulmonary HTN, cardiogenic shock, chronic ventricular dysfunction\, staged palliation/transplant

Rheumatic Fever (R2)

Multisystem inflammation resulting from an autoimmune response to Streptococcus pyogenes (GAS) usually after recurrent infection (pharyngitis or impetigo)

RF: Children age 5-14yrs, Aboriginal Origin, poverty, overcrowding, genetics, immunosuppression/↓ immunity

Sx: Fever/PUO, Cough, noisy breathing/breathing difficulties, swelling/oedema, failure to thrive/LOW, limp/joint pain, rash/skin changes

• Carditis: SOB, exercise intolerance, tachycardia, apical systolic/basal diastolic murmurs, HF

Ix: Clinical Exam (Duckett Jones ARF Criteria), Throat Swab, ECG (PR Prolongation), Echocardiograph (valvulitis, ventricular dysfunction), ESR/CRP, Antistreptolysin O Titre

• Major Criteria: carditis, polyarthritis, chorea, erythema marginatum, subcut. nodules

Mx: IM benzathine benzylpenicillin

• Acute: Aspirin, Oral Penicillin V/IM Benzyl Penicillin G

• Secondary Prevention: IM Bezathine Penicillin (every 3-4wks until 21yrs if no carditis or 40yrs if carditis present)

• Arthritis/Severe Arthralgia: naproxen, ibuprofen, aspirin

Cx: Chronic Rheumatic Heart Disease (valvular scarring, HF, AF, embolisms, need valvular transplants)

• Rheumatic Heart Disease: damage to the cardiac valves accumulating over recurrent episodes

Patent Ductus Arteriosus (R2)

Simple Acyanotic CHD

RF:

Sx: Cough, noisy breathing/breathing difficulties, swelling/oedema, failure to thrive/LOW, short stature, crying/irritable/unwell, newborn resp. distress

• Murmur = continuous ‘machinery’ murmur

Ix: Clinical Exam, CXR (↑ pulmonary blood flow), Echocardiogram (visualise ductus and quantify shunt)

Mx: Surgery/Interventional (Coil Embolisation, Amplatzer Ductal Occluder via catheter)

Cx: HF, pulmonary HTN, endarteritis

Tetralogy of Fallot/TOF (R2)

Complex Cyanotic CHD

A ventricular septal defect → blocked RV outflow → Aorta override → RV hypertrophy

RF:

Sx: Clinical Cyanosis, Failure to thrive/LOW, short stature, fits/faints/funny turns

• Tetrad: VSD, RV Outflow Obstruction, Overriding Aorta, RV Hypertrophy, Cyanosis, ‘Boot-Shaped’ Heart on CXR

• Clinical Cyanosis, Harsh Systolic Murmur

Ix: Clinical Exam (Harsh Systolic Murmur), CXR (‘Boot-Shaped’ Heart), Echocardiogram (RVOT obstruction, VSD severity)

Mx: requires early surgical intervention (shunt or repair: to ↑ pulmonary blood flow or repair TOF/close VSD)

Cx: Residual RVOT obstruction, pulmonary regurg., arrhythmias, long‑term RV dysfunction

Transposition of Great Arteries (R2)

Complex Cyanotic CHD

Aorta connects to RV rather than LV, receives cyanotic blood, whilst pulmonary arteries connect to LV

RF:

Sx: Cough, noisy breathing/breathing difficulties, failure to thrive/LOW, newborn resp. distress

• Severe Neonatal Cyanosis unresponsive to O2 (due to parallel circulations → survival depends on mixing via ASD, VSD, or PDA)

Ix: Clinical Exam, CXR, ECG, Echocardiogram (aorta arising from RV and pulmonary artery from LV)

Mx: requires early surgical intervention (transposition repair - switches Aorta and Pulmonary Arteries, Atrial septostomy to improve mixing)

• Maintain PDA w prostaglandin where needed

Cx: coronary insufficiency, ventricular dysfunction, arrhythmias

Infective Endocarditis (R2)

RF: valvular/congenital heart disease (RHD, CHD)

Sx: Fever/PUO, embolism, swelling/oedema, pallor, bruising/abnormal bleeding, fits/faints/funny turns, crying/irritable/unwell, eye issues, newborn resp. distress

• Murmur

Ix: Clinical Exam, blood cultures, CRP/ERC, ECG, Echocardiogram (vegetations, valve destruction)

Mx: IV abx, HF mx, Surgery (valve repair/replacement)

Cx: valve destruction, HF, embolic events, RHD

Croup Ix (R1)

RF:

Sx:

Ix:

First Line:

Gold Standard:

Croup Mx (R1)

Mx:

First Line:

Long Term:

Cx:

Asthma Ix (R1)

RF:

Sx:

Ix:

First Line:

Gold Standard:

Asthma Mx (R1)

Mx:

First Line:

Long Term:

Cx:

Cystic Fibrosis Ix (R1)

RF:

Sx:

Ix:

First Line:

Gold Standard:

Cystic Fibrosis Mx (R1)

Mx:

First Line:

Long Term:

Cx:

Bronchiolitis Ix (R1)

RF:

Sx:

Ix:

First Line:

Gold Standard:

Bronchiolitis Mx (R1)

Mx:

First Line:

Long Term:

Cx:

Pneumonia Ix (R1)

RF:

Sx:

Ix:

First Line:

Gold Standard:

Pneumonia Mx (R1)

Mx:

First Line:

Long Term:

Cx:

Obstructive Sleep Apnoea (R2)

RF:

Sx:

Ix:

Mx:

Cx:

Allergic Rhinitis (R2)

RF:

Sx:

Ix:

Mx:

Cx:

Tuberculosis (R2)

RF:

Sx:

Ix:

Mx:

Cx: