Cardiology

Question 1

Characteristics of innocent murmurs?

Answer 1

systolic
soft
short
symptomless
situational (squatting, sick)

Question 2

Causes of pan-systolic murmurs?

Answer 2

mitral regurgitation (mitral area)
tricuspid regurgitation (tricuspid area)
VSD (left lower sternal border)

Question 3

Causes of ejection systolic murmurs?

Answer 3

aortic stenosis (aortic area)
pulmonary stenosis (pulmonary area)
HOCM

Question 4

What is a patent ductus arteriosus?

Answer 4

failure of the ductus arteriosus to close after birth

Question 5

Presentation of PDA?

Answer 5

murmur
dyspnoea
difficulty feeding
poor weight gain
LRTIs

Question 6

What murmur does a PDA cause?

Answer 6

continous crescendo-decrescendo ‘machinery’ murmur

Question 7

Diagnosis of PDA?

Answer 7

echo

Question 8

Mx of PDA?

Answer 8

monitoring with echo for the first year -> high probability that PDA will spontaneously resolve
after 1 yr -> trans-catheter or surgical closure

Question 9

What is an Atrial Septal Defect?

Answer 9

hole in the wall between the two atria

Question 10

Types of ASD?

Answer 10

ostium secondum
patent foramen ovale
ostium primum (tends to lead to AVSD)

Question 11

Complications of ASD?

Answer 11

stroke (in DVT)
AFib or AFlutter
pulmonary HTN
right-sided heart failure
Eisenmenger’s syndrome

Question 12

What murmur does an ASD cause?

Answer 12

mid-systolic crescendo-decrescendo with a fixed split second heart sound

Question 13

Presentation of ASD?

Answer 13

murmur
asymptomatic in childhood (presents as an adult with HF or stroke)
dyspnoea
difficulty feeding
poor weight gain
LRTIs

Question 14

Mx of ASD?

Answer 14

referral to cardiology
watch and wait
transvenous catheter closure or open heart sx
anticoagulation

Question 15

Presentation of VSD?

Answer 15

murmur
poor feeding
dyspnoea
tachypnoea
failure to thrive

Question 16

What murmur is associated with VSD?

Answer 16

pan-systolic murmur mor prominently heard at left lower sternal border in the third and fourth intercostal spaces
+/- pansystolic thrill on palpation

Question 17

Mx of VSD?

Answer 17

referral to cardiology
watch and wait
transvenous catheter closure
open heart sx
consider antibiotic prophylaxis in sx for infective endocarditis

Question 18

What is Eisenmenger’s syndrome?

Answer 18

when a left-to-right shunt causes a build-up of pressure and pulmonary HTN causing reversal of the shunt to a right-to-left

can occur in childhood, adulthood or v quickly during pregnancy

Question 19

Presentation of Eisenmenger’s syndrome?

Answer 19

cyanosis
clubbing
dyspnoea
plethoric complexion (polycythaemia)

Question 20

Mx of Eisenmenger’s syndrome?

Answer 20

prevention is key-> once pulmonary pressure is high enough to cause the syndrome it can not be reversed
only definitive tx is heart-lungs transplant
symptomatic management

Question 21

What is coarctation of the aorta?

Answer 21

congenital condition where there is narrowing of the aortic arch, usually around the ductus arteriosus

results in reduction of the pressure in arteries distal to the narrowing and increase in the pressure proximally

Question 22

What condition is particularly associated with coarctation of the aorta?

Answer 22

Turner’s syndrome

Question 23

Presentation of coarctation of the aorta?

Answer 23

weak femoral pulses
systolic murmur
tachypnoea
incr. work of breathing
poor feeding
grey floppy baby
left ventricular heave
underdeveloped left arm
underdeveloped legs

Question 24

Investigations for coarctation of the aorta?

Answer 24

four limb BP measurement
echo

Question 25

Mx of coarctation of the aorta?

Answer 25

ranges depending on severity surgery critical cases -> prostaglandins to keep PDA open while waiting for surgery

Question 26

What is Tetralogy of Fallot?

Answer 26

congenital cyanotic heart condition VSD overriding aorta pulmonary valve stenosis right ventricular hypertrophy

Question 27

Risk Factors for ToF?

Answer 27

rubella infection maternal age >40 alcohol consumption in pregnancy maternal diabetes

Question 28

Investigations for ToF?

Answer 28

echo doppler flow studies CXR - boot shaped heart due to right ventricular thickening (not used)

Question 29

Presentation of ToF?

Answer 29

mostly picked up antenatally ejection systolic murmur (pulmonary stenosis) cyanosis clubbing poor feeding poor weight gain 'tet spells'

Question 30

What are 'tet spells'?

Answer 30

intermittent symptomatic periods where there is a worsening of the right to left shunt, resulting in cyanosis walking, physical exercise, crying irritable, SOB, cyanotic

Question 31

Treatment for Tet spells?

Answer 31

squatting, bringing knees to chest oxygen beta blockers IV fluids morphine sodium bicarbonate phenylephrine infusion

Question 32

Mx of ToF?

Answer 32

prostaglandin infusion in neonates to maintain PDA total surgical repair by open heart surgery is definitive mx (5% mortality rate) 90% live into adulthood with corrective sx

Question 33

What is Ebstein's anomaly?

Answer 33

cyanotic congenital heart condition where the tricuspid valve is set lower in the right side of the heart, causing a bigger atrium and smaller ventricle often associated with ASD and right-to-left shunt

Question 34

Presentation of Ebstein's anomaly?

Answer 34

HF symptoms gallop rhythm cyanosis dyspnoea tachypnoea poor feeding collapse or arrest

Question 35

Diagnosis of Ebstein's anomaly?

Answer 35

echo

Question 36

Mx of Ebstein's anomaly?

Answer 36

definitive is surgery medical mx to treat arrhythmias and HF prophylactic antibiotics to prevent infective endocarditis

Question 37

What is transposition of the great arteries?

Answer 37

cyanotic congenital heart condition where the aorta and the pulmonary artery are transposed to the wrong position only compatible with life when there is a shunt - ASD, VSD, PDA

Question 38

Presentation of transposition of the great arteries?

Answer 38

usually diagnosed antenatally cyanosis respiratory distress tachycardia poor feeding poor weight gain sweating

Question 39

Mx of transposition of the great arteries?

Answer 39

prostaglandins to maintain PDA balloon septostomy to create an ASD open heart sx is definitive management -> cardiopulmonary bypass machine is used to perform an arterial switch correction of ASD or VSD can be performed at the same time

Question 40

Murmur for congenital aortic stenosis?

Answer 40

ejection systolic murmur loudest at the second intercostal space on the right sternal border crescendo-decrescendo radiates to the carotids

Question 41

Presentation of congenital aortic stenosis?

Answer 41

fatigue dyspnoea dizziness fainting symptoms worse on exertion palpable systolic thrill slow rising pulse narrow pulse pressure

Question 42

Management of congenital aortic stenosis?

Answer 42

percutaneous balloon aortic valvoplasty surgical aortic valvoplasty valve replacement

Question 43

Complications of congenital aortic stenosis?

Answer 43

left ventricular outflow obstruction heart failure ventricular arrhythmia bacterial endocarditis sudden death on exertion

Question 44

Associations of pulmonary valve stenosis?

Answer 44

ToF William's syndrome Noonan syndrome Congenital rubella syndrome

Question 45

Presentation of pulmonary valve stenosis?

Answer 45

fatigue on exertion dyspnoea dizziness fainting murmur palpable thrill right ventricular heave raised JVP

Question 46

Murmur for pulmonary stenosis?

Answer 46

ejection systolic murmur loudest at the second intercostal space on the left sternal border

Question 47

Mx of pulmonary valve stenosis?

Answer 47

watch and wait balloon valvoplasty via venous catheter open heart surgery

Question 48

Acyanotic congenital heart disease?

Answer 48

VSD ASD PDA coarctation of the aorta aortic valve stenosis

Question 49

Cyanotic congenital heart disease?

Answer 49

Tetralogy of Fallot Transposition of great arteries Tricuspid Atresia Ebstein's anomaly