Cardiology

Question 0

What is a sign of heart failure in children? (You wouldn’t normally test in a adult)

Answer 0

Hepatomegally

Question 1

When describing murmurs which 5 things do you describe?

Answer 1

Timing - systolic/diastolic/continuous
Duration - ejection or pan
Loudness - grade 1-6
Site of maximal intensity 
Radiation

Question 2

What is the likely cause of a collapsing pulse in a child?

Answer 2

PDA

Aortic regurg

Question 3

What is the purpose of the firemen ovale?

Answer 3

In the fetus blood return from the lung is limited but return to the RA from body and placenta is increased.
It allows the blood to shunt R to L to spread the pressure

Question 4

What two structures does the ductus arteriosus connect?

Answer 4

Pulmonary artery and aorta

Question 5

What are the two types in innocent murmurs?

Answer 5

Ejection murmur

Venous hum

Question 6

What causes a venous hum?

Answer 6

Turbulent flow in head and neck veins

Question 7

Where is the venous hum heard best?

What can make it louder?

Answer 7

Beneath each clavicle

Inspiration
Exercise

Question 8

What can make a venous hum quiter?

Answer 8

Lying flat

Occluding the jugular vein on ipsilateral (same) side

Question 9

Does the vascular resistance in the lungs increase or decrease after birth?

Answer 9

Decrease to allow more blood to flow into lungs and therefore increase blood flow to LA

Question 10

When would you want to maintain a PDA?

Answer 10

In a duct dependant pulmonary circulation ie blood flows from aorta into pulmonary artery to lungs as pulmonary artery isn’t attached to RV

Question 11

What is the usual cause of heart failure in neonates?

Answer 11

Left hear obstruction eg coarctation of the aorta

Question 12

What percentage of VSD requires closure?

Answer 12

10%

Question 13

What are the 4 components of tetralogy of Fallots?

Answer 13

Large VSD
Overriding aorta
Pulmonary infundibular stenosis
Right ventricular hypertrophy

Question 14

In tetralogy of Fallots what might the X-ray show?

Answer 14

Boot shaped heart

Question 15

At what age is surgical correction carried out?

Answer 15

2/3 months

Question 16

Does tetralogy of Fallots lead to cyanotic heart disease or heart failure?

Answer 16

Cyanotic

Question 17

In tetralogy of Fallots is there a L to R R to L shunt

Answer 17

R to L as the deoxygenated blood moves from the right to left to cause cyanosis

Question 18

What are the 4 defects in Fallots tetralogy?

Answer 18

Pulmonary stenosis (R outflow obstruction)
Large VSD
Overriding aorta
R ventricular hypertrophy

(1st 2 are more important)

Question 19

What is the incidence of congenital heart disease?

Answer 19

7-8/1000 live births

Question 20

What does the transposition of the great arteries look like on X-ray?

Answer 20

Egg on a string on its side

Question 21

What is the immediate management of transposition of great arteries?

Answer 21

Prostaglandin E1

Balloon atrial septostomy

Question 22

What would the murmur sound like in 1) Fallots or 2) transposition

Answer 22

1) loud ejection systolic

2) no murmur usually

Question 23

What murmur does atrial septal defect present with?

Were is this best heard?

Answer 23

Fixed split S2 (no variation with resp)

Ejection systolic murmur

Also mid diastolic

(More blood going to R side of heart making blood flow more noisy at tricuspid and pulmonary valve)

Second intercostal L sternal edge

Question 24

Does ASD lead to L to R or R to L shunt?

Answer 24

L TO R

Question 25

What symptoms for you get with ASD?

Answer 25

Mainly assymptomatic, picked up as murmur

Question 26

In VSD where is the murmur best heard? What type of murmur is it? Where does it radiate?

Answer 26

Left lower sternal edge Harsh pan systolic All over the chest

Question 27

What are the signs of heart failure in neonates?

Answer 27

``` failure to thrive Tachycardia Tachypnoea Crepitations Hepatomegaly ```

Question 28

If VSD remains uncorrected either by not closing naturally or not getting surgery what happens to the shunt? Clinically what is seen?

Answer 28

It reverses from R to L sure to pulmonary hypertension the R can't push the blood through Pulmonary artery so goes backwards through the shunt. Intractable cyanosis

Question 29

What are the 3 categories that cause heart failure in children?

Answer 29

Obstructive causes Left to right shunt Cardiomyopathy

Question 30

What is a complication of VSD?

Answer 30

``` Infective endocarditis (No longer give antibiotic prophylaxis though) ```

Question 31

Describe a murmur with persistent PDA?

Answer 31

In younger children systolic murmur at L sternal edge | In older continuous murmur under left clavicle (is continuous as pressure is alway higher in the aorta)

Question 32

What is the triad of symptoms in aortic valve stenosis

Answer 32

Chest pain (less so in children) SOB Syncope

Question 33

What condition is associated with AVSD? W

Answer 33

Down's syndrome

Question 34

Describe a a murmur associated with pulmonary valve stenosis

Answer 34

Ejection systolic radiating to back loudest over upper L sternal edge

Question 35

There are two types of ASD secundum and ostium, what is the difference in a Anatomy?

Answer 35

Secundum - defect in foramen ovale and surrounding atrial septum Primium - defect of atrioventricular septum