Cardiology

Question 1

What is the definition of an acceleration of CTG?

Answer 1

An abrupt increase in the baseline foetal HR of > 15 bpm for > 15 seconds

Reassuring. Occur alongside uterine contractions

Their absense is not necessarily bad

Question 2

What murmur is heard in an ASD?

Answer 2

Systolic ejection murmur over the left second ICS sternal border

Widely split second heart sound which is fixed

Question 3

What congenital heart defect will cause a boot-shaped heart on CXR?

Answer 3

Tetralogy of Fallot

Right ventricular hypertrophy

Question 4

What is Eisenmenger syndrome?

Answer 4

A left-to-right shunt becomes a cyanotic right-to-left shunt

Left-to-right shunt → increased pulmonary flow → pulmonary hypertension → right ventricle hypertrophy → right ventricular pressure exceeds left ventricle pressure → the shunt reverses → right to left shunt → cyanosis

Question 5

What is the tetralogy of Fallot?

Answer 5

1. Pulmonary valve stenosis
2. Right ventricular hypertrophy
3. Ventricular septal defect
4. Overriding aorta (above VSD)

Question 6

How are murmurs graded?

Answer 6

Question 7

What is a normal foetal baseline rate?

Answer 7

>32 weeks 110-160 bpm

<32 weeks 125-160 bpm

Question 8

What is the definition of a deceleration on CTG?

Answer 8

An abrupt decrease in baseline HR of > 15 bpm for > 15 seconds

Question 9

What is the cause of this CTG abnormality?

Answer 9

Early decelerations

Uterine contraction → increased ICP → increased vagal tone

Question 10

What is more common, an ostium primum or secundum ASD?

Answer 10

Secundum (70%)

Question 11

Which pneumonic is used for cardiotocohraphy (CTG) interpretation?

Answer 11

DR C BRAVADO

DR - define risk

C - contractions

BRa - baseline rate

V - variability

A - accelerations

D - decelerations

O - overall impression

Question 12

What causes closure of the foramen ovale?

Answer 12

Expansion of the lungs at birth → increased pulmonary blood flow → increased pressure in the RA → apposition of the septum primum and secundum

Question 13

What is the most common congenital heart defect?

Answer 13

VSD

Question 14

Name 4 non-cyanotic congenital heart diseases

Answer 14

1. ASD
2. VSD
3. PFO
4. PDA
5. Coarctation of the aorta
6. Endocardial cushion defect

Question 15

What are 2 risk factors for a patent ductus arteriosus?

Answer 15

1. Prematurity (ductus arteriosus in a preterm is less responsive to O2 and is less likely to constrict after birth)
2. Maternal rubella infection
3. Maternal prostaglandin administration
4. Trisomies

Question 16

What murmur is heard in a VSD?

Answer 16

Holosystolic mumur over the left sternal border

Mid-diastolic murmur over the cardiac apex (increased flow through the mitral valve)

Question 17

What causes of closure of the ductus arteriosis?

Answer 17

O2 levels rise → vasoconstriction

Lungs release bradykinin → vasoconstriction

Prostaglandin E2 levels drop → vasoconstriction

Question 18

What features suggest a benign paediatric murmur?

Answer 18

Grade 2 or less intensity

Short systolic duration (not holosystolic or diastolic)

Minimal radiation

Musical or vibratory (not harsh or blowing)

Softer intensity when sitting upright

Normal S2

Go gallop, click or rub

Question 19

What is the definition of prolonged severe bradycardia?

Answer 19

Less than 80 bpm for more than 3 minutes

Question 20

Children with Tetralogy of Fallot will often do what to decrease R-L shunting?

Answer 20

Squat

Increases systemic vascular resistance → increases LV pressure

Question 21

Which congenital heart diseases are associated with Turner syndrome?

Answer 21

Coarctation of the aorta

Bicuspid aortic valve

Question 22

Which cardiac murmurs are associated with Marfan syndrome?

Answer 22

Mitral valve prolapse

Aortic root dilation

Aortic regurgitation

Question 23

Pre-syncope or syncope is associated with which congenital heart diseases?

Answer 23

Aortic stenosis

Hypertrophic cardiomyopathy

Question 24

Weak or absent femoral pulses is associated with which congenital heart disease?

Answer 24

Coarctation of the aorta

Question 25

What is the best sign of heart failure in children?

Answer 25

Hepatomegaly

Question 26

When does the foramen ovale close?

Answer 26

At birth

Question 27

When does the ductus arteriosus close?

Answer 27

2-3 days following birth

Question 28

What are some of the adverse effects associated with symptomatic PDAs in preterm infants?

Answer 28

Pulmonary **hyper**perfusion - Pulmonary haemorrhage - Bronchopulmonary dysplasia Cerebral, mesenteric and renal **hypo**perfusion - Metabolic acidosis - Intracranial haemorrhage - Periventricular leukomalacia - Necrotising enterocolitis - Oliguria

Question 29

Which cardiac disorder is associated with fixed splitting of the S2 heart sound?

Answer 29

Atrial septal defect There is a left to right shunt through the ASD which results in increased RA and RV volumes. As a result, there is increased flow through the pulmonic valve such that, regardless of breath, the pulmonic valve closes later every time.

Question 30

What is the structual difference between an ASD and a PFO?

Answer 30

The septal defect in ASD is due to missing tissue PFO results from an unfused septa

Question 31

An egg-shaped heart on CXR is characteristic of which condition?

Answer 31

Transposition of the great vessels

Question 32

What congenital heart disease may have this CXR?

Answer 32

Total anomalous pulmonary venous return

Question 33

A machinery murmur is characteristic of which congenital heart disease?

Answer 33

PDA

Question 34

What might the findings on clinical examination of a child with a PDA be?

Answer 34

Heavy "machinery" continuous murmur Tachycardia Wide pulse pressure, bounding pulse Hyperactive precordium

Question 35

How can cardiac and other causes of cyanosis be differentiated?

Answer 35

Hyperoxic test Obtain preductal right radial ABG in RA → repeat after child inspires 100% oxygen If PaO2 improves significantly, cyanosis is unlikely cardiac

Question 36

What is auscultated in tetralogy of fallot?

Answer 36

Harsh systolic murmur ## Footnote *Due to right ventricular outflow obstruction (pulmonary stenosis)*

Question 37

What is auscultated in transposition of the great vessels?

Answer 37

Single S2 ## Footnote *Holosystolic murmur if VSD is also present*

Question 38

A systolic ejection murmur and fixed splitting of S2 is characteristic of which cardiac condition?

Answer 38

ASD

Question 39

What heart condition is fragile X associated with?

Answer 39

Mitral valve prolapse

Question 40

What is Ebstein's abnormality?

Answer 40

Malformed and displaced tricuspid valve leaflets causing tricuspid valve regurgitation and right heart enlargement

Question 41

A continuous blowing noise heard below the clavicles is characteristic of which murmur?

Answer 41

Venous hum

Question 42

What are the clinical features of Still's murmur?

Answer 42

Vibratory or muscial quality along the left lower sternal border Louder when supine or during hyperdynamic states Benign

Question 43

What is the most significant risk factor for Ebstein's abnormality?

Answer 43

Prenatal lithium exposure

Question 44

What is the most common cause of cyanosis in the first few weeks of life?

Answer 44

Tetralogy of Fallot

Question 45

How might a left ventricular free wall rupture present following an MI?

Answer 45

Chest pain, dyspnoea Cardiac tamponade (hypotension, distended neck veins, muffled heart sounds)