Cardiology

Question 1

what are innocent murmurs

Answer 1

“flow murmurs” - caused by fast flow during systole

Question 2

features of innocent murmurs

Answer 2

4 ‘S’s

• Soft
• Short
• Systolic
• Symptomless

Question 3

what are the 3 shunts of the foetal circulation

Answer 3

ductus venosus – connects umbilical vein to inferior vena cava

foramen ovale – connects right atrium to left atrium

ductus arteriosus – connects pulmonary artery to aorta

Question 4

what causes the foramen ovale to close at birth

Answer 4

first few breaths the baby takes causes alveoli to expand – decreasing pulmonary vascular resistance
this decreased resistance causes pressure to drop in right atrium
left pressure > right pressure causes collapse of atrial septum
duct becomes sealed shut and becomes the fossa ovalis

Question 5

what causes the ductus arteriosus to close

Answer 5

needs prostaglandins to remain open

increasing blood oxygenation causes prostaglandins to drop – closure of duct to ligamentum arteriosum

Question 6

what is a patent ductus arteriosus (PDA)

Answer 6

failure of ductus arteriosus to close between pulmonary trunk + aorta
causes left to right shunt

Question 7

risk factors for PDA

Answer 7

prematurity

maternal rubella infection

Question 8

murmur in PDA

Answer 8

continuous machinery like murmur

• left subclavicular thrill
• bounding, collapsing pulse

Question 9

management of PDA

Answer 9

indomethacin – inhibits prostaglandin synthesis so closes the duct

Question 10

what is an atrial septal defect

Answer 10

hole in the septum between the two atria

Question 11

most common atrial septal defect

Answer 11

ostium secundum

Question 12

murmur heard in atrial septal defect

Answer 12

mid systolic crescendo- decrescendo with fixed split second heart sound

Question 13

ECG changes with ostium secondum

Answer 13

RBBB with RAD

Question 14

presentation of atrial septal defect in adulthood

Answer 14

asymptomatic in childhood but can cause 
- dyspnoea
- right heart failure 
- stroke 
in adulthood

Question 15

most common form of congenital heart disease

Answer 15

ventricular septal defect

Question 16

what conditions are associated with a ventricular septal defect

Answer 16

Downs syndrome
Edwards syndrome
Patau syndrome

Question 17

murmur heard in ventricular septal defect

Answer 17

pan systolic murmur at left sternal edge

Question 18

what is cortication of the aorta

Answer 18

narrowing of descending aorta

Question 19

signs of cortication of aorta

Answer 19

radio-femoral delay
rib notching on CXR
systolic murmur over left scapula

Question 20

what conditions are associated with coartication of aorta

Answer 20

Turners syndrome
Bicuspid aortic valve
Neurofibromatosis
Berry aneurysms

Question 21

what are the cyanotic congenital heart diseases

Answer 21

tetralogy of Fallot

transposition of great arteries

Question 22

what is tetralogy of fallot

Answer 22

Ventricular septal defect
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

Question 23

signs of tetralogy of fallot

Answer 23

cyanosis due to right to left shunt
ejection systolic murmur due to pulmonary stenosis
Boot shaped heart on CXR
right ventricular hypertrophy on ECG

Question 24

What is given in cyanotic heart disease until surgery can be performed

Answer 24

prostaglandins

Question 25

what is eisenmengers syndrome

Answer 25

``` reversal of a left to right shunt due to pulmonary HTN, resulting in a right to left shunt can be caused by - ventricular septal defect - atrial septal defect - patent ductus arteriosus ```

Question 26

signs of eisenmengers syndrome

Answer 26

cyanosis haemoptysis clubbing Right ventricular failure

Question 27

what is Ebsteins anomaly

Answer 27

triscupid valve set lower in right side of heart causes a bigger right atrium and a small right ventricle this causes poor blood flow - associated with Wolf Parkinson White syndrome

Question 28

what does a ventricular septal defect increase risk of

Answer 28

Endocarditis

Question 29

supravalvular aortic stenosis is seen in which genetic condition

Answer 29

Williams Syndrome

Question 30

cardiac complication of Fragile X

Answer 30

Mitral valve prolapse

Question 31

cardiac complication of Duchenne muscular dystrophy

Answer 31

cardiomyopathy

Question 32

what drug taken in pregnancy can cause an Ebstein anomaly

Answer 32

Lithium

Question 33

most common cause of hypertension in children

Answer 33

renal parenchymal disease

Question 34

features of a Venous hum

Answer 34

continuous blowing murmur below clavicles