Cardiology

Question 1

What are TORCH infections?

Answer 1

Toxoplasma
Rubella
CMV
Herpes

Question 2

What is the most common cardiac problem in trisomy 21?

Answer 2

ASD most common

VSD

AVSD less common

Question 3

What is most common cardiac problem in turner syndrome?

Answer 3

Co-arctation of aorta

Question 4

What is most common cardiac problem in noonan syndrome?

Answer 4

pulmonary stenosis

Question 5

What is most common cardiac problem in williams syndrome?

Answer 5

Supravalvular aortic stenosis

Question 6

What would central cyanosis indicate (cardiac)?

Answer 6

Right to left shunt

Question 7

What would feeding problems indicate (cardiac)?

Answer 7

Heart failure

Restless during feeding, sweating during feeds

Question 8

What symptoms could indicate a paediatric heart problem?

Answer 8

Feeding, weight and development

Cyanosis

Tachypnoea, dyspnoea

Exercise tolerance

Chest pain

Syncope

Palpitation

joint problems

Question 9

What examination features could indicate a heart problem in children?

Answer 9

Weight and height

Dysmorphic features

Cyanosis

Clubbing

Tachy/dyspnoea

Pulses/apex (remember femoral)

Heart sounds

Murmurs

Question 10

How can murmurs be characterised?

Answer 10

Cardiac timing
- systole/diastole/continuous

Duration

• early/mid/late
• ejection/holo- or pansystolic

Pitch/quality

• harsh or mixed frequency
• soft or indeterminate
• vibratory/pure frequency

Question 11

What does radio-femoral delay indicate?

Answer 11

Coarctation of aorta (late stage)

Question 12

What investigations can be used to assess cardiac problems?

Answer 12

BP
O2 sats
ECG
CXR
Echo
Angiography
MRI
Exercise testing

ABG rarely bc painful

Question 13

Describe innocent murmurs

Answer 13

70-80%

NOT a diagnosis of exclusion

Specific features

4 types

Question 14

What are features of innocent murmurs?

Answer 14

Systolic murmur (continuous in venous hum)
No other signs cardiac disease
Soft murmur, grade 1/6 or 2/6
Vibratory, muscial
Localised
Varies with position, respiration, exercise

Question 15

Describe Still’s murmur

Answer 15

LV outflow murmur

Age 2-7

Soft systolic; vibratory, musical, “twangy”

Apex, left sternal border

increases in supine position and with exercise

Question 16

Describe pulmonary outflow murmur

Answer 16

Age 8-10

Soft systolic; vibratory

Upper left sternal border, well localised, not radiating to back

Increases in supine position, with exercise

Often children with narrow chest

Question 17

Describe carotid/brachiocephal IC arterial bruits

Answer 17

Age 2-10

1/6 or 2/6 systolic; harsh

Supraclavicular, radiates to neck

Increases with exercise, decreases on turning head or extending neck

Question 18

Describe venous hum

Answer 18

Age 3-8

Soft, indistinct

Continuous murmur, sometimes with diastolic accentuation

Supraclavicular

Only in upright position, disappears on lying down or turning head

Question 19

What are the types of VSD?

Answer 19

• subaortic
• perimembranous
• muscular

Question 20

What type of shunt is present in VSD?

Answer 20

left to right shunt

not cyanotic

Question 21

How does VSD present?

Answer 21

Pansystolic murmur lower left sternal edge, sometimes with thrill

In small; early systolic murmur

Very large; diastolic rumble

Signs of cardiac failure in large VSDs leasing to biventricular hypertrophy and pulmonary hypertension

Question 22

What is eisenmenger syndrome?

Answer 22

Any untreated cardiac defect which leads to pulmonary hypertension, reversal of flow and cyanosis

Question 23

How is a VSD closed?

Answer 23

Amplatzer or other occlusion device, trans-catheter

patch closure, open heart surgery

Question 24

Describe atrial septal defects

Answer 24

few clinical signs in early childhood, good chance spontaneous closure

Sometimes detected in adulthood with AF, heart failure or pulmonary hypertension

Wide fixed splitting of 2nd heart sound, pulmonary flow murmur

Question 25

Describe AVSD

Answer 25

Associated with trisomy 21

Question 26

Describe pulmonary stenosis

Answer 26

Asymptomatic in mild in moder and severe; exertional dyspnoea and fatigue Ejection systolic murmur upper left sternal border with radiation to back

Question 27

Describe aortic stenosis

Answer 27

Mostly asymptomatic If severe; reduced exercise tolerance, exertional chest pain, syncope Ejection systolic murmur upper right sternal border, radiation into carotids

Question 28

What are changes in foetal circulation at birth?

Answer 28

``` Pulmonary vascular resistance falls Pulmonary blood flow rises Systemic vascular resistance is increased Ductus arteriosus closes Foramen ovale closes Ductus venosus closes ```

Question 29

How is pulmonary stenosis managed?

Answer 29

Balloon valvoplasty *replacement of valve not considered until stopped growing as child will outgrow valve

Question 30

How can aortic stenosis be treated?

Answer 30

Balloon aortic valvuloplasty

Question 31

Describe patent ductus arteriosus

Answer 31

Very common pre-term infants Treat with fluid-restriction/diuretics, prostaglandin inhibitors Can use surgical ligation In term babies; good chance spontaneous closure, not prostaglandin sensitive

Question 32

How is co-arctation of aorta managed?

Answer 32

Re-open DA with prostaglandin E1 or E2 (stabilisation) Resection with end-to-end anastomosis Subclavian patch repair Balloon aortoplasty