Cardiology Exam/ECG/CXR

Question 1

6-week-old baby, sweaty and breathless with feeds
Exam: Gallop rhythm, holosystolic murmur
CXR: Cardiomegaly
ECG: ST elevation and T wave inversion V5 and V6
(In a slightly older child may have deep or wide Q waves)

Answer 1

ALCAPA

• LCA arises from PA
• Inadequate perfusion to myocardium as PVR falls
• infarction and fibrosis
• Dilated LV, mitral regurg + heart failure

Question 2

Asymptomatic child
Exam: Widely split and fixed S2, grade II ESM at LUSB
ECG: LAD, incomplete RBBB
CXR: NAD or cardiomegaly

Answer 2

ASD Primum

Question 3

Toddler with poor growth and reduced exercise tolerance
Exam: Hyperdynamic precordium, Pansystolic murmur LLSE, loud P2, mid-diastolic rumble, hepatomegaly
ECG: LAD
CXR: Cardiomegaly, prominent pulmonary vascular markings

Answer 3

Moderate - Large VSD

Question 4

Toddler with poor growth and reduced exercise tolerance and generalised fatigue
Exam: Central cyanosis, single loud S2, no murmur, RV heave, hepatomegaly
CXR: Normal-large heart size, dilatation of the central pulmonary arteries with peripheral pulmonary artery “pruning

Answer 4

Eisenmengers

“pruning” = abrupt attenuation and/or termination of peripheral pulmonary artery branches

Question 5

Exam: Loud machinery murmur LUSE and loud P2
ECG: Normal or LAD
CXR: Normal or LVH

Answer 5

PDA

Question 6

18 month old p/w with cool peripheries and WOB.
Exam: SpO2 97%, single loud S2, ESM heard posteriorly (inter-scapular)
ECG: RAD, RBBB
CXR: Cardiomegaly

Answer 6

Coarct

Question 7

Exam: SpO2 , no murmur
ECG:
CXR: Normal or “egg on a string”

Answer 7

TGA

Question 8

20 hour old neonate
Exam: SpO2 78%, harsh ESM
ECG: RAD
CXR: Boot shaped heart, oligaemic lungs

Answer 8

TOF

Question 9

Exam: SpO2 55%, single S2, no murmur
ECG normal (occasional RAD)
CXR: Oligaemic lungs, normal to a slightly enlarged heart

Answer 9

Pulmonary atresia IVS

Question 10

6 year old child
Exam: clubbed, widely split S2, split S1, S3 and S4 present, systolic murmur and mid-diastolic murmur LLSE, hepatomegaly
ECG: RBBB, RAD
- some have short PR/deltas
- some have heart block

Answer 10

Ebsteins

Saying massive cardiomegaly makes it too easy…

Question 11

cardiomegaly.
Oligaemic lungs.
minimal RV forced on chest leads (ECG)
RAE (Ie tall p waves)
Delta waves/pre-excitation

Answer 11

ebsteins

Question 12

cyanotic at birth.
Left axis deviation
minimal RV forced on chest leads (ECG)

Answer 12

tricuspid atresia

RV very small because no blood getting in there

Question 13

ECG: left atrial enlargement (ie. long/bifid p waves), LVH, RSR with strain, LAD
cardiomegaly
Increased vascular marking

Answer 13

AVSD

Question 14

Causes of left axis deviation

Answer 14

AVSD
Tricuspid atresia
Noonans syndrome (even with normal heart)
CCTGA
DORV
ALCAPA

Question 15

A couple of months old
sats 80s
ESM LSB
cxr: upturned apex, cardiomegaly, decreased vascularity
ecg: RAD,RVH with strain

Answer 15

TOF (Or DORV)

Question 16

Maybe normal exam OR loud 2nd HS, narrow split +/- single 2nd HS, RV heave,

Answer 16

pulm HTN

Question 17

Most specific sign of pulm HTN

Is there a murmur?

Answer 17

loud 2nd HS

may have systolic murmur of TR and/or diastolic murmur of PR

Question 18

EDM
collapsing pulse (severe only) may have wide pulse pressure,
,ay have LVH if mod-severe

Answer 18

Aortic regurg

Question 19

PSM (may also develop EDM if severe). low vol pulse if severe. may get LVH if mod-severe.

Answer 19

mitral regurg

most common valvular disease in RF