Heart murmurs and congenital heart disease

Question 1

Early soft systolic vibratory murmur heard over lower left sternal edge, louder when supine

Answer 1

Still’s murmur

Question 2

Ejection systolic murmur, heard at the upper left sternal edge, does not radiate to back, no fixed splitting of S2

Answer 2

Pulmonary flow murmur

Question 3

Low pitch continuous murmur heard below the right clavicle, louder when erect

Answer 3

Venous hum

Question 4

Ejection systolic murmur, heard at the upper left sternal edge, radiates to back

Answer 4

Branch pulmonary stenosis

Question 5

What are the 4 abnormalities that make up tetralogy of fallot?

Answer 5

1. RV hypertrophy
2. RV outflow obstruction
3. VSD
4. Overarching aorta

Question 6

What are the Sx and signs of ToF?

Answer 6

Cyanosis (first day of life)
Tet spells 
Failure to thrive
Clubbing
SOB
Difficulty feeding
Murmur

Question 7

Pan systolic murmur heard at lower left sternal edge

Answer 7

VSD

Question 8

Boot shaped heart on CXR

Answer 8

ToF

Question 9

What is the management of a VSD?

Answer 9

Small VSDs will close spontaneously

Surgical correction of large VSDs should be performed by 12 months of age to prevent the development of pulmonary HTN

Question 10

Soft ejection systolic murmur in the upper left sternal edge is heard, with fixed splitting of S2

Answer 10

ASD

Question 11

What is the management of a ASD?

Answer 11

Often do not close spontaneously so requires Rx if symptomatic
If significant, correction is usually performed 3-5 years of age

Question 12

What is a PDA?

Answer 12

Patent Ductus Arteriosus - a failure of the ductus arteriosus to close following birth

Question 13

Bounding pulses

Answer 13

PDA

Question 14

What is the management for a PDA?

Answer 14

Symptomatic premature infants -
NSAID (indomethacin) to close the PDA
Asymptomatic mature infants - embolisation coil or occlusion device

Question 15

A child presents with weak femoral pulses, radio-femoral delay and relative HTN in upper limbs compared to lower limbs

Answer 15

Coarctation of aorta (a narrowing of the descending aorta)

Question 16

What is the management for coarctation of aorta?

Answer 16

Balloon angioplasty or open surgical repair

Question 17

What is transposition of great arteries?

Answer 17

When the aorta attaches to the right ventricle and the pulmonary artery connects to the left ventricle

Question 18

What are the Sx and signs of TGA?

Answer 18

Presents neonatally (very soon after birth, when ductus arteriosus closes) with cyanosis and circulatory compromise

Question 19

What is the management of TGA?

Answer 19

Prostaglandins to keep DA patent

Corrective surgery