Paediatric Cardiology

Question 1

8 common causes of congenital heart disease

Answer 1

1. Ventricular septal defect (VSD)
2. Patent ductus arteriosus (PDA)
3. Atrial septal defect (ASD)
4. Pulmonary stenosis
5. Aortic stenosis
6. Coarctation of the aorta
7. Transposition of the great arteries
8. Tetralogy of Fallot

Question 2

types of paediatric heart disease

Answer 2

• Congenital heart defects
• Screening and monitoring inherited disease; cardiomyopathy, long QT syndrome, Marfan
syndrome etc.
• Acquired disease : Kawasaki, Rheumatic Fever, bacterial Endocarditis
• Arrhythmias, mainly SVT

Question 3

teratogenic drugs

Answer 3

o Alcohol
o Amphetamines
o Cocaine
o Ecstasy
o Phenytoin
lithium

Question 4

teratogenic infection

Answer 4

TORCH

Question 5

materal causes of teratogenesis

Answer 5

DM

SLE

Question 6

chromosomal disorders and their defects: trisomy 13

Answer 6

90%

VSD and ASD

Question 7

chromosomal disorders and their defects: trisomy 18

Answer 7

80%

VSD and PDA

Question 8

chromosomal disorders and their defects: trisomy 21

Answer 8

40%

AVSD

Question 9

chromosomal disorders and their defects: turner

Answer 9

co-arctation of aorta

Question 10

chromosomal disorders and their defects: noonan

Answer 10

pulmonary stenosis

Question 11

chromosomal disorders and their defects: williams

Answer 11

supravalvular AS

Question 12

history in paeds cardiology

Answer 12

• Feeding, Weight and Development
• Cyanosis
• Tachypnoea, Dyspnoea
• Exercise Tolerance
• Chest Pain
• Syncope
• Palpitation
• Joint Problems

Question 13

examination in paeds cardiology

Answer 13

• Weight and Height
• Dysmorphic features
• Cyanosis
• Clubbing
• Tachy-/Dyspnoea
• Pulses/Apex (femoral pulses!)
• Heart Sounds (clicks, split, 3rd and 4th)
• Murmurs

Question 14

investigations in paeds cardiology

Answer 14

• Blood Pressure
• O2 saturation, arterial BGA
• ECG (12 lead, 24hrs, event monitor)
• CXR
• Echocardiogram
• Catheter
• Angiography
• MRI/A
• Exercise testing (ECG, sO2)

Question 15

treatment principles in paeds cardiology

Answer 15

• If you can fix it -> fix it
• If you can’t fix it -> improve the situation : - medication
o Palliative procedure, e.g.
o BT shunt, balloon valvoo
Plasty, Prostaglandin
o Infusion, pulmonary
o Banding
• If you can do neither ->replace it

Question 16

characterisation of murmurs

Answer 16

• Timing in Cardiac Cycle
o Systole / Diastole / Continuous
• Duration
o Early / Mid / Late
o Ejection / Holo or Pan Systolic
• Pitch / Quality
o Harsh or Mixed Frequency (Turbulence)
o Soft or Indeterminate
o Vibratory / Pure Frequency (Laminar Flow)

Question 17

common features of the innocent murmurs

Answer 17

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

Question 18

name the innocent murmurs

Answer 18

Stills - LV outflow murmur
Pulmonary outflow murmur
carotid/brachiocephalic arterial bruits
venous hum

Question 19

Still’s murmur

Answer 19

• Age 2-7 years
• Soft systolic; vibratory, musical, ”twangy”
• Apex, left sternal border
• Increases in supine position and with exercise

Question 20

Pulmonary outflow murmur

Answer 20

• Age 8-10 years
• 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 21

carotid/brachiocephalic arterial bruits

Answer 21

• Age 2-10 years
• 1/6-2/6 systolic; harsh
• Supraclavicular, radiates to neck
• Increases with exercise, decreases on turning head or extending neck

Question 22

venous hum

Answer 22

• Age 3-8 years
• Soft, indistinct
• Continuous murmur, sometimes with diastolic accentuation
• Supraclavicular
• Only in upright position, disappears on lying down or when turning head

Question 23

types of VSD

Answer 23

subaortic
perimembranous
muscular

Question 24

shunt in VSD

Answer 24

L to R

Question 25

clinical presentation of VSD

Answer 25

• Pansystolic murmur lower left sternal edge, sometimes with thrill • In very small VSDs, early systolic murmur • In very large VSDs diastolic rumble due to relative mitral stenosis • Signs of cardiac failure in large VSDs, eventually leading to biventricular hypertrophy and pulmonary hypertension

Question 26

ASD deatures

Answer 26

There are few clinical signs of these in early childhood, with a good chance of spontaneous closure. They are sometimes detected in adulthood with atrial fibrillation, heart failure or pulmonary hypertension. Wide fixed splitting of 2nd heart sound, pulmonary flow murmur.

Question 27

AVSD

Answer 27

associated with trisomy 21 | AV valve with ostium primum ASD and high VSD

Question 28

pulmonary stenosis features

Answer 28

Pulmonary stenosis is asymptomatic when its mild. In moderate and severe stenosis patients have exertional dyspnoea and fatigue. Ejection systolic murmur upper left sternal border with radiation to back.

Question 29

aortic stenosis features

Answer 29

This is mostly asymptomatic. If severe there is reduced exercise tolerance, exertional chest pain and syncope. Ejection systolic murmur in upper right sternal border, radiation into carotids

Question 30

changes in the foetal circulation at birth

Answer 30

* Pulmonary Vascular Resistance Falls * Pulmonary Blood Flow Rises * Systemic Vascular Resistance is increased * Ductus Arteriosus Closes * Foramen Ovale Closes * Ductus Venosus Closes

Question 31

patient ductus arteriosus management

Answer 31

Very common in pre-term infants, treatment with fluid restriction/diuretics, prostaglandin inhibitors (Indomethacin, Ibuprofen), surgical ligation. In term babies good chance of spontaneous closure, not prostaglandin sensitive.

Question 32

management of coarctation of the aorta

Answer 32

* Re-open PDA with Prostaglandin E1 or E2 * Resection with end-to-end anastomosis * Subclavian patch repair * Balloon Aortoplasty

Question 33

tetralogy of fallot

Answer 33

over riding aorta VSD pulmonary stenosis RV hypertrophy