Paeds Cardiac conditions

Question 1

What are the classification of Heart Murmurs ?

Answer 1

Grande 1 to 6

Question 2

Grade 1

Answer 2

Soft, barely audible

Question 3

Grade 2

Answer 3

Soft, audible

Question 4

Grade 3

Answer 4

Loud without a thrill

Question 5

Grade 4

Answer 5

Loud with a thrill

Question 6

Grade 5

Answer 6

very loud, audible with the stethoscope
placed lightly on the chest

Question 7

Grade 6

Answer 7

extremely loud, audible with the stethoscope off
the chest

Palpable murmur

Question 8

What is innocent murmurs ?

Answer 8

Asymptomatic and localised to the left sternal edge

Question 9

When can the innocent murmur be seen ?

Answer 9

Occur due to changes in blood flow within the normal heart, often a child will get an innocent murmur when they get hyper-dynamic circulation following an infection

Question 10

What is the timing of innocent murmur ?

Answer 10

Early Ejection systolic

Question 11

What is the character of innocent murmur ?

Answer 11

Short, Soft
Vibrating, musical
No radiation, vary with posture and position
Sternal Edge

Question 12

What is it associated with

Answer 12

No added sounds/Thrill/Ventricular lift

Question 13

What is pathologic murmurs ?

Answer 13

Symptomatic

Question 14

What is the timing of pathologic murmur ?

Answer 14

Diastolic

Question 15

What is the character of pathologic murmur ?

Answer 15

• Long and Loud
  Grade would be >3/6
• High-pitched, harsh
• Radiation over precordium

-

Question 16

What is Pathologic murmur associated with ?

Answer 16

Loud / Fixed S2

Precordial thrill

Question 17

What are the cardiac problems in children ?

Answer 17

Congenital Heart Disease
Acquired Heart Problems
Arrythmias

It can be either Structural or Functional

Question 18

How is Fetal Circulation happens ?

Answer 18

involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta

Question 19

What does congenital heart disease Contain ?

Answer 19

Cyanotic R-L Shunt

One of the most important reasons for congenital malformations, this cause more still birth

Question 20

who tend to have problems with the septum of the heart ?

Answer 20

People with trisomy 21 and the babies could be present with atroventricular defect.

Question 21

What is Edward’s syndrome ? also called as Trisomy 18

Answer 21

very severe genetic condition that affects how your child’s body develops and grows. Children diagnosed with trisomy 18 have a low birth weight, multiple birth defects and defining physical characteristic

The condition occurs when a person has an extra copy of chromosome 18,

Question 22

How does the babies get oxygenated blood ?

Answer 22

Oxygenated blood is delivered to the baby from placenta through the Umbilical vein

Question 24

How does the Fetal circulation works in Prenatal?

Answer 24

The Lungs don’t provide gas exchange, and the pulmonary vessels are vasoconstrictive, so the placenta plays a role here!

The placenta acts as a gas exchange unit to oxygenate fetal blood.

Question 25

What are the 3 vascular structures most important in the transitional circulation ?

Answer 25

ductus venosus, foramen ovale, and ductus arteriosus

Question 26

How does the Foetal blood vessel and circulation works ?

Answer 26

Once the main arteries and veins as well as the heart are developed, usually after the 8th week of fetal development, deoxygenated blood is returned from the fetal systemic circulation to the placenta via two umbilical arteries, which branch off the fetal internal iliac arteries.

Question 27

What does the umbilical vein pass through ?

Answer 27

Highly oxygenated, nutrient-rich blood flows from the placenta to the fetus via the umbilical vein. Approximately half of the blood in the umbilical vein bypasses the liver to flow into the ductus venosus, a fetal vessel connecting the umbilical vein to the inferior vena cava.

Question 28

What structure in the RA takes the oxygenated blood through a hole?

Answer 28

Foramen ovule , will then go to the LA and will be delivered to the body whereas the poor blood go to the lungs

Question 29

What does the Structure Ductus Arteriosus do?

Answer 29

This is in between the pulmonary artery the aortic arch which takes some blood back to the body instead of sending all the bloods to the lungs

Question 30

What is Ventricular septal defect ?

Answer 30

Asynotic Left to right shunt and get mixed and go to the lungs Children with Down syndrome can develop this condition in common

Question 31

Why type of murmur is heard in the Ventricular septal Defect ?

Answer 31

Systolic Murmur

Question 32

What does the physical findings of the ventricular septal defect look like ?

Answer 32

Depends on the size of the defect as if it is small, the pt may be completely asymptomatic but if the defect is very large the pt could have HF

Question 33

Investigation of VSD?

Answer 33

Echo with Doppler This is to see the flow within the heart

Question 34

How does the Small defect close?

Answer 34

Close by themselves

Question 35

How does the Large defect close ?

Answer 35

Treatments for HF - surgically closing them Diuretics, sometimes use inotropes like digoxin, ACE inhibitors to reduce afterload

Question 36

What is Atrial Septal Defect?

Answer 36

30-50% of children with a congenital heart defect will have ASD. Asymptomatic Soft Systolic Ejection Murmur (Grade 2 to 3)

Question 37

What is the Diagnosis of ASD?

Answer 37

Echo

Question 38

What is the treatment of ASD?

Answer 38

If asymptomatic, wait till the child turns by 4-5 years of age, so that the surgery becomes easier If symptomatic, treat the HF and then close it

Question 39

What is Patent Ductus arteriosus ?

Answer 39

failure of the ductus arteriosus to close within the first 72 hours of life.

Question 40

Why is the PDA present in Foetal life ?

Answer 40

When there is a higher pressure on the right side of the heart, therefore the blood flows from the pulmonary circulation into the systemic circulation. When the baby is breathing air through the lungs, the pressure in the heart reverses but if the ductus stays open the flow of the blood reverses and goes from aorta back into the pulmonary circulation

Question 41

PDA?

Answer 41

Acynotic as the mixed blood is going back to the lungs if the defect is small, will close soon but if it's large it can cause real problems such as poor growth, difficulty feeding, heart failure and a risk of endocarditis, and can get a resp infection

Question 42

Where could you hear the PDA murmur?

Answer 42

grade 1 to 4/6 continuous Machinery murmur left infraclavicular area or upper left sternal border.

Question 43

What investigation for PDA?

Answer 43

ECHO cxr /ecg

Question 44

What is the treatment of PDA? (asymptomatic) /if they're well?

Answer 44

wait until 1 year for it to close, then regular ECHOs for spontaneous closure Closure usually via cardiac catheterisation

Question 45

What is the treatment of PDA for symptomatic ?

Answer 45

For Premature infants - ibuprofen or paracetamol For Term infants - cardiac cath or surgery meds works well in premature infants

Question 46

Eisenmenger syndrome ?

Answer 46

Becomes Cyanotic becuase it Cause reversible Vascular injury - which would make the right side of the heart to have more pressure than the left (hypertrophy on the right side of the heart) this will increase the pressure on right side of the heart even more pressure than the left side which will cause the shunt to reverse , then the child will become cyanotic as the blood is not delivered to the lungs but delivered to the body and the child will become hypoxic.