29.1 Cardiolgy Part II

Question 1

What is eisenmenger syndrome?

Answer 1

VSD, pulmonary artery receives a lot of blood
Leads to left ventricular hypertrophy 
Fluid overload
Stiffens arteries causing increased BP
RV hypertrophies

Question 2

What does eisenmernger syndrome lead to

Answer 2

Leads to…..

Need heart and lung transplant to cure

Question 3

How do you close VSD’s

Answer 3

Put catheter up femoral, into right atrium and patch up defect

Question 4

Discuss atrial septal defects?

Answer 4

Few clinical signs, good chance of spontatnous closure

Sometimes detected in adulthood with a fib, HF or pulmonary hypertension

Question 5

What is a trio-ventriculo septal defects associated with?

Answer 5

Trisomy 21

Question 6

How does atrioventricular septal defects affect the valves?

Answer 6

Mitral and tricuspid valves are fused

Question 7

Discuss pulmonary stenosis?

Answer 7

The most common heart murmur in children
Typically asymptomatic
In severe there is exertion all dyspnoea and fatigue
Ejection subtopic murmur round in the left sternal border radiating to back

Question 8

What is a ejection systolic murmur?

Answer 8

Murmur that occurs in the systole and is there is a crescendo then descrescendo

Question 9

What is the worry with pulmonary stenosis?

Answer 9

The valve will not grow when the heart grows. This can cause a more severe stenosis. Therefore children with pulmonary stenosis is followed up

Question 10

How do you treat pulmonary stenosis

Answer 10

Balloon valvoplasty, up through the femoral vein into the right ventricle

Increases pulmonary circulation

Question 11

How does aprtic stenosis present?

Answer 11

Mostly asymptomatic, if severe reduced exercise tolerance, exertional chest pain, syncope
Ejection systolic murmur, upper right sternal border. Radiation into carotids

Question 12

How do you treat aprtic stenosis

Answer 12

Balloon aortic valvoplasty through the femoral artery

Question 13

Discuss foetal circulation

Answer 13

Placenta—> umbilical vein—> vena cava—> right atrium—> foramen ovale—> left ventricle—> aorta —> umbilical artery

Or

Placenta, umbilical vein, vena cava right atrium—> right ventricle —> pulmonary trunk—> ductus arteriosus—> aorta

Question 14

What are the changes in fetal circulation at birth (common exam question!)

Answer 14

Pulmonary vascular resistance falls
Pulmonary blood flow rises
Systemic vascular resistance is increased
Ductus arteriousus closes
Ductus venous closes

Question 15

What is meant by a patent ductus arteriosus?

Answer 15

Very common in preterm infants, patent ductus arteriosus

Treated with fluid restriction (diuretics) and prostaglandin inhibitors. IV ibuprofen also used to conservatively close problem

Can also do surgical ligation

Question 16

What is coarctation of the aorta

Answer 16

A kink in the aortic wall

Question 17

How do coarctation of the aorta present?

Answer 17

Cardiac shock

Feel for femoral pulses and they’re gone

Question 18

How do you treat coarctation of the aorta?

Answer 18

Stabilise the baby by opening duct with prostataglandin E1 or E2

Ship to cardiothoracic centre (Glasgow)

Resection of end to end anastomoses

Subclavian patch repair

Balloon aortoplasty

Question 19

What is transposition of the great arteries?

Answer 19

Aorta comes of the right ventricle
The pulmonary artery comes off the left ventricle
Need a shunt or VSD to survive

Question 20

How do you treat a transposition of the great arteries?

Answer 20

Immediately inset venous catheter and give prostaglandins to kept any ducts open

Do arterial septostomy- rib the atrial septum to allow mixing of blood

After time do the switch procedure (put great arteries back)

Question 21

What is fallot’s tetralogy?

Answer 21

Right ventricular outflow obstruction (pulmonary artery stenosis)
Right ventricular hypertrophy
Large vestrosepticular defect
Overriding aorta

Question 22

What gives the highest indicator of poor prognosis of fallots tetralogy

Answer 22

Right pulmonary outflow obstruction

If large then causes large hypertrophy leading to more pressure and more oxygenated blood in the aorta