Cardiac

Question 0

Name the three most common causes of left to right shunts (acyanotic) congenital heart disease. (3)
What symptom would parents be likely to describe? (1)

Answer 0

VSD
ASD
PDA

Breathless

Question 1

Name the 5 causes of cyanotic congenital heart disease. (5)

Answer 1

Truncus arteriosus
Transposition of the great vessels*
Tricuspid atresia
Tetralogy of Fallot*
Total anomalous pulmonary venous drainage
* most common

Question 2

Why is it important to examine femoral pulses in a neonate? (1)

Answer 2

Coarctation of the aorta… Femoral pulses reduced or absent

Brachiofemoral delay in older children

Question 3

Describe the normal circulatory changes that occur at birth. (3)

Answer 3

First breath = reduced resistance in lungs
Increased return => increased pressure in LA=> foramen ovale closed

Ductus arteriosus connects pulmonary artery to aorta
Closes after first few hours to days.

Ductus venosus allows some oxygenated blood to bypass liver by connecting umbilical vein to IVC. Closes during first week in full term.

Question 4

What is the characteristics of an innocent heart murmur? (4)

Why do they occur? (2)

Answer 4

Asymptomatic
Systolic
Soft
Small (left sterna, edge, no radiation)

During febrile illness, anaemia or exercise, increased cardiac output in a small heart causes turbulent flow heard as a murmur.

Question 5

Name 2 causes of heart failure for neonates, infants and older children.

Answer 5

Neonates- obstructed systemic circulation (duct dependent)
Hypoplastic left heart syndrome
Severe coarctation of the aorta

Infants- high pulmonary blood flow
VSD & large PDA

Children- right or left HF
Rheumatic heart disease, Eisenmenger syndrome (RHF), cardiomyopathy

Question 6

How is the ductus arteriosus kept patent? (1)

Why would you want it to be? (2)

Answer 6

Prostaglandin infusion
Most neonates presenting with cyanotic heart disease are dependent on the patent duct for mixing of oxygenated and deoxygenated blood.

Question 7

What is tetralogy of Fallot? (4)

Answer 7

Overriding aorta ( sits either side of ventricular septum)
Large VSD
Sub Pulmonary stenosis ( causes RV outflow obstruction)
RV hypertrophy as a result.

Question 8

What is the initiating event of rheumatic fever? (1)

What ages are usually affected? (1)

Answer 8

In susceptible individuals, infection with Group A b-haemolytic streptococcus leads to abnormal immune response.
Sore throat then 2-6 weeks latent period, before polyarthritis, mild fever and malaise.
Mainly between ages of 5 and 15.

Question 9

What is the most common cause of hypertension in children? (1)
Name 3 other causes. (3)

Answer 9

80% due to renal parenchymal disease.

Essential, renal vascular disease, phaechromocytoma, congenital adrenal hyperplasia, coarctation of the aorta