Cardiac

Question 1

Left to right shunt - pathology

Answer 1

Left heart - starts with big left ventricle, and then resistance is less on the right so blood goes to Right side, and to pulmonary even though it is already oxyegnation.
Eventually turns into a right big heart because resistance of right builds up
Do not go cyanotic originally then turns cyanotic
–> eissenmengers syndrome (shunt reversal and pulmonary hypertension)

Question 2

Atrial septal defect

Answer 2

-Associated with downs syndrome
-Any age, close in early age often
small defect - asyx
large defect - easy fatigue, frequest resp infections, FTT
Auscultation - wide, fixed split s2

-Exam - fixed, split s2
Dx - echo   
Xray - cardiomegaly 
ECG - RBH, RA enlargement, PR prolongation 
Tx - close hole, device

Question 3

Ventricular septal defect

Answer 3

Pt: less than 1 year of age
-fix it or die
-failure to thrive, congestive heart failure 
-Dx - echo (LVH) 
Tx - asys  - wait, symptomatic - treat

• down syndrome, torch infections
• recurrent resp infections, heart failure symptoms
• hash holosystolic murmur at left lower sternal border (loarder if smaller defect)

Question 4

Patent ductus arteriosis

Answer 4

ductus arteriosis is the conneciton between the aorta and pulmonary artery, to bypass the lungs while baby in utereo
-this is closed at birth so o2 can get to the lungs

Pt: continous machine like murmur - loadest at left intercostal sapce sternal boreder.
“multiple continuous”, may be asymptomaptic, failure to thrive, resp infections, clubbing and CHF
-wide Pulse pressure
-load s2
-bounding peripheral pulses

Dx - echo (colour flow doppler)
Tx - closure -indomethicin (prostaglandins to keep it open till surgery e.g tetraoly of fallot )
(cannot give indomethicin if intraventiruclar haemorhage)
ecg - LVH

Question 5

infant presenting in a shocklike state for first few weeks of life - differential

Answer 5

• sepsis
• inborn error of metbaolism
• ductal dependent cngejital heart disease (left side lesion)
• congenital adrenal hyperplasai

Question 6

Coarctation of the aorta

Answer 6

Turners syndrome, male, berry anurgysm
-past great vessels or would be dead
-can get blood to upper extremities but not lower
Pt: HTN upper extemiietes, hypotenison - lower
-can get differetn BP in each arm
-syncope, epistaxis, headache
-weak femoral pulse, radiofemoral delay, short systolic murmur in left axilla
Claudication (looks like peripheral vascular disease)
Dx - echo
cxr - shows cardiomegaly and pulmonary congestion
Tx - surgical
(if severe in infancy, keep ductus open with prostaglandin)
-surgical correct or baloon angioplasty

Question 7

Transposition of the great vessels

blue baby

Answer 7

Most common cyanotic congenital heart lesion in the new born
(aorta is connect to RV, and pulmonary to LV creating parallel systems)
-whtout a septal defect, and a PDA - cannot live
RF: Diabetic mother

Hist/Pe - cyanosis in first few hours of life
-tachypnea, progressive hypoxaemia, extreme cyanosis
-CHF signs
-load S2 present
DX - echo
CXR - egg shaped silhoutte and increase pulmonary vascular markings

Treatment - IV prostaglandisn to maintian PDA
-srugery - or baloon atrial septostomyt to create enlarge SD, then surgical correction

Question 8

tetraology of fallot

Answer 8

-most common chidlhood congenital heart disease
shared opening of aorta and pulmonary arteries
Path - endocardial cushion defect, downs syndrome

Things associated

1. VSD
2. Overriding aorta
3. Pulmonary stenosis
4. RVH

pt: blue baby, dies at briht
older baby - blue then red when squats
-may present in childhood with dyspnea, fatigability , cyanosis
-can get CHF, diaphoressi with feeding ro tachpnoea
Dx - chest xray - boot shaped heart, decreased pulmonary vascular markings
echo
ecg - rvh, right axis deviaiton
Tx: surgery