Cardiac conditions

Question 1

What vessel caries blood from the placenta to the fetus?

Answer 1

Umbilical vein

Question 2

What vessel carries blood from the fetus to the placenta?

Answer 2

Umbilical artery

Question 3

What are the three shunts that are specific to foetal life and what do they do?

Answer 3

Ductus venosus (Connects the umbilical vein to the IVC)
Foramen Ovale (Opening in the atrial septum connecting the RA to the LA)
Ductus arteriousis (Connects the pulmonary bifurcation to the descending aorta)

Question 4

What is the purpose of the ductus venosus?

Answer 4

It connects the umbilical vein to the IVC. This is because the nutrients are coming straight from the placenta and don’t need to be processed in the liver. The ductus venosus allows the liver to be bypasses and blood to directly enter the circulation.

Question 5

What is the purpose of the foramen ovale?

Answer 5

It allows blood to flow from the right to left atrium. This means that all the best oxygenated blood can enter the left atrium, then the left ventricle and then the aorta, carotids etc

Question 6

What is the purpose of the ductus arteriosus?

Answer 6

Only 7% of the RV output goes to the lungs (the lungs do not oxygenate the blood in fetal life!) The rest goes via the ductus arteriosus to join the descending aorta.

Question 7

About what % of the adult population have a patent foramen ovale?

Answer 7

35%

Question 8

What is persistent pulmonary hypertension of the newborn?

Answer 8

The lung vascular resistance fails to fall due to a failure of closure of the foramen ovale and/or the ductus arteriosis. This menas that the baby is blue and that there is a large difference between pre and post ductal oxygen saturation.

Question 9

What maintains the patency of the ductus arterious in the fetus?

Answer 9

Prostoglandin E2

Question 10

Give examples of mild congenital heart disease

Answer 10

Small VSD
Small ASD
Small PFO
Small PDA

Question 11

Describe transposition of the great vessels

Answer 11

A group of congenital heart disease where the great vessels are in the wrong place. For example in transposition of the great arteries the aorta and the pulmonary artery are switches meaning that deoxigenated blood gets pumped around the body and there is no blood flowing to the lungs to become oxygenated (hence the cyanosis)

Question 12

How does transposition of the great vessels tend to present?

Answer 12

Presents at the time of duct closure (between 2 and 7 days)
Severe Cyanosis, tachypnoea, Absent pulses
Acidosis

Question 13

What is the initial managment of a baby who is cyanotic due to transposition of the great vessels?

Answer 13

ABC
Prostoglandin E2 (opens duct)
Transfer to cardiac surgical unit

Question 14

What is hypoplastic left heart syndrome and how does it present?

Answer 14

The left side of the heart in severely underdeveloped. This results in cyanosis at the time of duct closure

Question 15

How does a large ventricular septal defect present?

Answer 15

A murmur develops as the pulmonary pressure drops over the first few weeks. This leads to increased pulmonary circulation and congestive cardiac failure.

Question 16

List the common acyanotic heart defects

Answer 16

Patent ductus arteriosus
Coarctation of the aorta 
Ebsteins anomaly 
Atrial Septal defect 
Ventricular Septal defect

Question 17

What is coarctation of the aorta and how does it present?

Answer 17

The aorta is narrowed at the area where the ductus arteriosus inserts. There is sometimes no symptoms and children present when they are older with failure to thrive. They are more common in girls with turners syndrome.

Question 18

List the common cyanotic heart defects?

Answer 18

Tetralogy of Fallot 
Transposition of the great arteries
Tricuspid atresia 
Pulmonary atresia 
Hypoplastic left heart syndrome

Question 19

What is tetralogy of fallot?

Answer 19

Cyanotic heart defect that included four defects:

1. Pulmonary stenosis (narrowing of the exit from the right ventricle)
2. Ventricular septal defect
3. Right ventricular hypertrophy
4. Overriding aorta (blood from both ventricles can enter the aorta)

Question 20

What is ebstein’s anomaly?

Answer 20

Congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced downwards towards the apex of the right ventricle. This means that the right atria is very large and the right ventricle is very small.,

Question 21

What medication increases the risk of an ebsteins anomaly?

Answer 21

Lithium

Question 22

A baby is found to have a constant “machine like murmur’ and a heaving apex beat found on their newborn baby check.

Answer 22

Patent ductus arteriosus

Question 23

What medication can be given to close a patent ductus arteriosis?

Answer 23

Indomethacin

Question 24

What kind of murmur do you get in tetralogy of fallot and why?

Answer 24

Ejection systolic murmum due to pulmonary stenosis