Cardio

Question 1

Tetralogy of fallot

Answer 1

4 things:

• VSD
• Overriding aorta (taking mixed oxygenated/deoxygenated blood)
• Pulmonary stenosis (as less room for it)
• Leads to r sided hypertrophy

Presentation:

• Some present with cyanosis at birth
• Others may have an ejection systolic murmur
• Cyanotic spells especially with crying, improved by squatting (as increases L ventricular pressure - reverses shunt)

Investigation:

• CXR shows boot shaped heart
• ECG
• Echo

Management:

• Give prostaglandins to keep any ducts open
• Correct surgically at 3-6 months

Question 2

Transposition of the great arteries

Answer 2

The aorta and pulmonary artery are the wrong way round - pulmonary artery comes from L ventricle, aorta from R ventricle. So, the only way oxygenated blood from the lungs gets around the body is by ducts e.g. VSD

Presentation:

• Soon after birth with profound cyanosis

Investigations:

??

Management:

• Prostaglandins to keep ducts open
• Surgery - atrial sepstostomy to allow mixing of blood in atria
• Then definitive surgery to swap

Question 3

Coarctation of the aorta

Answer 3

Presentation:

• If severe, can present with shock after day 2 of life, once PDA closes
• Weak/absent femorals
• But can present later (i.e. adult) if milder

Investigations:

??

Management:

• If severe - prostaglandins to keep duct open while waiting on surgery