Cardio

Question 1

When are most congenital cardiac abnormalities detected?

Answer 1

antenatally during fetal anomoly scan (18-20weeks) - 70% that require surgery in first 6 months of life detected

Question 2

How common is an innocent heart murmur and what does it sound like?

Answer 2

~30% of normal children have a innocent heart murmur

Think innoSent:
Short
Soft
aSymptomatic
Systole only
left Sternal edge
Sitting/Standing (posture dependant)

More apparent during illness or exercise

Can arrange follow-up with GP when the child is well to review
If any doubt: echo

Question 3

Congenital defects of the heart that can result in heart failure?

Answer 3

VSD, ASD, Large persistent ductus arteriosus, coarctation of the aorta, Fallot’s (transposition of aorta)

Question 4

How would a partial AVSD sound different to a ASD or AVSD?

Answer 4

Partial AVSD = pansystolic murmur best heard at apex

ASD = ejection systolic at ULSE
AVSD = often no murmur as gap is v. big
(VSD = systolic murmur best hear at LLSE)

Question 5

Presenting symptoms of a left to right shunt?

Answer 5

HF –> poor feeding, FTT, sweating and cold peripheries

Pulmonary hypertension + oedema +/- hepatomegaly

Question 6

management of ASD secundum?

Answer 6

Catheter device closure at 3-5 years to prevent right ventricular failure and arrhythmias later in life

Question 7

What would be seen on CXR in left to right shunt?

Answer 7

Enlarged heart
Enlarged pulmonary arteries
Increased pulmonary vascular markings

Question 8

What should be given to babies with transposition of the great arteries?

Answer 8

Prostaglandins - keeps PDA patent

Question 9

What are the features of tetralogy of fallot?

Answer 9

Overriding aorta
Large VSD
Sub pulmonary stenosis
RV hypertrophy

–> harsh ejection systolic murmur on left sternal edge

Will present with cyanosis

Question 10

What is sinus arrhythmia?

Answer 10

changes in the HR due to inspiriation/expiration

Question 11

What is the most common clinical arrhythmia in children and how is it managed?

Answer 11

Supra-ventricular tachycardia

Attack:
ABCDE
Vagal stimulating manoeuvre (e.g. carotid sinus massage)
Adenosine bolus +/- electrical cardioversion

Maintenance (stopped at 1yr old)
Digoxin if no delta wave on ECG (i.e. WPW syndrome)
Propanolol/ amioaderone in WPW

Question 12

What is the aetiology of complete heart block?

Answer 12

Abs from mother prevent normal development of AV node - will require pacemaker if not still-born

Question 13

What is a juvenile t-wave pattern on a paediatric ECG?

Answer 13

T wave inversion V1-3

Question 14

What might indicate right ventricular hypertrophy on a paediatric ECG?

Answer 14

Upright t wave on V1

Question 15

What might indicate pulmonary hypertension on a paediatric ECG?

Answer 15

Upright T waves

Question 16

What might indicate left ventricular strain?

Answer 16

inverted T wave at V6x

Question 17

Vebous hum

Answer 17

Innocent murmur
- around 20% blood goes to head –> internal jugular veins

The flow of blood results in a ‘hum’ which can be heard loudest underneath the clavicle

Question 18

PDA

Answer 18

Usually closes on day 1-2 of life, disappears by 3 weeks

RF:

• Prematurity
• Downs
• Congenital rubella
• Maternal valproate exposure

Usually small and asymptomatic

Big –> FTT, recurrent LRTIs (pulmonary HTN)
Machine hum murmur

Question 19

Management of PDA

Answer 19

Preterm: ibuprofen, indometacin
Diuretics for HF
Surgical ligation

Asymptomatic: regular echo review and catheter closure if still patent at 1 year

Question 20

Turner’s syndrome example

Answer 20

Short - low set ears
Co-arctation of the aorta (HS I+II+systolic murmur loudest in L infraclavicualr area and radiating into the back) -->
- Weak femoral pulses
- proximal HTN
- ventricular hypertrophy --> HF

Question 21

Coarctation of the aorta investigations

Answer 21

Investigations: CXR, ECG, MRI, Echo, U+E +/- cardiac catheter

Question 22

Management of coarctation of the aorta

Answer 22

Critical stenosis in neonate - prostaglandins
HF - diuretics
HTN - anti-hypertensives

Question 23

Maneuver to encourage blood to flow proximally in tetralogy of fallot

Answer 23

Knee-to-chest position

Imitates ‘tet spell’ tetralogy of fallot children will do after exercise

Can give morphine to encourage blood flow to lungs