CARDIOL

Question 1

Newborn presents with radiofemoral delay. What cardiac condition does this indicate?

Answer 1

CoA

Question 2

Which is more likely to be abnormal - a 3rd heart sound or a 4th heart sound?

Answer 2

S4

S3 can be normal in children, but an S4 is almost always abnormal in children

Question 3

Causes of S4

Answer 3

Aortic stenosis, HOCM, HF + HTN with LVH

Question 4

What is the most common benign murmur of infancy?

Answer 4

Physiologic peripheral pulmonary stenosis
Due to turbulence caused by 2 factors: 1) branch pulmonary arteries being small compared to main PA
2) sharp angle of origin of the branch arteries off main PA

Question 5

Describe the murmur of physiologic peripheral pulmonary stenosis

Answer 5

Soft, harsh, systolic ejection murmur best heard at base of the heart, axilla and in both R and L hemithoraces
Disappears by 12 months old

Question 6

7 yo presents with continuous murmur with the following qualities:
- low pitched sound
- absent when patient is supine
- turning the head, valsalva maneuver, or compression of the jugular vein make the murmur go away
What is the most likely murmur?

Answer 6

VENOUS HUM
Due to blood draining down collapsing jugular veins into the larger intrathoracic veins. High velocity makes the vein walls “flutter”, resulting in a low pitched murmur. Absent when patient supine, because neck veins distend and there is no pressure gradient between the 2 areas
Innocent murmur + very common in childhood

Question 7

Infant fails the newborn hearing screen and on ECG has a prolonged QT interval.

What is the likely diagnosis?