Cardiology

Question 1

How does patent ductus arteriosus present?

Answer 1

left to right shunt
linked with prematurity and rubella
continuous crescendo decrescendo machinery murmur

Question 2

How do you keep ductus arteriosus open?

Answer 2

prostaglandins

Question 3

How to close a PDA?

Answer 3

ibuprofen or indomethacin

Question 4

What is an ASD?

Answer 4

left to right shunt
mid systolic crescendo decrescendo murmur
watch and wait or surgical correction

Question 5

What is a VSD?

Answer 5

linked with Down’s and Turner’s syndromes
left to right shunt
pan systolic murmur loudest at left lower sternal border at 3rd and 4th intercostal space

Question 6

What are the causes of eisenmenger syndrome?

Answer 6

PDA
ASD
VSD

Question 7

What is eisenmenger syndrome?

Answer 7

over time left to right shunt causes pulmonary hypertension and increased right sided pressure leading to right to left shunt developing
cyanosis
right ventricular heave
prognosis is 20 years reduced life expectancy due to heart failure, thromboembolism and haemorrhage
need heart lung transplant once got this far
Plus some medical management like sildenafil for pulmonary hypertension, venesection for polycythaemia and anticoagulants for VTE prevention

Question 8

Coarctation of aorta

Answer 8

linked with turners syndrome
narrowing of aortic arch around ductus arteriosus
low bp distal to narrowing, high bp before narrowing
weak femoral pulses
systolic murmur below left clavicle
later signs- left ventricular heave, under developed legs and underdeveloped left arm

Question 9

Aortic valve stenosis

Answer 9

born with narrow aortic valve
ejection systolic crescendo decrescendo murmur in aortic area, radiates to carotids
diagnose by echo
treat with valve replacement

Question 10

Pulomonary valve stenosis?

Answer 10

thickened leaflets of valve
ejection systolic murmur in pulmonary area
palpable thrill
raised JVP
may be on its own or associated with tetralogy of fallot, William syndrome, Noonan syndrome or congenital rubella syndrome
diagnose by echo
valve replacement

Question 11

What is Tetralogy of fallot?

Answer 11

4 coexisting pathologies- VSD, overriding aorta, pulmonary valve stenosis, right ventricular hypertrophy
Right to left shunt
diagnose by echo or doppler flow studies
boot shaped heart due to right ventricular thickening
murmur of pulmonary stenosis
cyanosis, clubbing and tet spells

Question 12

What is a tet spell and the treatment?

Answer 12

due to peripheral vasodilation- right to left shunt gets worse.
Often happens due to exercise
children squat to increase systemic vascular resistance and get blood into pulmonary vessels
other treatments- oxygen, beta blockers, iv fluids, morphine, sodium bicarbonate, phenylephrine infusion

Question 13

Treatment for tetralogy of fallot?

Answer 13

maintain PDA as neonatal temporary treatment

Open heart surgery

Question 14

What is ebstein’s anomaly?

Answer 14

Low set tricuspid valve, causes large right atrium and small right ventricle
Also often have ASD with right to left shunt causing cyanosis
Gallop rhythm on auscultation
associated with Wolff Parkinson white syndrome
diagnose by echo
need surgical management of underlying condition

Question 15

What is transposition of great arteries?

Answer 15

aorta and pulmonary trunks swapped
two separate circulations that don’t mix
can be alone or associated with VSD, pulmonary stenosis or coarctation of aorta
Can be cyanosed immediately after birth or within a few weeks if PDA or VSD
Can create atrial septal defect to buy time before definitive arterial switch surgery