Cardiology

Question 1

define ventricular septal defects (VSD)

Answer 1

a birth defect of the heart in which there is a hole in the wall (septum) that separates the two lower chambers of the heart

Question 2

aetiology of VSD

Answer 2

septum dividing the left and right ventricle that fails to completely close - causes left to right shunting

Question 3

clinical features of VSD

Answer 3

if small, often asymptomatic

if large: 
dyspnoea on exertion
poor weight gain 
tachypnoea 
failure to thrive

Question 4

examination findings in VSD

Answer 4

pan-systolic murmur at left lower sternal border

systolic thrill

Question 5

investigations of VSD

Answer 5

echocardiogram
CXR
ECG

Question 6

management of VSD

Answer 6

if small:
self-resolve in 1yr
calorie intake increase
observations

if large/causing symptoms:
diuretics (e.g. captopril)
transvenous catheter closure
open heart surgery

Question 7

additional requirements in VSD surgery

Answer 7

consider antibiotic prophylaxis to reduce risk of infective endocarditis

Question 8

conditions commonly associated with VSD

Answer 8

Down’s Syndrome

Turner’s Syndrome

Question 9

define atrial septal defect (ASD)

Answer 9

a cardiac malformation causing the hole between left and right atria that allows left-right shunting of blood

Question 10

types of ASDs

Answer 10

ostium secondum (failure  of septum secondum to close)
patent foramen ovular 
ositum primum (septum primum fails to close)

Question 11

clinical features of ASDs

Answer 11

often asymptomatic but can present with:

dyspnoea
difficulty feeding
poor weight gain
recurrent LRTIs

Question 12

examination findings in ASD

Answer 12

ejection systolic murmur in upper left sternal edge

fixed split second heart sound

Question 13

management of ASD

Answer 13

refer to paeds cardiologist

if small: watching + waiting

if large: transvenous catheter closure or open heart surgery

Question 14

additional requirements in ASD

Answer 14

provide anticoagulants (e.g. warfarin, aspirin and NOACs) to reduce clot and stroke risk

Question 15

complications of ASD

Answer 15

strokes (in context of DVT)
atrial fib/flutter 
pulmonary hypertension
Eisenmenger Syndrome 
right sided heart failure

Question 16

define coarctation of the aorta

Answer 16

a narrowing of the aorta just before the ductus arteriosus causing diversion of blood into the brachiocephalic artery, constricting flow to distal branches supplying of the right leg

Question 17

conditions associated with coarctation of the aorta

Answer 17

Turners Syndrome:
XO karyotype
webbed neck
wide spaced nipples

Question 18

clinical features of coarctation of aorta

Answer 18

tachypnoea
poor feeding
greying and floppy baby
underdeveloped limbs

Question 19

examination findings in coarctation of aorta

Answer 19

systolic murmur below left clavicle and scapula
left ventricular heave
radio-femoral delay

Question 20

investigations of coarctation of aorta

Answer 20

CXR - rib notching appearance

echocardiogram

Question 21

management of coarctation of aorta (mild)

Answer 21

echo monitoring

Question 22

management of coarctation of aorta (severe)

Answer 22

prostaglandin E (alprostadil)
stent insertion or surgical repair

Question 23

reasoning behind use of prostoglandin E (alprostadil) in coarctation surgeries

Answer 23

keeps ductus arteriosus open while waiting for surgery

Question 24

types of coarctation of aorta

Answer 24

preductal - before ductus

postductal - after ductus

Question 25

complications of coarctation of aorta

Answer 25

cerebral aneurysms due to triggering of renin-angiotension-aldosterone system

Question 26

define patent ductus arteriosus (PDA)

Answer 26

failure of ductus arteriosus to close after birth

Question 27

clinical features of PDA

Answer 27

dyspnoea difficulty feeding poor weight gain LRTIs

Question 28

examination findings in PDA

Answer 28

continuous crescendo-decresendo 'machinery' murmur during 2nd heart sound collapsing pulse systolic thrill bradycardia

Question 29

investigations in PDA

Answer 29

echocardiogram doppler CXR ECG (if older)

Question 30

management of PDA (haemodynamically stable)

Answer 30

indomethacin - inhibits prostaglandin synthesis

Question 31

management of PDA (haemodynamically unstable)

Answer 31

trans-catheter | surgical ligation/closure

Question 32

define Tetralogy of Fallot

Answer 32

congenital condition of four existing pathologies: VSD overiding aorta pulmonary valve stenosis right ventricular hypertrophy

Question 33

risk factors of Tetralogy of Fallot

Answer 33

rubella infection increased maternal age alcohol consumption in pregnancy diabetic mother

Question 34

clinical features of Tetralogy of Fallot

Answer 34

appearance of antenatal scans Tet spells (acute cyanotic episodes with hypoxia, pain, crying and cyanosis) poor feeding poor weight gain

Question 35

examination findings in Tetralogy of Fallot

Answer 35

ejection systolic murmur

Question 36

investigations in Tetralogy of Fallot

Answer 36

echocardiogram doppler flow studies CXR - will show 'boot shaped' heart

Question 37

management of Tet spells in Tetralogy of Fallot

Answer 37

``` knees to chest position supplemental oxygen beta blockers morphine IV fluids sodium bicarbonate phenylephrine infusion ```

Question 38

management of Tetralogy of Fallot

Answer 38

``` prostoglandin infusion (alprostadil) total surgical repair ```