Cardiology

Question 1

What is the first-line tx for a newborn with cyanotic congenital heart disease?

Answer 1

Prostaglandin E1 should be given to maintain a patent ductus arteriosus

Question 2

What is the pathophysiology of transposition of the great arteries?

Answer 2

In normal development, the aortopulmonary septum spirals. In transposition of the great vessels, this spiral doesn’t happen, which means that the aorta leaves the right ventricle and the pulmonary artery leaves the left ventricle.

Question 3

What defects is transposition of the great arteries also associated with?

Answer 3

Atrial septal defect and ventricular septal defect (allows mixing of the blood from the left and right sides of the heart)

Question 4

How is transposition of the great arteries managed?

Answer 4

Prostaglandins

Surgery within the first few months of life

Question 5

How can severe tet spells in a baby be managed?

Answer 5

Severe Tet spells can be managed with a vaso-constrictive agent (e.g. phenylephrine) as a ‘last line’ medical therapy. Vasoconstriction will help to increase systemic vascular resistance, reducing the right-to-left shunt and improving cyanosis.

Question 6

What are the features of tetralogy of fallot?

Answer 6

Pulmonary stenosis - harsh ejection systolic murmur @ left sternal edge, pulmonary stenosis causes a right-to-left shunt of deoxygenated blood across the ventricular septal defect.
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect.
Tet spells - crying (hypoxia -> pain), turning blue

Question 7

Mx of tetralogy of fallot?

Answer 7

Definitive surgery to correct the ventricular septal defect and widen the right ventricular outflow tract.

Question 8

What is the most common cardiac defect in a fetus of a chronically diabetic mother?

Answer 8

Transposition of the great arteries