Cardiology

Question 1

Examples of acyanotic and cyanotic heart disease*

Answer 1

> Acyanotic

• VSD 32%
• PDA 12%
• ASD 5%
• Pulmonary/ Aortic stenosis
• Coarctation of aorta

> Cyanotic

• TOF 6%
• Transposition of great artery 5%
• Tricuspid atresia
• Eisenmenger syndrome

Question 2

Investigation for cyanotic heart disease

Answer 2

• FBC: r/o polycythemia
• ABG: PaO2 low in respiratory/ circulatory abnormality, normal in methemoglobinemia, polycythemia
• CXR: lung or heart abnormalities (eg: boat-shaped heart in TOF)
• ECG
• Echocardiography

Question 3

4 cardinal features of ToF

Answer 3

• VSD
• Pulmonary stenosis
• RVH
• Overriding aorta

Question 4

Management of ToF

Answer 4

> Conservative

• Oxygen
• Propranolol (relieve infundibular spasm + peripheral vasoconstriction)
• Bicarbonate (corrects acidosis)

> Surgery

• Temporary (eg: BT shunt to increase pulmonary blood flow)
• Corrective: usually done at 6 months of age

Question 5

Grading of murmur

Answer 5

• 1: detected by cardiologist
• 2: Soft murmur
• 3: Louder
• 4: palpable thrill
• 5: Very loud murmur, audible when placed lightly on chest
• 6: Extremely loud murmur audible with stethoscope off

Question 6

Clinical features of heart failure in children

Answer 6

> Symptoms

• Feeding difficulty
• Recurrent chest infection
• Failure to thrive

> Sign

• Resting tachypnea, subcostal recession
• Tachycardia, poor peripheral pulse/ perfusion
• Hyperactive precordium
• Hepatomegaly
• Wheezing
• Increase JVP, leg edema, basal lung crackles are not usually found in children

Question 7

Management of heart failure

Answer 7

> General measure

• Oxygen supplementation
• Keep warm
• Fluid restriction
• Optimized calories intake
• Correct anemia, electrolyte imbalance

> Anti-failure medication

• Frusemide
• Spironolactone
• Captopril: afterload reduction
• Digoxin: increase contraction force