Cardiology

Question 1

What are the three fetal shunts

Answer 1

Ductus venosus - umbilical vein to inferior vena cava, bypasses the liver
Foramen ovale - right atrium and left atrium, bypasses pulmonary circulation
Ductus arteriosus - pulmonary artery to aorta, bypasses pulmonary circulation

Question 2

What keeps the ductus arteriosus open

Answer 2

Prostaglandins

Question 3

Define innocent murmurs

Answer 3

Also known as flow murmurs, are common in children. Caused by fast blood flow through various areas of the heart during systole

Question 4

Features of an innocent murmur

Answer 4

S
Soft
Short
Systolic
Symptomless
Situation dependant

Question 5

Examples of a pan systolic murmur

Answer 5

Mitral regurgitation - mitral area
Tricuspid regurgitation - tricuspid area
Ventricular septal defect - left lower sternal border

Question 6

Examples of an ejection systolic murmur

Answer 6

Aortic stenosis - aortic area
Pulmonary stenosis - pulmonary area
Hypertrophic obstructive cardiomyopathy

Question 7

What murmur is heard in an atrial septal defect

Answer 7

Mid-systolic, crescendo-decrescendo murmur heard loudest at the upper left sternal border with a fixed split second heart sound

Question 8

What murmur is heard in a patent ductus arteriosus

Answer 8

Continuous crescendo-decrescendo machinery murmur.

Question 9

What murmur is heard in tetralogy of fallot

Answer 9

Ejection systolic murmur heard loudest at the pulmonary area - pulmonary stenosis

Question 10

Define cyanotic heart disease

Answer 10

Where deoxygenated blood enters the systemic circulation - there is a right to left shunt that bypasses the pulmonary circulation

Question 11

Examples of cyanotic heard disease

Answer 11

Transposition of the great arteries

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
(Eisenmenger syndrome)

Question 12

Define patent ductus arteriosus

Answer 12

Ductus arteriosus that fails to close - normal happens within first 2-3 weeks. Often caused by genetics, infection or prematurity

Question 13

Which direction is the shunt in patent ductus arteriosus

Answer 13

Left to right
Aorta at much higher pressure than pulmonary artery.
Shunt increased pressure leading to right heart strain and hypertrophy

Question 14

Presentation of patent ductus arteriosus

Answer 14

Shortness of breath
Difficulty feeding
Poor weight gain
LRTI
Machinery like murmur heard

Question 15

Investigation in patent ductus arteriosus

Answer 15

Echocardiogram

Question 16

Managment of patent ductus arteriosus

Answer 16

Monitoring echos until 1 year when should close
If not - trans-catheter or surgical closure

Question 17

Define Eisenmenger syndrome

Answer 17

Where pulmonary pressure is greater than systemic pressure causing a reversal of a right to left shunt making the patient cyanotic

Question 18

Examples of atrial septal defects

Answer 18

Ostium secondum
Patent foramen ovale
Ostium primum

Question 19

Complications of atrial septal defects

Answer 19

Stroke - VTE
Atrial fibrillation or flutter
Pulmonary hypertension
Eisenmenger syndrome

Question 20

Presentation of atrial septal defect

Answer 20

Mid-systolic murmur with fixed split second heart sound
Shortness of breath
Difficulty feeding
Poor weight gain
LRTI

Question 21

Management of atrial septal defects

Answer 21

Conservative
Surgical closure
Anticoagulants in adults

Question 22

What genetic conditions are VSD associated with

Answer 22

Down’s and Turner

Question 23

Presentation of a ventricular septal defect

Answer 23

Pan-systolic murmur at lower sternal border
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive

Question 24

Management of ventricular septal defects

Answer 24

Conservative
Surgical closure
Abx for infective endocarditis

Question 25

Clinical signs of Eisenmenger syndrome

Answer 25

Right ventricular heave Loud P2 Raised JVP Peripheral oedema Murmur Cyanosis Clubbing Dyspnoea Plethoric complexion

Question 26

Management of Eisenmenger syndrome

Answer 26

Management of underlying defect Heart-lung transplant Oxygen Treat pulmonary hypertension Treat arrythmia Prevent thrombosis Prevent endocarditis

Question 27

Define coarctation of the aorta

Answer 27

Congenital condition where there is narrowing of the aortic arch - usually around the ductus arteriosus

Question 28

What genetic conditions are associated with coarctation of the aorta

Answer 28

Turners syndrome¬

Question 29

Presentation of coarctation of the aorta

Answer 29

Weak femoral pulses Four limb blood pressure - variation Systolic murmur - Tachypnoea Poor feeding Grey and floppy Left ventricular heave Underdevelopment

Question 30

Management of coarctation of the aorta

Answer 30

Prostaglandin - keep ductus arteriosus open Surgical correction and removal of ductus arteriosus

Question 31

Presentation of aortic stenosis

Answer 31

Fatigue Shortness of breath Dizziness Fainting Worse on exertion Ejection systolic murmur Ejection click Palpable thrill

Question 32

Management of aortic stenosis

Answer 32

Echo! Balloon aortic valvoplast Surgical aortic valvotomy Valve replacement

Question 33

Complications of aortic stenosis

Answer 33

Left ventricular outflow tract obstruction Heart failure Ventricular arrhythmia Bacterial endocarditis Sudden death

Question 34

What conditions are associated with pulmonary valve stenosis

Answer 34

Tetralogy of fallot William syndrome Noonan syndrome Congenital rubella syndrome

Question 35

Presentation of pulmonary valve stenosis

Answer 35

Fatigue Shortness of breath Dizziness Fainting Ejection systolic murmur Palpable thrill Raised JVP - A waves

Question 36

Management of pulmonary stenosis

Answer 36

Echo! Conservative Balloon valvuloplasty

Question 37

Define tetralogy of Fallot

Answer 37

Ventricular septal defect Overriding aorta Pulmonary valve stenosis Right ventricular hypertrophy

Question 38

Define overriding aorta

Answer 38

An aorta that sits further right overlying a VSD As a result right ventricular blood passes through VSD and directly up aorta

Question 39

Risk factors for tetralogy of Fallot

Answer 39

Rubella Increased maternal age Alcohol consumption during pregnancy Diabetic mothers

Question 40

Investigations in tetralogy of Fallot

Answer 40

Echo! - dopple flow Chest xray

Question 41

What is seen on CXR in tetralogy of Fallot

Answer 41

Boot shaped hear - due to right ventricular thickening

Question 42

Clinical signs of tetralogy of Fallot

Answer 42

Cyanosis Clubbing Poor feeding Poor weight gain Ejecction systolic murmur Tet spells

Question 43

Define tet spells

Answer 43

Intermittent symptomatic periods where the right to left shunt becomes worsenedm causing a cyanotic episode. This happens because of increased pulmonary resistance or decreased systemic resistance - during exercise build up CO2 which causes dilation decreasing resistance

Question 44

Management of Tet spells

Answer 44

Squat to increase systemic vascula rresistance Oxygen Beta blockers IV fluids - increase preload Morphine - decrease resp drive, Sodium bicarbonate Phenylephrine

Question 45

Management of tetralogy of Fallot

Answer 45

Prostaglandin infusion to maintain ductus arteriosus Total surgical repair

Question 46

Define Ebstein's anomaly

Answer 46

Congenital heart condition where the tricuspid valve is set lower in the right causing a bigger atrium and smaller ventricle. Leads to poor flow to pulmonary vessels

Question 47

Define transposition of the great arteries

Answer 47

Condition where the attachment of the aorta and pulmonary trunk are swapped - the pulmonary and systemic systems are completely separate

Question 48

Presentation of transposition of the great arteros

Answer 48

Antenatal scans Cyanosis at birth - patent shunt allows initial compensation Respiratory distress Tachycardia Poor feeding Poor weight gain Sweating

Question 49

Management of transposition of the great arteries

Answer 49

Prostaglandin infusion - maintain right to left shunt Balloon septostomy Surgical management