Cardiology

Question 1

Pansystolic LLSE =

Answer 1

VSD

Question 2

ESM itself suggests…?

Answer 2

RVOT or LVOT

Question 3

ESM RUSE?

Answer 3

AS
coarct

Question 4

VSD murmur

Answer 4

PSM LLSE
mid diastolic rumble at mitral area (relative MS)

Question 5

AS murmur / findings

Answer 5

ESM at RUSE
radiates to carotids
with systolic click

narrow pulse pressure

Question 6

left parasternal heave

Answer 6

right heart dilatation

Question 7

palpable P2 =

Answer 7

pulmonary HTN

Question 8

coarctation ECG

Answer 8

RVH after birth, but usually LVH (bc its a LVOTO)

Question 9

PS ECG

Answer 9

RVH

Question 10

ways to calculate axis

Answer 10

I positive, aVF positive = normal axis, 0 to +90
I positive, aVF negative = possible LAD, 0 to -90. if II positive, then normal axis.
I negative, aVF positive = RAD, +90 to 180
I negative, aVF negative = extreme axis, 180 to -90. check lead placement.

Question 11

MR ECG

Answer 11

RVH

Question 12

dextrocardia

Answer 12

extreme RAD
aVR pos, otherwise globally negative

Question 13

pre-repair TOF ECG and CXR

Answer 13

RVH and RAH
boot shaped CXR

Question 14

post-repair TOF: findings, ECG and CXR

Answer 14

• Fixed at 6-10 months of age
• Most have a degree of PS/PR after
• Great to and fro pulm murmur
• Old sternotomy scar
• RVH/RBBB with wide QRS on ECG- width of QRS correlates RV dilation
• 25-30% will need PVR before 18

Question 15

Ebstein’s ECG

Answer 15

RA enlargement
1st degree heart block
RBBB

Question 16

chest scars:
- right thoracotomy
- left thoracotomy
- midline sternotomy

Answer 16

• right: valves / PA banding / shunt
• left: CoA / valve / PDA / PA banding / shunt
• midline: VSD, fontan or other

Question 17

ASD: findings, ECG and CXR

Answer 17

• RV heave/ sternal deformity
• PV ESM, wide and fixed split S2
• IRBBB on ECG in 95%+, RVH
• CXR: heart big, lungs wet

Question 18

Progression for palliative cyanotic patients

Answer 18

• initial operation in first days of life (Norwood or Shunt or PA band)
• BCPS at 3-12 months; SaO2 around 80-85 after
• Fontan completion around 4-5yrs; SaO2 around 90 after
• How old is your pt and their scar?

Question 19

Older cyanotic child with continuous shunt murmur suggests?

Answer 19

suggests that pulm artery growth poor e.g. complex CCHD

Question 20

4 classic post-op cardiac shorts

Answer 20

1. TOF
2. AVSD
3. CoA
4. TGA

Question 21

AVSD in shorts - key features

Answer 21

• Usually fixed 2-4 months old
• T21 in 80% !!
• Residual LAVVR (MR) common- so apical PSM
• ECG: left superior axis, +/- LA/LV big

Question 22

post CoA repair - key features

Answer 22

• may have been fixed from the side (pretty much only coarct and PDA in modern era, occasional complex shunt)
• Strong assoc BicuspAoV; so aortic ESM
• 4 limb BP’s for residual; HT main complication

Question 23

old midline scar and acyanotic - what could it be?

Answer 23

1. TOF - RBBB, PS/PR murmur ‘to and fro’
2. TGA - no RBBB, PS common (ESM)
3. AVSD - left axis, MR (apical PSM)

Question 24

sites of radiation and what it means

Answer 24

neck = aortic
back/side = pulmonary
axilla = pulmonary / MR

Question 25

options:
- pink and no scar
- pink and scar
- blue and no scar
- blue and scar

Answer 25

• pink and no scar: ASD, VSD, PDA, PS
• pink and scar: anything, but think AVSD, VSD, TOF, TGA
• blue and no scar: unrepaired TOF, Ebstein’s (the other cyanotic lesions are a bit unrealistic)
• blue and scar: TOF with shunt or palliative congenital lesion for single ventricle pathology