Cardiology

Question 1

What are clinical features of ventricular septal defects?

Answer 1

Asymptomatic
Heart failure - tachypnoea, tachycardia, enlarged liver
Recurrent chest infection
Pansystolic murmur

Question 2

What are investigations for VSD?

Answer 2

CXR
ECG
ECHO

Question 3

What is medical management of VSD?

Answer 3

Diuretics - e.g. furosemide and spironolactone
ACE inhibitor - e.g. captopril
Additional calorie input – e.g. high calorie formula, NG tube
Spontaneous closure of VSD

Question 4

What is surgical management of VSD?

Answer 4

VSD closure (3-6mths)
Required if medical management not controlling symptoms

Question 5

What are clinical features of atrial septal defects?

Answer 5

Asymptomatic, chest infections, wheeze
Ejection systolic murmur

Question 6

What are investigations for ASD?

Answer 6

ECG
ECHO
CXR

Question 7

What is management of ASD?

Answer 7

Cardiac catheterisation or surgical correction to close the defect and prevent right heart failure

Question 8

What are future complications of ASD?

Answer 8

Arrhythmias
Stroke

Question 9

What is ductus arteriosus?

Answer 9

Ductus arteriosus connects the pulmonary artery to the descending aorta - usually closes shortly after birth

Question 10

What is patent ductus arteriosus?

Answer 10

Failure of ductus arteriosus to close 1 month after birth - left to right shunt from aorta to pulmonary artery

Question 11

What are clinical features of PDA?

Answer 11

Continuous (machinery) murmur beneath the left clavicle
Heat failure – faultering growth and LRTI

Question 12

What is the investigation for PDA?

Answer 12

ECHO

Question 13

What is the management of PDA?

Answer 13

Coil or occlusion device via cardiac catheterisation
Preterm infants – Indomethacin (NSAID)

Question 14

What are options for management of aortic stenosis?

Answer 14

Balloon aortic valvuloplasty
Surgical repair
Valve replacement

Question 15

What is coarctation of the aorta?

Answer 15

Narrowing of aortic arch - high blood pressure in upper body and low blood pressure in lower body (low volume femoral pulse)
Left ventricular hypertrophy

Question 16

What are clinical features of coarctation of the aorta?

Answer 16

Examination on first day of life is usually normal
Severe heart failure – enlarged liver
Absent femoral pulses
Severe metabolic acidosis

Question 17

What are investigations of coarctation of the aorta?

Answer 17

CXR - cardiomegaly from HF and shock
ECG - normal

Question 18

What is the management of coarctation of the aorta?

Answer 18

ABC resuscitation
Prostaglandin infusion - Dinoprostone
Surgical repair or stent insertion

Question 19

What is atrioventricular septal defect?

Answer 19

Abnormality of the inlet valves - one conjoint inlet valve instead of separate mitral and tricuspid valve

Complete AVSD has interatrial and interventricular defects

Question 20

What is tetralogy of fallot?

Answer 20

VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

Question 21

What is the presentation of tetralogy of fallot?

Answer 21

Antenatally
Pulmonary stenosis - ejection systolic murmur
VSD - pansystolic murmur

Question 22

What are clinical features of tetralogy of fallot?

Answer 22

Hypercyanotic spells - turning blue
Clubbing in older children

Question 23

What is tetralogy surgical repair?

Answer 23

Pulmonary artery patch
VSD patch

Question 24

How are congenital heart defects screened?

Answer 24

Antenatal scans
Newborn check
6 week check - auscultation, femoral pulse, respiration, weight gain, colour