Cardiology

Question 1

What is a Blalock-Taussig shunt? what is scar?

Answer 1

A Blalock-Taussig (BT) connects arterial supply to lungs
Usually L side thoracotomy scar

Question 2

What are the syndromes likely to appear in cardiac exam?

Answer 2

Downs, Turners, Noonan’s, di George, Marfans

Question 3

What CHD is associated with Marfans?

Answer 3

Mitral valve prolapse/ regurgitation
Aortic regurgitation
Aortic root dilatation

Question 4

What condition is associated with coarcation of the aorta?

Answer 4

turner’s syndrome

Question 5

What CHD is associated with Downs syndrome?

Answer 5

VSD, AVSD, pulmonary hypertension

Question 6

What condition is associated with pulmonary artery stenosis?

Answer 6

Noonans

Question 7

What are congenital long- QT syndromes?

Answer 7

Romano-Ward Syndrome
Jervell-Lange-Nielsen Syndrome - a/w deafness

Question 8

Absent/ strange thumb suggests what?

Answer 8

VACTERL syndrome (absent radii) - multiple cardiac anomalies
Holt-Oram syndrome funky radii absent thumb - ASD

Question 9

What to comment on from end of bed:

Answer 9

Nutritional status: ‘I would like to plot his height and weight on a growth chart’
O2 tank/ sats monitor
Work of breathing: Respiratory rate, recessions Cyanosis
Dysmorphism – Down’s Williams, Digeorge Turner’s , Noonan’s, Marfans

Question 10

what to check on fingers during cardiac exam?

Answer 10

Clubbing
Peripheral cyanosis
Splinter haemorrhages
Capillary refill

Question 11

What to check on hands ?

Answer 11

JAneway nodes, osler lesions, xanthomas
thumb anomalies!

Question 12

How to measure HR ?

Answer 12

radial/ brachial
(Count, rhythm, character) – count over 6 sec X10

Question 13

What to comment on face?

Answer 13

Eyes: Sclera – Jaundice ( Congestive cardiac failure à Hepatic congestion)
Conjunctive – Pallor (Anaemia)
Face: Mitral flush / malar flush
Polycythaemia (Cyanotic heart disease à Increased haematocrit)
Tongue: Central cyanosis ( Right to left shunt/ Inadequate oxygenation in lungs)
Lips/oral mucosa: Pallor
Teeth: Dental Caries
Palate: High arch palate (Marfan’s)

Question 14

What to look for on neck

Answer 14

JVP (in older child) can be high if hepatic congestion

Question 15

What to look for on chest?

Answer 15

Chest wall - asymmetry? Harrison’s sulcus,
Scars - thoractomoy/ sternotomy. IF b/l thoracotomy Tetralogy of fallot repair. See slides
Visible pulsations (hyperdynamic apex beat)
Chest drain scars
Mediastinal drains
Chest wall pacemaker

Question 16

Apex beat displaced to left means what?

Answer 16

Cardiomegaly, pectus excavatum, scoliosis

Question 17

Apex beat displaced to right means what?

Answer 17

Congenital dextrocardia (feel for liver- Kartagener syndrome),
Left diaphragmatic hernia,

Question 18

Where should you feel for thrills?

Answer 18

Parasternal notch - aortic stenosis
Lower left sternal edge -VSD
Upper left sternal edge- pulmonary stenosis

Question 19

If you hear a murmur how should you describe it?

Answer 19

– Systolic / diastolic murmur

– Site

– Loudness (Grade 1-6)

– Radiation

– Character: harsh, blowing, high-pitched, low-pitched

Question 20

What murmurs can be heard at upper left sternal edge?

Answer 20

Ejection systolic - Pulmonary stenosis
Diastolic- Aortic regurgitation, pulmonary regurgitation

Question 21

What murmur can be heard at lower left sternal edge?

Answer 21

Pansystolic: Tricuspid regurgitation

               VSD

Diastolic: Tricuspid stenosis

              Aortic regurgitation

Still’s murmur

Question 22

What murmur can be heard at the apex?

Answer 22

Pansystolic: Mitral regurgitation

               VSD

Late systolic: Mitral Valve Prolapse

Mid-diastolic: Mitral stenosis

Question 23

What murmur can be heard at upper right sternal edge?

Answer 23

Ejection systolic: Aortic stenosis

Continuous: Rt BT shunt

Venous hum

Question 24

Where to also auscultate and why?

Answer 24

• Axillary area (if there is murmur at Apex or LUSE)
  – Back (If there is murmur at LUSE)
  – Neck (if there is murmur at RUSE) - AS radiates to corotid

Question 25

How do you differentiate between aortic stenosis and pulmonary stenosis?

Answer 25

Murmurs louds in expiration à Left heart disease à Aortic stenosis

Murmurs loudest in inspiration à Right heart disease à Pulmonary stenosis

Question 26

Complete this sentence: I would like to complete my cardiac examination by :

Answer 26

Feeling for hepatomegaly
Feeling for femoral pulses and looking for scars on inguinal area for cardiac catheterisation/ arterial lines
Measure blood pressure and oxygen saturation (if not mentioned earlier )
Measure height and weight and plot on growth chart appropriate for age and size
Feeling for peripheral and sacral oedema
Auscultate lung bases (if not done earlier)

Question 27

What are salient points of cardiac exam?

Answer 27

Cyanosis/Pink
Stable/not in respiratory distress
Clubbing
Scars
Heart sounds I + II + murmur (grade)