Cardiology

Question 1

Name two innocent murmurs and their features

Answer 1

Venous hums - Heard as continuous blowing noise just below clavical.
Still’s murmur - Low pitched sound heart at lower left sternal edge

Question 2

What are the characteristics of an innocent murmur?

Answer 2

Soft- blowing murmur in pulmonary area
Short buzzing murmur in aortic area.
May vary with posture,
Localised with no radiation.
No diastolic component.
No thrill.
No added sounds.
Asymptomatic

Question 3

Different causes of Acyanotic heart disease?

Answer 3

VSD
ASD (present later in life),
Patient ductus arteriosis,
Coarctation of the aorta,
Aortic valve stenosis

Question 4

Different causes of cyanotic heart disease?

Answer 4

Tetralogy of fallot
Transposition of the great arteries,
Tricuspid atresia

Question 5

Presentation and management of ventricular septal defects?

Answer 5

Poor feeding,
Dyspnoea,
Tachypnoea,
Failure to thrive,
Pan-systolic murmur - left lower sternal border.
Can lead to pulmonary HTN and heart failure
Rx - Transcatheter closure vis femoral vein or open heart surgery.

Question 6

Associations of VSDs?

Answer 6

Down’s syndrome
Truner syndrome
Risk of progression to Eisenmenger syndrome

Question 7

Types of atrial septal defects?

Answer 7

Ostium secondum - failure of septum secondum to close.
Osteum primum - failure of septum primum to close.

Question 8

Presentation, complications, and management of ASDs

Answer 8

Often asymptomatic and therefore diagnosed later in life. Can present with:
SOB,
Difficulty feeding,
Poor weight gain,
LRTI,
Mid-systolic cresendo-decrescendo murmur heard louded over upper left sternal edge.

Complications - stroke, atrial fibrillation, pulmonary HTN, eisenmenger syndrome.

Rx - Wait and watch, surgical closure, anticoagulation in adults.

Question 9

Explain Eisenmonger’s syndrome

Answer 9

Can occur in ASD, VSD or patient ductus arteriosus.
Occurs when pulmonary pressure exceeds systemic pressure so blood flow swaps and flows from right to left. Thus blood bypasses lungs and patient becomes cyanotic.
Presents with signs of Pulmonary HTN (RV heave, raised JVP, peripheral oedema) and cyanosis, clubbing, dyspnoea and plethoric complexion (due to polycythaemia).
Definitive management - heart and lung transplant.