Cardiology

Question 1

Congenital Heart Disease: Cyanotic

1. Definition (1)
2. Pathogenesis (3)
3. Examples (4*, 10)

Answer 1

1. Deoxygenated blood or mixed blood into the systemic circulation
2. Structural defects that cause:
   - Right to left, or bidirectional shunting
   - Malposition of the great arteries
   - Increased pulmonary vascular resistance
3. Types:
   - Tetralogy of Fallot*
   - Total anomalous pulmonary venous connection*
   - Transposition of the great arteries*
   - Eisenmenger’s syndrome*
   - Hypoplastic L) heart
   - Persistent truncus arteriosus
   - Tricuspid atresia
   - Interrupted aortia arch
   - Pulmonary atresia
   - Pulmonary stenosis

Question 2

Congenital Heart Disease: Acyanotic

1. With shunting (4)
2. Without shunting (3)

Answer 2

1. Where blood is shunted from left to right
   - VSD
   - ASD
   - AVSD
   PDA
2. Without shunting
   - Pulmonary stenosis
   - Aortic stenosis (bicuspid aortic valve)
   - Coarctation of the aorta

Question 3

Cardiac Effects of Medications for IOL

Medication
- Mechanism
- Dose
- Cardiac effects
- Safety

Answer 3

Prostin:
- PGE2 analogue
- 1-2mg Q6H
- Minimal cardiac effects
- Safe in CVD

Misoprostol
- PGE1 analogue
- 25mcg Q2H
- High dose (800mcg) can cause hypotension/arrhythmias
- Low dose in CVD

Syntocinon
- Oxytocin
- 2-32mIU/min (Wellington)
- Low infusion rates do not cause cardiovascular compromise
- Safe in CVD

Mifepristone
- Anti-progestogenic
- 200mg
- No cardiovascular effects
- Safe in CVD

Mechanical (foley, Dilapan)
- No cardiac effects
- Safe in CVD

Question 4

Cardiac Effects of Medications for PPH

Medication (4)
- Mechanism
- Dose
- Cardiac effects
- Safety

Answer 4

Syntocinon
- Uterine contractions
- 5u IV bolus over 60s; IV infusion, IM
- Hypotension from widespread vasodilation, tachycardia, myocardial ischaemia/ST depression, reduced CO with some PET
- Slow/repeated low dose reduces CV effects

Ergometrine
- Sustained uterine contraction
- 250-500mcg IM/IV
- Coronary vasoconstriction, systemic hypertension, pulmonary hypertension, pulmonary oedema, heart failure, cerebral haemorrhage, aortic dissection
- Contraindicated: hypertension/PET, cardiac disease

Carboprost
- Prostaglandin analogue, helps with haemostasis at site of placentation, synergistic with other ecbolics
- 250mcg IM Q15 mins
- Hypertension, bronchoconstriction, pulmonary vasoconstriction, vasovagal
- Contraindicated: pulmonary hypertension, cyanotic heart disease, pulmonary oedema

Misoprostol
- PGE1 analogue
- 400-1000mcg PR/PO/SL; start with 25mcg Q5-10mins with CVD
- High doses can cause coronary vasospasm and hypotension
- Low doses safe in CVD