Cardiology

Question 1

Cardiac history points

Answer 1

Preterm?
Heart failure - breathlessness, poor feeding, faltering growth, cold peripheries
Cyanosis?
Neonatal collapse?
FH
Syndrome?
Medications or illnesses during pregnancy?

Question 2

Signs of heart failure in children

Answer 2

Faltering growth
Excessive forehead sweating
Tachycardia
Breathlessness, recession
Poor peripheral perfusion
Hepatomegaly

NB. Left to right shunts never cause heart failure in first week of life.
Up to 7 days of age heart failure implies a duct-dependent circulation

Question 3

Risk factors for congenital cardiac disease

Answer 3

FH (esp mother) - including FH abnormal genotype
Syndrome/other anomaly
Maternal SLE (anti-Ro and -La –> congenital heart block)
Maternal lithium (Ebstein anomaly)
3rd trimester viruses - enterovirus, Coxsackie (dilated cardiomyopathy)

Question 4

Complications of Cyanotic Congenital Heart Disease

Answer 4

Brain abscess
Haem - polycythaemia, DIC/thrombocytopenia, thromboembolism (stroke)
Haemoptysis
Gum disease
Gout
Arthritis
Clubbing
FTT
Psychomotor delay

Question 5

Steinberg’s sign

Answer 5

Thumb in clenched hand protrudes beyond the palm

Marfan’s, arachnodactyly

Question 6

Cardiac defects in Patau’s syndrome

Answer 6

VSD
ASD
PDA
Coarctation
Biscuspid aortic or pulmonary valve

Question 7

TAR syndrome

Answer 7

= thrombocytopenia and absent radius

Associated with ASD and ToF

Question 8

Signs of acute pericardial effusion

Answer 8

Tamponade - pulsus paradoxus, RV end-diastolic collapse (echo)
Muffled heart sounds
Shock

Question 9

VSD

Answer 9

80% in membranous septum
50% small of which 75% close spontaneously
other 50% large, of which 10% close spontaneously
90% of those that close will do so before 10y

Loud S2 = onset of pulmonary hypertension
Big LtR shunt causes high flow over mitral valve and “relative stenosis”
No abx for dental procedures

Question 10

Rheumatic Fever - Major Criteria

SCARS

Answer 10

Sydenham's chorea
Carditis
Arthritis (poly)
Rash (erythema marginatum)
Subcutaneous nodules

Question 11

Rheumatic Fever - Minor Criteria

Answer 11

Arthralgia
ESR
Fever
Prolonged PR

Question 12

Tetralogy of Fallot

Answer 12

VSD + PS + overriding aorta + RVH

Harsh USE murmur from d1
Unwell d2
Boot-shaped heart
Cyanosis but not failure

Question 13

Transposition of Great Arteries

Answer 13

No murmur
Very sick from d2
Egg-on-side shaped heart

Question 14

Ebstein’s anomaly

Answer 14

Malformed, leaky tricuspid valve
Assoc with maternal lithium use
Loud PSM + unwell from 2d