Cardiology

Question 1

Which defect is associated with wide fixed splitting of S2?

Answer 1

ASD - due to equal volume of blood in RV during inspiration & expiration (normally there is more on inspiration)

Question 2

What are the acyanotic heart defects? What is they key symptom?

Answer 2

VSD, ASD, PDA. Breathless (left to right shunts)

Question 3

Which condition is associated with increased risk of bacterial endocarditis?

Answer 3

Small VSD

Question 4

What does a small VSD sound like?

Answer 4

Loud pansystloic murmur at L sternal edge

Question 5

What are the symptoms + signs of a large VSD?

Answer 5

Symptoms: HF, SOB and FTT from 1w onwards. Presents in first 2 months of life. Recurrent chest infections, hepatosplenomegaly.

Signs: quiet pan systolic murmur L sternal edge, increased HR + RR

Question 6

A 48y/o lady has presented with recent onset AF. Upon echo, a heart defect is noted. What likely defect does she have?

Answer 6

ASD

Question 7

What features may be visible on a CXR of VSD or ASD?

Answer 7

Cardiomegaly, enlarged pulmonary As, increased pulmonary vascular markings

Question 8

When might you see a collapsing/bounding pulse?

Answer 8

PDA (due to volume overload)

Question 9

What are the auscultation signs in PDA?

Answer 9

Machine hum murmur, heard loudest under L clavicle –> radiates to back

Question 10

At what age must PDA be operated on if not closed?

Answer 10

by 1y

Question 11

What non-surgical options are there for Tx of PDA?

Answer 11

Ibuprofen –> opposes effects of pristine

Prostaglandin inhibitor e.g. indomethacin

Question 12

When is a cyanotic heart defect likely to present?

Answer 12

Within 1st week of life

Question 13

What are the main cyanotic heart defects?

Answer 13

Transposition of great As, tetralogy of fallot’s,

Question 14

When does the ductus arteriosus usually close?

Answer 14

Within 1st 2 days of life

Question 15

What is the classic radiological findings of transposition great As?

Answer 15

Looks like an egg on the side, narrow mediastinum, increased pul vascular markings

Question 16

What murmur may be heard with ToF?

Answer 16

Ejection systolic murmur - due to pul stenosis

Question 17

A 3 day old baby suddenly becomes very pale and breathless. After a minute or so he returns to normal. What is this?

Answer 17

A cyanotic (Tet) spell - closure of ductus arteriosus around day 2/3 causes R–>L shunt –> sudden SOB, irritable, cyanosed, pale, poss lose consciousness briefly.

However, spells do not last long as the overriding aorta means blood can still get from LA to aorta.

Question 18

What are the CXR features of ToF?

Answer 18

Small heart, boot shaped

Question 19

How can tet spells be managed?

Answer 19

Usually self-limiting, followed by period of sleep.
If longer than 15 mins:
- sedation & pain relief
- IV propanolol
- Oxygen
- If acidotic --> bicarbonate

Question 20

What defect is associated with Down’s?

Answer 20

AVSD - often no murmur. Progressive HF over 1-2 months of life –> rapid breathing, nasal flaring during feeding, FTT

Question 21

What condition is aortic coarctation associated with?

Answer 21

Turner’s

Question 22

What are the signs of aortic coarctation?

Answer 22

Examination on day 1 = normal.

When DA closes –> constricts aorta –> circulatory collapse, severe HF, weak femoral, metabolic acidosis, renal failure

Question 23

Which organism is assoc with bacterial endocarditis? How is it Tx?

Answer 23

Strep viridans.

Tx = gentamicin + penicillin for 6w