Cardiology

Question 1

Universal Newborn Screening for Critical Congenital Heart Disease

Answer 1

Preductal and postductal O2 saturation

Question 2

During development of the aortic arch, the area near the insertion of the ductus arteriosus fails to develop correctly, resulting in a narrowing of the aortic lumen

Answer 2

Coarctation of Aorta

Infants presenting with coarctation of the aorta frequently have hypoplastic aortic arches, abnormal aortic valves, and VSDs. They may be dependent on a patent ductus arteriosus to provide descending aortic flow. Symptoms develop when the aortic ampulla of the ductus closes.

Question 3

Criteria for negative congenital heart disease screen

Answer 3

> /= 95% O2 in R hand or R foot, and < 3% difference between the two

Question 4

Soft, split S2

Slower progression

Answer 4

ASD

Question 5

Soft, systolic
split S2
Slower progression

Answer 5

ASD

Question 6

Harsh, loud
Pansystolic, heard at LLSB

High rate of closure

Answer 6

VSD

The most common congenital heart defect, accounts for 25% of all congenital heart disease. Perimembra­nous VSDs are the most common of all VSDs (67%).

Question 7

“machinery-like” murmur, heard around the left infraclavicular area. often well heard over the left side of the back.

Answer 7

PDA

Question 8

Acyanotic congenital heart diseases include

Answer 8

Left -to-right shunts resulting in:
PDA
VSD
ASD

Obstructive lesions:
Coarctation of Aorta
Pulmonary Stenosis
Aortic Stenosis

Question 9

Are large VSDs symptomatic at birth?

Answer 9

Large VSDs are not symptomatic at birth because the pulmonary vascular resistance is normally elevated at this time. As the pulmonary vascular resistance decreases over the first 6 to 8 weeks of life, the amount of shunt increases, and symptoms may develop.

-pulmonary over-circulation > heart failure

Question 10

Are small VSDs symptomatic?

Answer 10

Small VSDs are often asymptomatic but they have a loud murmur

Question 11

Where are VSDs best heard

Answer 11

Lower Left Sternal Border

Question 12

Are ASDs symptomatic?

Answer 12

Even with large ASDs and significant shunts, infants and children are rarely symptomatic.

Medical management is rarely indicated. If a significant shunt is still present at around 3 years of age, closure is usually recommended.

Question 13

Are PDAs symptomatic?

Answer 13

Small PDAs are asymptomatic;

Moderate to large shunts can produce the symptoms of heart failure as the pulmonary vascular resistance decreases.

Question 14

Where are PDAs heard best?

Answer 14

left infraclavicular area, radiating along the pulmonary arteries and often well heard over the left side of the back.

Question 15

Classic pulse findings with coarctation of aorta

Answer 15

Classically the femoral pulses are weaker and delayed compared with the right radial pulse. Blood pressure in the lower extremities is lower than that in the upper extremities.

Question 16

Systolic ejection murmur at the second left intercostal space which radiates to the back.

Answer 16

Pulmonary stenosis

Question 17

A systolic ejection murmur is heard at the right second intercostal space along the sternum and radiating into the neck.

Answer 17

Aortic stenosis

Question 18

Cyanotic Heart Lesions: 5 Terrible T’s

Answer 18

Tetralogy of Fallot
Transposition of the great arteries
Tricuspid atresia
Truncus arteriosus 
Total anomalous pulmonary venous return

Question 19

Tetralogy of Fallot’s 4 structural defects

Answer 19

1. ventric­ular septal defect (VSD),
2. pulmonary stenosis,
3. overriding aorta
4. right ventricular hypertrophy

Question 20

Usually the initial abnormal finding in ToF

Answer 20

Cyanosis OR Pulmonary Stenosis murmur

Question 21

Typical findings in ToF, in addition to cyanosis and pulmonary stenosis murmur

Answer 21

Single S2

Right ventricular impulse at the left sternal border