Cardiology

Question 1

5 causes of Acyanotic CHD

Answer 1

• PDA
• Coartation
• ASD
• VSD

Question 2

VSD

Answer 2

• Small VSD
  
  • asymptomatic
  • loud pansystolic murmur best head at lower left sternal edge
  • no cxrt changes or ECG
  • often close spontaneoulsy
• larger VSD
  
  • children - breathless, failure to trhive
  • tachyponoe, tacycardia, parasternnal heave, soft panystolic murmur
  • HF - treat with ACE -I and direurects
  • management - most close on their own, surgical repair if irreversible lung damange due to increased PR by age 2

Question 3

ASD

Answer 3

• ostium secundum - centre of atrial septum affects the foramen ovale
• ostium priumum- in AV spetum often associated with Downs syndrome, fetal alcohol syndrome and MR
• symptoms
  
  • asymptomatic in childhoon, breathless when older
• signs
  
  • split and fixed second heart sound
  • soft ejection systolic murmur best heard in pulmonary area upper left sternal edge
  • ECG - RAD, RBB
• management
  
  • aims to prevent right cardiac failure and arrhytmias
  • interventions at 3-5 years
  • secundum - cardiac cathetrisation and insertion of occlusion device
  • primum - surgical repair

Question 4

PDA

Answer 4

• causes - congenital rubella, prematurity, perinatal distress
• symptoms
  
  • usually asymptomatic
  • if large - heart failure
• signs
  
  • bounding pulses due to wide pulse pressure
  • continious machinery murmur
  • CXR and ECG resemble VSD
• duct closed with coil occlusive device via cardiac catheterisation
• NSAID can be used to close duct in pre-term babies

Question 5

Coarctations of the Aorta

Answer 5

• narrowing of the aorta
• either preductal or post ductal
• preductal
  
  • antenatasl ultrasound diagnsois
  • post ductal - severly ill neonate with absent femoral pulses, collapse, heart failure
  • adequate cardiac output whilst ductus arteriosis remains open, cardiac failure once duct closes
  • prostaglandin infusion is given to open/ maintain ductus arteriosis then surgical repair
• post ductal
  
  • usually asymptomatic
  • O/e - upper body hypertension, poor femoral pulses, ejection systolic murmu heard in left interscapular area
  • CXR - cardiomegaly and rib notching
• surgery - balloon dilation and stenting, resection of coarcted segment with end to end anastomosis