Cardiology

Question 1

What are the 8 common lesions that cause congenital heart disease?

Answer 1

Ventricular Septal Defect (VSD)
Patent Ductus atreriosus (PDA)
Atrial Septal Defect (ASD)
Pulmonary stenosis
Aortic stenosis
Coarctation of the Aorta
Transposition of great arteries
Tetralogy of Fallot

Question 2

What are some risk factors for congenital heart disease?

Answer 2

• Genetic susceptibility
• Environmental hazard; drugs, infections, maternal DM/SLE
• Teratogenic insult (18-60 days post conception)

Question 3

What are some chromosomal abnormalities associated with CHD?

Answer 3

Trisomy 13 90%
Trisomy 18 80%
Trisomy 21 40% - specifically AVSD.

Question 4

What congenital defect is Turner’s syndrome associated with?

Answer 4

Co-arctation of the Aorta

Question 5

What congenital defect is Noonan syndrome associated with?

Answer 5

Pulmonary stenosis

Question 6

What congenital defect is William’s syndrome associated with?

Answer 6

Supravalvular aortic stenosis.

Question 7

How does CHD typically present?

Answer 7

Feeding, weight and development reduced. 
Cyanosis
Tachypnoea
Dyspnoea
Decreased exercise tolerance
Chest pain
Syncope
Palpitations
Joint problems

Question 8

What is seen on examination of someone with CHD?

Answer 8

Weight and height abnormalities
Dysmorphic features
Cyanosis
Clubbing
Tachy/dyspnoea
Additional heart sounds
Murmurs
Abnormal pulses/apex beat.

Question 9

What are some investigations for CHD?

Answer 9

Blood pressure
O2 saturation
Arterial Blood gases
ECG
CXR
ECHO
Catheter
Angiography
MRI
Exercise testing

Question 10

How can murmurs be characterised?

Answer 10

Timing in cycle - systole, diastole, continuous.
Duration - earl/mid/late, ejection/Holo- or pan systolic.
Pitch/quality - turbulence, soft or indeterminate, vibratory (laminar flow)

Question 11

What are some common features of innocent murmurs?

Answer 11

Systolic murmur (continuous venous hum)
No other signs of cardiac disease.
Vibratory, musical
Localised
Varies with position, respiration and exercise.

Question 12

What is Still’s murmur?

Answer 12

2-7yrs
Left Ventricular outflow murmur. 
Soft systolic, vibratory, musical. 
Located at apex on left sternal border. 
Increased in supine position/exercise.

Question 13

What are some features of Pulmonary Outflow Murmur?

Answer 13

8-10yrs
Soft systolic, vibratory
Upper left sternal border, well localised. 
Increases in supine and exercise.
Often children with narrow chest.

Question 14

What are some features of Carotid/brachiocephal IC arterial bruits?

Answer 14

2-10yrs
1/6-2/6 systolic, harsh.
Supraclavicular that radiates to neck.
Increased with exercise, decreased in turning head/neck extension.

Question 15

What are some features of Venous hum?

Answer 15

3-8yrs
Soft, indistinct
Continuous murmur, sometimes with diastolic accentuation.
Supraclavicular
Only in upright position, disappears lying down/turning head.

Question 16

What are the 3 types of Ventricular Septal defects?

Answer 16

Subaortic
Perimembranous
Muscular

Question 17

What is the clinical presentation of Ventricular Septal Defects?

Answer 17

Pansystolic murmur lower left sternal edge, sometimes with thrill.
In small VSDs early systolic murmur.
In large VSDs diastolic rumbles due to relative mitral stenosis.
Signs of cardiac failure.

Question 18

What is Eisenmenger Syndrome?

Answer 18

Pressure in the pulmonary arteries becomes so high that it causes oxygen-poor blood to flow from the right to left ventricle and then to the body, causing cyanosis.
Blood in wrong direction.
Ventricular septal defect.

Question 19

How is a VSD closed?

Answer 19

Amplatzer
Transcatheter
Patch closure
Open heart surgery

Question 20

What are some features of Atrial Septal defects?

Answer 20

Few clinical signs in early childhood.
Good chance of spontaneous closure.
Sometimes detected n adulthood with AF, heart failure or pulmonary hypertension.
Wide fixed splitting of 2nd heart sound, pulmonary flow murmur.

Question 21

What are some features of pulmonary stenosis?

Answer 21

Asymptomatic in mild.
Exertional dyspnoea and fatigue in moderate/severe.
Ejection systolic murmur upper left sternal border with radiation to back.

Question 22

What is a balloon valvoplasty?

Answer 22

Procedure to repair a heart valve that has a narrowed opening.

Question 23

What are the features of aortic stenosis?

Answer 23

Mostly asymptomatic
Severe - reduced exercise tolerance, external chest pain, syncope.
Ejection systolic murmur upper right sternal border, radiation to carotids.

Question 24

What happens to foetal circulation at birth?

Answer 24

Pulmonary vascular resistance falls and pulmonary blood flow rises. 
Systemic vascular resistance increases. 
Ductus arteriosus closes
Foramen ovale closes
Ductus venosus closes

Question 25

What are some treatment options for patent ductus arteriosus?

Answer 25

Fluid restriction
diuretics
Prostaglandin inhibitors e.g. indomethacin, ibuprofen.
Surgical ligation.
Term babies good chance of spontaneous closure, not prostaglandin sensitive.

Question 26

What is the management of Co-arctation of the Aorta?

Answer 26

Reopen Ductus arteriosus with prostaglandin E1 or E2.
Resection with end to end anastomoses.
Subclavian patch repair
Balloon Aortoplasty

Question 27

What is transposition of the Great arteries?

Answer 27

The pulmonary and aortic arteries are swapped over. Aorta carries deoxygenated blood and Pulmonary carries oxygenated blood.

Question 28

What is Fallot’s Tetralogy?

Answer 28

Combination of 4 congenital heart defects:
Ventricular septal defect (VSD)
Pulmonary valve stenosis, Misplaced aorta
Right ventricular hypertrophy.