Cardiology in Pediatrics

Question 1

Q: What are the key differences between an innocent and a pathological heart murmur?

Answer 1

A:

• Innocent murmur: Soft, usually Grade I-II, no associated symptoms, common in children (40-45%).
• Pathological murmur: May be louder, associated with symptoms like cyanosis, breathlessness, or poor growth.

Question 2

Q: What are the grades of heart murmurs?

Answer 2

Grade I: Barely audible.
Grade II: Soft, audible.
Grade III: Loud without a thrill.
Grade IV: Loud with a thrill.
Grade V: Audible with a stethoscope lightly placed.
Grade VI: Audible with a stethoscope off the chest.

Question 3

Q: What are the two main types of congenital heart disease?

Answer 3

1- Cyanotic: Right-to-left shunt (e.g., Tetralogy of Fallot, Transposition of Great Arteries).

Causes cyanosis due to deoxygenated blood bypassing the lungs.

2- Acyanotic: Left-to-right shunt (e.g., Ventricular Septal Defect, Atrial Septal Defect).

Causes increased pulmonary blood flow and heart failure symptoms.

Question 4

Q: What is the most common congenital heart defect?

Answer 4

A: Ventricular Septal Defect (VSD).

Question 5

Q: What is Kawasaki disease, and how is it diagnosed?

How do you treat it ?

Answer 5

A:

Kawasaki disease is a systemic vasculitis affecting children under 5 years old.
Diagnosis requires fever for 5 days plus 4 out of 5 criteria (Warm + CREAM):

C: Conjunctivitis
R: Rash
E: Erythema of extremities
A: Adenopathy (cervical lymphadenopathy)
M: Mucosal changes (e.g., strawberry tongue).

Management: IV immunoglobulin and aspirin therapy.

Question 6

Q: How is coarctation of the aorta typically diagnosed?

Answer 6

A:

Symptoms: Poor feeding, lethargy, and congestive heart failure in severe cases.

Clinical signs: Delayed lower limb pulses, higher BP in upper limbs, systolic murmur in the left infraclavicular area.

Question 7

Q: What is the primary management for transposition of the great arteries (TGA)?

Answer 7

Keep the ductus arteriosus open with prostaglandin infusion.
Early surgical correction is required.

Question 8

Q: What are the complications of untreated Kawasaki disease?

Answer 8

A:

Coronary artery aneurysms (15-25%).

Cardiac impairment and mitral regurgitation.

Question 9

Q: What is rheumatic fever, and how is it diagnosed?

Answer 9

Rheumatic fever is caused by Group A Streptococcal infection.

Diagnosis is based on the Jones Criteria:

Recent strep infection + 2 major or 1 major and 2 minor criteria.

Question 10

What type of murrmur would you expect with a VSD ?

Answer 10

Pansystolic murmur

Question 11

What is Transposition of the great arteries (TGA)?

Answer 11

Definition: The aorta and pulmonary artery are switched, causing deoxygenated blood to circulate systemically

Question 12

Q: What are common teratogens associated with congenital heart disease?

Answer 12

A:

Rubella: Coarctation, PDA, VSD.
Alcohol: VSD.
Phenytoin: ASD.
Lithium: Ebstein’s anomaly.
Warfarin: TOF, VSD.

Question 13

What type of murmur is typically heard in Ventricular Septal Defect (VSD)?

Answer 13

1. B. Pansystolic murmur at the lower left sternal border

Question 14

Which murmur is characteristic of Atrial Septal Defect (ASD)?

Answer 14

2. Soft systolic ejection murmur at the upper left sternal border

Question 15

What type of murmur is commonly associated with Patent Ductus Arteriosus (PDA)?

Answer 15

Continuous machinery murmur at the upper left sternal border

Question 16

What murmur is expected in Tetralogy of Fallot (TOF)?

Answer 16

4. Harsh systolic ejection murmur at the upper left sternal border

Question 17

What murmur would you expect in Coarctation of the Aorta?

Answer 17

5. C. Systolic murmur in the left infraclavicular area

Question 18

When would you see this ?

Answer 18

Tetralogy of Fallot

Question 19

When would you see this ?

Answer 19

Transposition of the great arteries.