cardiovascular

Question 1

what an innocent systolic murmur

Answer 1

soft systolic murmur best heard in the 2nd and 4th intercostal spaces

Question 2

what is an innocent venous murmur

Answer 2

• continuous murmur best head below the clavicles
• disappears when child lies down
• occurs due to turbulent flow in the head and neck veins

Question 3

innocent murmur presentation

Answer 3

• asymptomatic, worse with fever
• no radiation or thrill, change with respiration and position (decreases when sitting up, increases when lying down)

Question 4

what is a ventricular septal defect

Answer 4

• murmur is a loud pan-systolic murmur best heard at lower left sternal edge but radiates throughout precordium
• associated with thrills and sometimes symptoms of heart failure

Question 5

ventricular septal defect causes

Answer 5

• chromosomal disorders (Down’s syndrome, Edward’s, Patau’s, cri-du-chat)
• congenital infections
• acquired (post MI)

Question 6

ventricular septal defect diagnosis

Answer 6

may be detected in utero during routine 20 week scan

Question 7

ventricular septal defect presentation

Answer 7

• failure to thrive
• heart failure features (hepatomegaly, tachypnoea, tachycardia, pallor)
• pan-systolic murmur (louder in smaller defects)

Question 8

ventricular septal defect management

Answer 8

• small defects may be asymptomatic and close spontaneously but require monitoring
• moderate to large defects usually result in heart failure in first few months
• nutritional support
• medication for heart failure (diuretics)
• surgical closure of defect

Question 9

ventricular septal defects complications

Answer 9

• aortic regurgitation
• infective endocarditis
• right heart failure
• Eisenmenger’s complex

Question 10

what is Eisenmenger’s complex

Answer 10

• due to prolonged pulmonary hypertension from left to right shunt
• results in right ventricular hypertrophy and increased right ventricular pressure (this eventually exceeds the left ventricular pressure, resulting in reversal of blood flow)
• this results in cyanosis and clubbing
• indication for heart and lung transplant

Question 11

atrial septal defect presentation

Answer 11

• soft ejection systolic murmur best heard at the upper left sternal edge with fixed splitting of S2
• embolism may pass from venous system to left side of heart causing stroke

Question 12

atrial septal defect subtypes

Answer 12

• ostium secundum
• ostium primum

Question 13

ostium secundum presentation

Answer 13

• more common
• associated with Holt-Oram syndrome
• ECG shows right bundle branch block and right axis deviation

Question 14

ostium primum presentation

Answer 14

• presents earlier
• associated with abnormal AV valves
• ECG shows right bundle branch block with left axis deviation, and prolonged PR interval

Question 15

coarctation of the aorta associations

Answer 15

• turner’s syndrome
• bicuspid aortic valve
• berry aneurysms
• neurofibromatosis
• men > women

Question 16

what is coarctation of the aorta

Answer 16

congenital narrowing of the descending aorta

Question 17

coarctation of the aorta presentation

Answer 17

• ejection systolic murmur heard between shoulder blades
• infancy: heart failure
• adult: hypertension
• radio-femoral delay
• mid-systolic murmur, maximal over back
• apical click from aortic valve
• notching of inferior border of ribs (due to collateral vessels), but this isn’t seen in young children

Question 18

coarctation of the aorta management

Answer 18

• neonates: IV prostaglandins as this maintains patent ductus arteriosus before surgery
• surgery

Question 19

patent ductus arteriosus risk factors

Answer 19

• premature babies
• born at high altitude
• mother’s that suffered from maternal rubella in the 1st trimester

Question 20

patent ductus arteriosus presentation

Answer 20

• continuous machine-like murmur, best heard below the left clavicle
• left sub clavicular thrill
• large volume, bounding, collapsing pulse
• wide pulse pressure
• heaving apex beat

Question 21

patent ductus arteriosus pathophysiology

Answer 21

• generally classed as acyanotic, however if uncorrected, can eventually result in late cyanosis in lower extremities (differential cyanosis)
• connection between the pulmonary trunk and descending aorta
• usually ductus arteriosus closes with first breathes due to increased pulmonary flow which enhances prostaglandin clearance

Question 22

patent ductus arteriosus management

Answer 22

• indomethacin or ibuprofen
• if associated with other congenital heart disease and going for surgery, prostaglandin E1 is used to keep duct open until after surgical repair

Question 23

tetralogy of fallot cause

Answer 23

anterior malalignment of the aorticopulmonary septum

Question 24

tetralogy of fallot has characteristics from which 4 defects

Answer 24

• ventricular septal defect
• right ventricular hypertrophy
• right ventricular outflow
• overriding aorta

Question 25

tetralogy of fallot presentation

Answer 25

• cyanosis
• right to left shunt
• ejection systolic murmur due to pulmonary stenosis
• right sided aortic arch

Question 26

tetralogy of fallot diagnosis

Answer 26

• chest x-ray shows boot shaped heart
• ECG shows right ventricular hypertrophy

Question 27

tetralogy of fallot management

Answer 27

• surgical repair in two parts
• cyanotic episode may be helped by beta blockers as this will reduce infundibular spasm