Cardiovascular

Question 1

How common are innocent murmurs in children?

Answer 1

Up to 30% will have them at some point

Question 2

What features of a murmur make it likely to be innocent?

Answer 2

Soft
Short
Symptom-free
Systolic only
Site heard over is small
Sitting and standing - disappears with change of position

Question 3

What type are the vast majority of innocent murmurs?

Answer 3

Flow murmurs (80%) - Turbulent blood flow results in audible murmur, often best heard at left sternal edge
Other 20% are venous shunts - vibration audible hum, loudest beneath clavicle, silent when lying flat

Question 4

What is the most common congenital heart defect in Down’s syndrome?

Answer 4

Atrio-ventricular septal defect

Question 5

What is the most common congenital heart defect in Turner’s syndrome?

Answer 5

Coarctation of the aorta

Question 6

What is the most common congenital heart defect in Marfan’s syndrome?

Answer 6

Aortic aneurysms

Question 7

What heart defects are classed as left to right shunts?

Answer 7

VSD, ASD, AVSD, PDA

Question 8

What heart defects are classed as right to left (‘cyanotic’) shunts?

Answer 8

Tetralogy of Fallot, Transposition of the Great Arteries

Question 9

Which heart defect is a ‘duct-dependent’ shunt?

Answer 9

Coarctation of the Aorta

Question 10

Which congenital heart disease is most associated with DiGeorge syndrome?

Answer 10

Tetralogy of Fallot

Question 11

What four things make up the Tetralogy of Fallot?

Answer 11

Pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, overriding aorta

Question 12

What happens during a ‘Tet spell’?

Answer 12

To prevent cyanosis worsening, child squats to increase systemic vascular resistance and venous blood return

Question 13

What is the most common congenital heart defect?

Answer 13

Ventricular septal defect - accounts for 30% of all CHDs

Question 14

Which congenital heart defect may cause a widely split and fixed 2nd heart sound?

Answer 14

Atrial septal defect.

Question 15

In VSD, which size defect will produce the most obvious murmur?

Answer 15

Small defects - loudest murmur but asymptomatic usually.

In contrast, large defects may have no murmur but most severe disease

Question 16

When is the heart murmur heard in VSD?

Answer 16

Pansystolic murmur, best heard at LLSE

Question 17

How is the murmur in Patent Ductus Arteriosus described?

Answer 17

Continuous machinery murmur - best heard under left clavicle

Question 18

If a baby with PDA is symptomatic, what treatment should be given?

Answer 18

NSAIDs, indomethacin as a prostaglandin inhibitor - to encourage closure of the PDA. Diuretics if heart failure develops. If necessary, surgical ligation to close the duct.

Question 19

What type of pulse is seen in PDA?

Answer 19

Bounding pulse

Question 20

What is coarctation of the aorta dependent on to allow perfusion of the lower half of the body?

Answer 20

Requires a patent ductus arteriosus - allowing some blood to flow from pulmonary artery to aorta

Question 21

What treatment is given to maintain patency of the ductus arteriosus in coarctation of the aorta?

Answer 21

Prostaglandin E. Definitive treatment is surgical correction, unless very mild coarctation

Question 22

Where is the systolic murmur of coarctation of the aorta best heard?

Answer 22

Between the shoulder blades

Question 23

Presence of which other defects can make transposition of the great arteries compatible with life?

Answer 23

Relies on some mixing of blood so
ASD, VSD, PDA.
Requires urgent surgical correction