Cardiovascular

Question 1

Describe the foetal circulation.

Answer 1

Placenta -> umbilical vein -> IVC -> RV -> foramen ovale -> LA -> aorta -> umbilical arteries -> placenta. OR: … RV -> pulmonary artery -> ductus arteriosus -> aorta …

Question 2

What is the function of the foramen ovale and the ductus arteriosus in the foetal circulation?

Answer 2

They are used to bypass the non-functioning lungs.

Question 3

Name 4 congenital heart problems that can cause a L -> R shunt.

Answer 3

1. VSD.
2. ASD.
3. AVSD.
4. PDA.

Question 4

Give 5 signs of a VSD.

Answer 4

Poor feeding and failure to thrive

Small VSD:
Pan-systolic murmur at LLSE

Large VSD:
Active precordium
Loud P2
Soft murmur
Tachypnoea
Hepatomegaly.

Question 5

You request a CXR for a patient with a VSD. What would you expect to see?

Answer 5

1. Cardiomegaly.
2. Pulmonary oedema.
3. Enlarged pulmonary arteries.

Question 6

Why are ASD’s often asymptomatic?

Answer 6

ASD’s are often asymptomatic because the blood flow in the atria is low pressure and so breathlessness etc is uncommon.

Question 7

Give 3 signs of an ASD secundum.

Answer 7

1. Ejection systolic murmur at ULSE

2. Fixed split S2

Question 8

AVSD is a common defect in people with which chromosomal abnormality?

Answer 8

Trisomy 21 (Down’s syndrome).

Question 9

Give 5 signs of a PDA.

Answer 9

left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat

Question 10

Describe the management for congenital health defects that cause a L->R shunt.

Answer 10

Diuretics and ACEi to prevent HF symptoms.

Surgical repair.

Question 11

Name 3 congenital heart problems that can cause a R -> L shunt.

Answer 11

1. Tetralogy of fallot.
2. Transposition of the great arteries.
3. Tricuspid atresia.

Question 12

What 4 components make up Tetralogy of fallot?

Answer 12

1. Pulmonary stenosis.
2. RVH.
3. Overriding aorta.
4. VSD.

Question 13

Give 3 signs of Tetralogy of fallot.

Answer 13

Cyanosis
Ejection systolic murmur due to pulmonary stenosis (the VSD doesn’t usually cause a murmur)
A right-sided aortic arch is seen in 25% of patients
Clubbing of fingers and toes (older)
Hypercyanotic spells

Question 14

What do you see on on a TOF CXR?

Answer 14

Boot shaped heart

Question 15

What do you see on a TOF ECG?

Answer 15

RVH

Question 16

What is coarctation of the aorta?

Answer 16

a congenital narrowing of the descending aorta.

Question 17

Give 3 signs of coarctation of the aorta.

Answer 17

radio-femoral delay
mid systolic murmur, maximal over back
apical click from the aortic valve

Question 18

Give 3 signs of aortic stenosis.

Answer 18

1. Palpable thrill.
2. Ejection systolic murmur.
3. LVH.

Question 19

Name 3 congenital heart problems that are often associated with Down’s syndrome.

Answer 19

endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)

Question 20

Give 2 signs of pulmonary stenosis.

Answer 20

1. Ejection systolic murmur, often radiates to the back.

2. RV heave if severe.

Question 21

Name 2 congenital heart problems that are often associated with Turner syndrome.

Answer 21

Bicuspid aortic valve

Coarctation of the aorta

Question 22

What is a possible consequence of persistent pulmonary hypertension, like that seen in CHD associated with a L->R shunt?

Answer 22

Eisenmenger syndrome: high pressure pulm. blood flow damages pulmonary vasculature -> increased resistance (pulm. hypertension) -> RV pressure increase -> shunt direction reverses -> CYANOSIS!

Question 23

Giv 2 mx in ductal dependent cyanotic heart diseases.

Answer 23

1. prostaglandin E1 (alprostadil) is infused to prevent closure of the patent ductus arteriosus until a surgical correction can be carried out. This will allow mixing of deoxygenated and oxygenated blood so as to provide adequate systemic circulation.
2. Antibiotics- prophylaxis for bacterial endocarditis.

Question 24

How is central cyanosis recognised?

Answer 24

Concentration of reduced haemoglobin in the blood exceeds 5g/dl

Question 25

How to differentiate cardiac from non-cardiac causes of cyanosis?

Answer 25

Nitrogen washout test. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease

Question 26

What is acrocyanosis?

Answer 26

• Seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities.
• It is caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition.
• Acrocyanosis is differentiated from other causes of peripheral cyanosis with significant pathology (eg, septic shock) as it occurs immediately after birth in healthy infants. It is a common finding and may persist for 24 to 48 hours.

Question 27

List 3 signs of partial AVSD.

Answer 27

1. ESM at ULSE
2. Flixed split S2
3. Pansystolic murmur at apex

Question 28

List 2 features of TGA.

Answer 28

1. Neonatal cyanosis

2. No murmur

Question 29

List 2 mx of TGA.

Answer 29

1. Prostaglandin infusion

2. Balloon atrial septostomy

Question 30

List the mx of aortic stenosis.

Answer 30

Balloon dilatation

Question 31

List the mx of pulmonary stenosis.

Answer 31

Balloon dilatation

Question 32

List the mx of coarctation of the aorta.

Answer 32

Stent insertion/surgery