Child with heart murmur

Question 1

Where is the narrowing in coarctation of the aorta?

Answer 1

• in infants - most are preductal (70% of cases)
• ie. after the aortic arch and before the ductus arteriosus
• the ductus arteriosus usually remains patent

Question 2

Key sign in coarctation of the aorta?

Answer 2

• weak or absent femoral pulses
• BP higher in arms than legs

Question 3

What is the most common congenital heart defect in babies?

Answer 3

• ventricular septal defect (VSD)

Question 4

What conditions are associated with VSD?

Answer 4

• fetal alcohol syndrome
• down syndrome

Question 5

What percentage of VSDs close spontaneously?

Answer 5

30-50%

Question 6

What is Eisenmenger syndrome?

Answer 6

• when a left to right shunt becomes right to left

1. increased blood volume in the RV due to left-right shunt
2. pulmonary HTN and increased pressure in RV
3. blood travels from high pressure (RV) to low pressure (LV) = cyanosis

Question 7

What kind of murmur is heard in VSD?

Answer 7

• holosystolic murmur (pansystolic)
  
  • large VSD = reduced murmur

Question 8

What are the different types of ASD?

Answer 8

1. ostium secundum (90% of ASDs)
2. ostium primum (10%) - associated with down’s

Question 9

What kind of murmur is heard in ASD?

Answer 9

• split S2 due to delayed pulmonic valve closure
• systolic murmur

Question 10

What is the treatment of ASD?

Answer 10

• monitor child to see if it goes away
• surgery

Question 11

What treatment is given for patent ductus arteriosus?

Answer 11

• Indomethacin
  
  • NSAID that inhibits prostglandin E2
  • prostaglandin E2 is a vasodilator that keeps the ductus open
• surgical ligation

Question 12

What are the 4 heart abnormalities in tetrology of fallot?

Answer 12

1. RVH - boot shaped heart on xray
2. pulmonary stenosis
3. VSD
4. overriding of the aorta

Question 13

What usually happens in a “tet spell”?

Answer 13

• baby squats down
• increase in vascular resistance
• pressure from left to right

Question 14

What conditions is tetrology of fallot associated with?

Answer 14

• chromosome 22 deletion
• di george syndrome

Question 15

What is the treatment of tetrology of fallot?

Answer 15

• surgery
• beta blockers for tet spells

Question 16

What is Persistent Truncus Arteriosus?

Answer 16

• The two Great Arteries (Aorta and Pulmonary Artery) have a single origin from the heart and blood from both ventricles passes across a VSD into the single arterial trunk
• The lung circulation is exposed to very high pressure and increased blood flow (as with a large VSD).