Congenital heart disease

Question 1

Name the defect:

Patient presents with low exercise tolerance, fatigue, palpitations and syncope.

Systolic ejection murmur is heard at the left upper sternal border, along with a fixed split S2, mid-diastolic murmur, cyanosis and clubbing.

Tall P waves, tall R waves in V1 and an RSR complex are seen on ECG. CXR reveals cardiomegaly..

Answer 1

ASD

Mid-diastolic murmur indicates increase flow across tricuspid valve due to left to right shunt.

Treatment: nothing or surgery

Question 2

Atrialisation of right ventricle (low tricuspid valve) associated with ASD, tricuspid regurgitation and Wolff-Parkinson-White syndrome

Answer 2

Ebstein’s anomaly

Question 3

Name the defect:

Patient presents with low exercise tolerance, fatigue, palpitations and syncope.

Pansystolic murmur is heard at the left upper sternal border with normal S1 and S2 heart sounds. Cyanosis and clubbing.

Answer 3

VSD

Treatment: nothing or surgery

Question 4

Name the defect:

Baby has an ejection systolic murmur and signs of heart failure. ECG reveals left ventricular hypertrophy. CXR reveals LVH and a dilated ascending aorta.

Answer 4

Bicuspid aortic valve.

Treatment: nothing, or valve replacement

Question 5

Name the defect:

Patient presents with severe hypertension. On examination, they have a pulse delay and a murmur. ECG reveals LVH. CXR shows a dilated ascending aorta and notching of ribs 3-9.

Answer 5

Coarctation of the aorta.

Treatment: surgery

Question 6

Name the defect:

Patient presents with dyspnoea. On examination you note cyanosis, clubbing, tachypnoea and a systolic ejection murmur.

ECG shows RVH. CXR shows a boot-shaped heart due to RVH.

Answer 6

Tetralogy of Fallot

Question 7

4 components of the tetralogy of Fallot

Answer 7

1. Ventricular septal defect
2. Pulmonary valve stenosis
3. Overriding aorta
4. Right ventricular hypertrophy