Congenital heart disease

Question 1

Why might you palpate liver?

Answer 1

Could be enlarged in heart failure

Question 2

Describe the correlation between VSD and loudness of the murmur?

Answer 2

Loudness of murmur is inversely proportionate to the size of the defect

Question 3

What does a loud P2 suggest?

Answer 3

Suggests presence of pulmonary hypertension

Question 4

CXR findings in VSD

Answer 4

Cardiomegaly and pulmonary oedema (increased pulmonary vascular markings) if severe VSD (presence of heart failure), enlarged pulmonary artery

Question 5

ECG findings in VSD

Answer 5

In patients with moderate or large VSD, the ECG may demonstrate LV hypertrophy (LVH) manifested as increased voltage in V5 and V6, or leads II, III, and aVF
In patients with elevated RV pressure, the ECG demonstrates RV hypertrophy (RVH), often manifested by tall R waves in leads V4R and V1, or upright T waves in these leads beyond the first 24 hours of life, in addition to LVH.

Question 6

Where is the murmur best heard in atrial septal defect?

Answer 6

Upper left sternal border (ULSB)

Question 7

Auscultation findings of VSD

Answer 7

• murmur at upper left sternal edge border
• widely fixed splitting of second heart sound (this is because you have left to right shunting, which means right ventricular filling time is increased, so pulmonary valve shuts much later than aortic valve)