CV

Question 1

2 main questions when assessing congenital heart disease?

Answer 1

compensated??

cyanosis?

Question 2

what direction of shunt causes cyanosis?

Answer 2

Right to Left

Question 3

CF of decompensation in child

Answer 3

poor feeding, SOB, hepatomegaly, engorged neck veins, tachycard, weak pulse +/- acidosis

Question 4

Cauuuuses of Acyanotic and Cyanotic

Answer 4

Acyanotic (Left to Right shunt)
ASD,VSD, coarctation aorta, isolated valve lesion, patent ductus

Cyanotic (R to L)
Fallots tetrad, transpoosition great arteries, tricuspid/pulm atresia, TA PVR, hypoplastic left heart syndrome

Question 5

Common investigations of congenital heart disease

Answer 5

ECHO, c xray, cardiac catheter
ECG, SpO2
FBC

Question 6

Typical chromosomal disease congenital heart dis

Answer 6

DOWNS - AVSD/VSD/ASD/Tertralogy of Fallot

TURNERS - AS/Coarctation aorta/ bicuspid aortic valve

DiGeorge - conotruncal abnorm

Question 7

VSD - CF/o/e / I / T

Answer 7

CF - mild (80%) with harsh/loud pansystolic blowing murmur +/- thrill leading to cardiac failure

I - ECG (norm at biirth, later in life = L/RVH) cxray - pulm engorgment

T - 20% will close spontaneously within 9 months but can be treated pharmacologically / Larger defects will require surgery

Question 8

ASD - CF/ I

Answer 8

No CF as such, but widely ssplit, fixed S2 + systolic murmur heard.

I - cxray = cardiomegaly // ECG - RVH +/- incomplete RBBB

Question 9

Patent Ductus - CF / II / T

Answer 9

CF - failure to thrive,,,,,,,,, bounding fem pulse, pnneumonias, CCF, SBE, collapsing, loud S2, systolic pulm murmur

I - cxray - increased vascular markings, big aorta / ECG - LVH

T - Dexamethasone (duing pre-term labour) +/- indometacin or ibuprofen

Question 10

Coarctation of Aorta - CF / I / T

Answer 10

CF - often SHOCKED! diff to feel fem pulses, CCF, unequal BP across limbs (up in arms, low in legs), systolicc murmur, absent foot pulses.

I - cxray - rib notching + cardiomegaly / EECG - LVH

T - surgery or stenting/balloon

Question 11

Transposition of great arteries - CF / I / T

Answer 11

CF - cyanosis, CCF, +/- systolic murmur

I - cxray - egg shaped heart / ECG - RVH

T - balloon atrial septostomy

Question 12

Causes of Heart Failure in NeoNate/ infant/ child

Answer 12

NeoNate - PDA / hypoplastic left heart syn / coarctation of aortta

Infant - VSD / cardiomyopathy

Child - Cardiomyopathy / failing congentical heart disease

Question 13

Non cardiac causes of heart failure?

Answer 13

• Stress (fever/ hypoxia / infection)
• Anaemia
• Fluid Overload

Question 14

Tetralogy of Fallots - ?/ CF/ I

Answer 14

? - VSD + RVH + Aortic overriding of VSD + Pulm Stenosis (RV outflow obs)

CF - cyanosis as ductus closes, SOB, faints, clubbing, thrills, harsh systolic murmur.
(child copes with symp by squatting)

I - FBC (Hb up) , cxray (boot shaped heart + RVH)

Question 15

Infective Endocarditis - C / CF / I / T

Answer 15

C - ctrep viridans,
CF - fever, splinter haem, spleomeg, haematuria, weight down, malaise, clubbing??

I - blood cultures x3 (diferent sites)
ECHO - any vegetation of valve

T - IV abx’s for at least 6 weeks (ben pen and gent until cultures back)