CVS

Question 1

Investigations for TGA

Answer 1

CXR: normal, ‘egg on the side’ cardiac shadow, increased pulmonary vascular markings
Echo: diagnostic
ABG

Question 2

Clinical Features of TGA

Answer 2

Severe cyanosis within 24-48 hours of birth as PDA closes
- will be less severe if there is ASD/VSD due to mixing of blood
No murmur usually (if got, systolic), loud 2nd heart sound

Question 3

Managing TGA

Answer 3

Must maintain PDA, so infuse PGs
Balloon atrial septostomy: create ASD via catheterisation
Arterial switch procedure: in first few days of life

Question 4

TOF clinical features

Answer 4

Cyanosis when crying
Squats a lot
Hypercyanotic/tet spells when exerting
- child is cyanosed, paroxysmal rapid breathing, irritable, floppy, LOC (can cause (MI and stroke)

Harsh ejection systolic murmur with single loud S2 at left lower sternal border, clubbing of fingers and toes

Question 5

Tests for TOF

Answer 5

CXR: small boot-shaped heart (RVH), pulmonary artery bay, pulmonary oligemia
ECG: RVH, RAD
echo diagnostic

Question 6

Management of TOF

Answer 6

Initially medical unless very cyanosed as neonate: need Blalock-Taussig shunt/balloon dilatation of RV outflow tract
Definitive surgery at 6 months

Question 7

Management of tet spells

Answer 7

Usually self-limiting & followed by sleep

If prolonged > 15 mins:

• sedation and pain relief
• IV propanolol
• IV volume administration
• O2
• bicarbonate

Question 8

Moderate/large VSD features

Answer 8

• HF with failure to thrive after 1 week, recurrent chest infections
• tachypnoea, tachycardia (worse when feed), enlarged liver, pulmonary HTN
• soft pan systolic murmur loudest at 4th intercostal space, HF signs, loud P2, sometimes mid-diastolic murmur

Question 9

Investigations for VSD

Answer 9

Echo diagnostic

CXR: cardiomegaly, enlarged Pulmonary artery and vascular markings, pulmonary edema

Question 10

Management of VSD

Answer 10

ACE-I and diuretics, high calorie intake

Surgery at 3-6 months to prevent eisenmenger

Question 11

Features of ASD

Answer 11

Normally asymptomatic, presents in teens or later
Can have recurrent chest infections and arrhythmias

Secundum: ejection systolic murmur at ULSE, fixed and widely split S2
Partial AVSD: Apical pansystolic murmur due to AV valve regurg

Question 12

Tests for ASD and findings

Answer 12

Echo diagnostic
CXR same as VSD
ECG: secundum: RBBB, RAD
partial AVSD: superior QRS axis

Question 13

Management for ASD

Answer 13

For significant defects, close at age 3-5

Secundum: cardiac catheterisation with occlusion
Partial AVSD: surgical correction

Question 14

Investigations for rheumatic fever

Answer 14

Blood: FBC, ESR, CRP, U&E, ASOT, anti DNAse B
Bedside: throat swab for culture, vitals, ECG (3rd AV block with progress backwards)

Question 15

Managing rheumatic fever

Answer 15

Bed rest till acute phase reactants normal
IV C.Penicillin 50K IU/kg/dose 6hrly OR Oral penicillin V 250mg/500mg 6hourly for 10 days. Oral erythromycin if allergic
Anti-inflammatory
- mild: oral aspirin 80-100mg/kg/d in 4 doses for 2-4 weeks
- mod: oral prednisolone 2mg/kg/day in 2 doses for 2-4 weeks
HF: ACE-I and diuretics
Chorea: carbamazepine or valproate
Prophylaxis: IM benzathine penicillin monthly/oral penicillin V 250mg BD until age 21/5 years after last attack

Question 16

Infective endocarditis diagnostic criteria and other investigations

Answer 16

2 major/1 major + 3 minor/5 minor
Major: 2 blood cultures (>12 hours apart) positive for IE, evidence of endocardial involvement via echo
Minor: predisposing factors, temp > 38 C, vascular phenomena, immunologic phenomena, microbio evidence

FBC, ESR CRP, U&E, LFT, urinalysis, CXR, ECG

Question 17

Management of IE

Answer 17

If strep: benpen 1.2g/4hrly IV for 4-6 weeks
Need surgery if infected prosthetic valve
Prophylaxis: good dental hygiene, prophylactic antibiotics before certain dental procedures

Question 18

Clinical signs of IE

Answer 18

fever, anemia, pallor, splinter hemorrhages, clubbing, necrotic skin lesions, changing cardiac signs, splenomegaly, neuro signs, retinal infarct, arthritis/arthralgia, microscopic hematuria

Question 19

Symptoms of HF in kids

Answer 19

SOB, sweating, poor feeding, recurrent chest infection

Poor weight gain, tachypnoea, tachycardia, murmur, gallop rhythm, cardiomegaly, hepatomegaly, cool peripheries

Question 20

Features of PDA

Answer 20

only symptomatic if large: apnea/bradycardia, poor feeding, CHF, accessory muscle use

continuous machine-like murmur at upper left sternal border, bounding pulse, displaced apex beat, tachycardia

Question 21

Findings for PDA

Answer 21

CXR: signs of HF, hard to diff from VSD
ECG: usually normal, but maybe bilateral ventricular hypertrophy
Echo: diagnostic

Question 22

Management of PDA

Answer 22

Preterm: close with indomethacin
Term: close via cardiac catheter (coil/occlusion device) 1 year later. Immediately if symptomatic