Examination Findings In Congenital Heart Disease

Question 1

Single loud S2, ESM, mild cyanosis in initial first days of life

Answer 1

Truncus Arteriosus

Question 2

Initial mild cyanosis, then later symptoms of pulmonary overcirculation with split S2 and ESM

Answer 2

Unobstructed TAPVD (similar to ASD with Left to Right shunting)
Obstructed TAPVD presents as shocked neonate

Question 3

Are murmurs a common feature in TGA?

Answer 3

No, unless VSD is present.

Question 4

Ebstein’s Anomaly

Answer 4

Displaced TV leading to atrialisation of RV, tricuspid regurg and poor RV function. Cyanosis if increased RV pressures cause right to left shunting across ASD. Splitting of S2 possible due to RBBB. Pansystolic murmur (TR)

Question 5

LUSE continuous murmur, crescendo/decrescendo

Answer 5

PDA

Question 6

Mid systolicnejection murmur, LUSE, radiation to axilla or back

Answer 6

Peripheral pulmonary stenosis. Turbulent flow through pulmonary arteries. Occurs in early infancy as pulmonary vascular resistance decreases. Innocent murmur

Question 7

LLSE, blowing quality, systolic murmur

Answer 7

Tricuspid Atresia

Question 8

Tet spell useful exam finding

Answer 8

Reduction in intensity of murmur (as shunting is reducing and more pulmonary blood flow)

Question 9

Murmur in VSD

Answer 9

Pansytolic, LLSE

Increased left ventricular flow can lead to a mid-diastolic rumble at the lower left sternal border. Additionally, a septal aneurysm may occasionally produce a systolic click

Question 10

PDA murmur

Answer 10

Continuous machinery murmur, infraclavicular. Can also be a split between systolic and diastolic phases so can get systolic and diastolic murmur

Question 11

HOCM murmur

Answer 11

Crescendo decrescendo harsh systolic murmur