General

Question 1

Presentation of cardiac failure

Answer 1

• antenatal cardiac US diagnosis
  
  • fetal heart anatomy 18-20 weeks
  • any abnomrality detected/ risk factors (prev. child, trisomy 21, materal CHD)–> fetal echocardiogram by paediatric cardiologist
  • parent counselling
  • arrangmentsfir birth
• heart murmur
• heart failure
  
  • symptoms: breathlessness (feeding/ exertion), sweating, poor feeding, recurrent chest infections
  • signs: poor weight gain/ poor growth rate, tachypnoea, tachycardia, heart murmur (gallop rhythm), cardiomegaly, hepatomegaly, cold peripherals
  • signs of right sided heart failure: ankle, sacral, ascites
• shock
• cyanosis
  
  • peripheral: hands/ feet
    
    • cold, unwell, polycythaemia
  • central: tongue
    
    • fall in arterial O2

Question 2

Key features that distinguish ‘innocent’ murmur from pathological

Answer 2

Think ‘S’ for innoSent

• aSymptomatic patient
• Soft blowing murmur
• Systolic murmur only, no diastolic
• left Sternal edge
• no added heart sounds, no parasternal thrill, no radiation
• can be more obvious when child febrile
  
  • increase CO

Question 3

Differential diagnoses for cardiac failure

Answer 3

• Neonates
  
  • ​obstructed/ duct-dependent lesion
    
    • hypoplastic left heart syndrome
    • aortic valve stenosis
    • coarctation of the aorta
    • interruption of aortic arch
• Infants
  
  • ​high pulmonary blood flow
    
    • VSD
    • AVSD
    • Large PDA
• Older children/ adolescents
  
  • ​right or left heart failure
    
    • Eisenmenger syndrome RS only
    • Rheumatic heart disease
    • Cardiomyopathy