Heart Defects and Murmurs

Question 1

What heart defects are cyanotic?

Answer 1

Transposition of the great arteries
Tetralogy of Fallot
Triscuspid or pulmonary valve atresia

Question 2

What is an innocent heart murmur?

Answer 2

Common benign murmurs during childhood

Question 3

What are the causes of an innocent heart murmur?

Answer 3

Still’s murmur
Venous hum
Acute infective illness

Question 4

What are the features of innocent murmurs?

Answer 4

6 Ss
- Soft
- Systolic
- Sensitive
- Short
- Single
- Small

Question 5

What is the management of an innocent murmur?

Answer 5

Review in a few weeks

Question 6

What is coarctation of the aorta?

Answer 6

Narrowing of the aorta (typically just before the ductus arteriosus

Question 7

What is the presentation of coarctation of the aorta?

Answer 7

Varies on severity:
- Systolic murmur heard loudest between the scalpulae
- Radio-femoral delay
- Hypertension
- Heart failure

Question 8

What genetic condition is coarctation of the aorta associated with?

Answer 8

Turner’s syndrome

Question 9

What are the management options for mild coarctation?

Answer 9

Monitoring using echocardiogram
Antihypertensives

Question 10

What are the management options for more severe coarctation?

Answer 10

Angioplasty - stent placement
Surgery

Question 11

What type of murmur is heard with a patent ductus arteriosus?

Answer 11

Machine wirring murmur
- throughout the cardiac cycle

Question 12

What is the medical treatment of a patent ductus arteriosus?

Answer 12

NSAIDs (indomethacin)- inhibit prostaglandin synthesis that promotes patency

Question 13

What is Ebstein’s anomaly?

Answer 13

Caused by lithium use in pregnancy - the tricuspid valve doesn’t form properly, leading to a large right atrium and a small left ventricle

Question 14

What is the most common congenital cardiac abnormality?

Answer 14

VSD

Question 15

What murmur is associated with a VSD?

Answer 15

Pan-systolic murmur heard loudest at the left lower sternal edge

Question 16

What is transposition of the great arteries?

Answer 16

Aorta comes out of the right ventricle
Pulmonary artery comes out of the left ventricle

Question 17

What are the maternal risk factors for congenital heart disease?

Answer 17

Infectious diseases during pregnancy
Type 1 and 2 diabetes (pre-existing)
Teratogenic medicines
Substance abuse

Question 18

What is Eisenmenger syndrome?

Answer 18

When a left-to-right shunt is reversed to a right-to-left shunt

Question 19

How does eisenmenger syndrome occur?

Answer 19

Increased pulmonary vascular pressure as a cause of the left-to-right shunt causes pulmonary hypertension
Pulmonary hypertension results in the reversal of the shunt

Question 20

What is the presentation of Eisenmenger’s syndrome?

Answer 20

Typically presents in late teens
Cyanosis
Right heart failure

Question 21

What is the prognosis of Eisenmenger’s?

Answer 21

Irreversible
Often progresses to heart failure in 40s

Question 22

What is the treatment of Eisenmenger’s?

Answer 22

Prevention
Heart-lung transplant

Question 23

What medication can be used to keep the ductus arteriosus open?

Answer 23

Prostaglandin E

Question 24

What is triscupsid atresia?

Answer 24

A condition where the triscuspid valve does not form

Question 25

What is a venous hum?

Answer 25

A continuous blowing noise below the clavicles, due to the sound of venous return

Question 26

What is Still’s murmur?

Answer 26

A low pitched sound heard at the lower left sternal edge created by blood flow through the heart

Question 27

What sound is associated with an ASD?

Answer 27

Ejection systolic murmur heard loudest over the upper left sternal angle

Question 28

What sound is heard in coarctation of the aorta?

Answer 28

Murmur heard on the back between the scapulae

Question 29

What murmur is associated with tetralogy of fallot?

Answer 29

A harsh ejection systolic murmur heard loudest over the upper-left sternal angle