Investigations

Question 1

Report this Cardiac Chest X-ray

Answer 1

 Check that it is marked ‘right’ on the correct side – ie that you are looking at it the right way around (look at gastric bubble)

 This is an (AP/PA) CXR of _____ taken today

 It is well centred with good penetration (this is a rotated film…); degree of inspiration

 LOOK FOR HARDWARE!! o Sternal wires/NGT/clips

 Lungs are adequately inflated/hyperinflated

 Cardiac size (CT ratio) and contour (normal = 50%, neonates 60%) o Contour = Size of pulmonary artery, position of aortic arch

 Lung fields: reduced/increased vascularity

o Increased: VSD, TGA, TA, TAPVD

o Decreased: ToF, PA, TA, critical PS, Ebsteins o (If the patient is blue they will have poor vascularity (dark lung fields) cf L‐R shunt will have plethoric lung fields)

 Diaphragm, effusions

 Ribs: notching in CoA

Question 2

Report this ECG

Answer 2

ECG

1. Rate
2. Rhythm
3. Axis
   a) Birth  +60 to +180 degrees
   b) 1 year  +10 to + 100 degrees
   c) 10 years  +30 to +90 degrees
   d) Also check p‐wave axis (should be  or +ve in avF/II/III)
4. Then waves
   a) P wave
   b) P‐R interval
   c) QRS complex
   d) ST interval
   e) T waves
5. Ventricular hypertrophy

Rules of thumb for RVH and LVH – the 5,4,3,2,1 rules

Question 3

RVH and LVH Criteria

Answer 3

see pic

Question 4

Advanced Child Hypertrophy criteria (RVH, LVH, and Combined)

Answer 4

Question 5

ECG finding and Differentials

Answer 5