March 1, 2016 - Congenital Heart Disease

Question 1

Most Common Congenital Heart Defect

Answer 1

VSD with 3.3/1000 total births

ASD with 1.93/1000 total births

Question 2

Fetal Cardiac Shunts

Answer 2

1. Ductus venosus
2. Foramen ovale
3. Ductus arteriosus

Question 3

Changes to Fetal Circulation at Birth

Answer 3

Fluid in the fetal airways is removed during delivery because of compression and spontaneous breathing.

Breathing increases pulmonary bloodflow, increases blood return to the left atrium, helps with closure of the foramen ovale gap, and increased output from the LV.

Question 4

Still’s Murmur

Answer 4

Produced by increased velocity flow across a low-normal diameter left ventricular outflow tract.

Typically in ages 2-7 with a 1 or a 2/6 murmur.

Increases with exercise, fever, and being supine.

Decreases with sitting or standing or Valsalva.

Question 5

Pulmonary Flow Murmur

Answer 5

Vibrations produced in the right ventricular outflow tract.

Typically 8-16 years old.

Grade 1 or 2/6 murmur.

Normal S2 with normal splitting - very important as this helps to rule out other causes that are not benign.

Question 6

Venous Hum

Answer 6

Flow within the jugular venous system.

Typically ages 3-8.

Grade 1 or 2/6 murmur.

Soft or blowing continuous murmur with diastolic accentuation.

Question 7

Syncope in Children

Answer 7

Most syncope in children is benign.

Most is vasovagal syncope.

It is VERY important to take a history and make sure there are no red flags or warning signs which could indicate more sinister pathology.

Question 8

Red Flags in Syncope - Children

Answer 8

Sudden syncope - no prodrome

Syncope with exertion

Syncope associated with chest pain / palpitations

Syncope associated with sudden increase in sympathetic tone (fright/emotion)

Syncope at a young age

Family history of syncope

Known congenital heart disease

Hyper-cyanotic events in infancy (Tet spells)