paediatric cardiologu

Question 1

changes in fetal circulation at birth

Answer 1

pulmonary vascular resistance falls
pulmonary blood flow rises
systemic vascular resistance increases
ductus arteriosus closes
foramen ovale closes
ductus venosus closes

Question 2

patent ductus arteriosus

Answer 2

common in Pre-term infants: treatment with fluid restriction, diuretics, prostaglandin inhibitors (ibuprogen), surgical ligation

term babies: good chance of spontaneous closure, not prostaglandin sensitive

Question 3

pulmonary valve stenosis clinical features

Answer 3

asymptomatic in mild stenosis
mod/severe: exertional dyspnoea, fatigue

ejection systolic murmur upper left sternal border with radiation to back

Question 4

pulmonary valve stenosis intervention

Answer 4

balloon valvuloplasty

valve replacement often delayed until after puberty when child finished growing

Question 5

aortic stenosis clinical features

Answer 5

mostly asymptomatic
severe - reduced exercise tolerance, exertional chest pain, syncope

ejection systolic murmur upper right sternal border, radiation to carotids

Question 6

aortic stenosis treatment

Answer 6

balloon valvuloplasty

valve replacement

Question 7

coarctation of aorta

Answer 7

narrowing of aorta, usually the descemding part of aortic arch

Question 8

coarctation of aorta clinical features

Answer 8

weak/absent femoral pulse
radio-femoral delay (chronic, late sign)
harsh systolic murmur L sternal edge radiating to back
sudden deterioration and collapse of baby

Question 9

management of coarctation of aorta

Answer 9

• reopen ductus arteriosus with prostaglandin E1 or E1
• resection with end-to-end anastomosis
• subclavian patch repair
• balloon aortoplasty

Question 10

transposition of great arteries

Answer 10

aorta comes out R ventricle (instead of left) and pulmonary a comes out L ventricle

Question 11

problem with transposition of great arteries

Answer 11

no shunt between circulations and no oxygenation takes place

oxygen on L side of heart that goes through pulm circulation but no way of getting is circulated systemically

Question 12

definitive treatment for transposition of great arteries

Answer 12

switch procedure

Question 13

teratology of fallot

Answer 13

ventricular septal defect
pulmonary valve stenosis
misplaced aorta (overriding aorta)
thickened right ventricular wall

Question 14

when is Fallot’s teratology corrected

Answer 14

6mo/5kg

Question 15

3 main types of ventricular septal defect

Answer 15

subaortic
perimembranous
muscular

Question 16

ventricular septal defect clinical presentation

Answer 16

pansystolic murmur lower L sternal edge, sometimes w thrill

signs of cardiac failure in large VSDs eventually leading to biventricular hypertrophy + pulm htn

Question 17

VSD closure

Answer 17

amplatzer or other occlusion device, trans-catheter

patch closure, open heart surgery

Question 18

ASD clinical features

Answer 18

few signs in early childhood, good chance of spontaneous closure

sometimes in adulthood AF, heart failure, pulm htn
wide fixed splitting of 2nd heart sound, pulm flow murmur

Question 19

innocent murmurs are

Answer 19

soft
short
systolic 
symptomless
situation dependent

Question 20

concerning murmurs

Answer 20

louder 2/6
diastolic
other symptoms: FTT, feeding difficulty, cyanosis