Paediatric Cardiology

Question 1

list the types of innocent murmurs

Answer 1

• Still’s murmur
• pulmonary flow murmur
• venous hum
• carotid bruit
• physiological pulmonary flow murmur in neonate

Question 2

what are the characteristics of an innocent murmur?

Answer 2

• soft 1-2/6
• systolic, except venous hum which is a continuous murmur
• varies with posture
• no thrill
• short duration
• child is asymptomatic

Question 3

what is the most common type of innocent murmur?

Answer 3

Still’s murmur
- mostly in school age children

Question 4

features of physiological pulmonary stenosis

Answer 4

• common in newborns, may last up to 3-6 months of age
• localised to LUSE, radiation to the back
• systolic murmur

Question 5

features of pulmonary flow murmur

Answer 5

• common in older children and teenagers
• those with thin chest walls
• location LUSE
• systolic in nature
• normal blood flow through pulmonary vessels

Question 6

clinical features of pulmonary stenosis

Answer 6

• mild > asymptomatic
• moderate and severe > exertional dyspnoea and fatigue
• ejection systolic murmur upper left sternal border with radiation to back

Question 7

clinial features of aortic stenosis

Answer 7

• mostly asymptomatic
• if severe: reduced exercise tolerance, exertional chest pain, syncope
• ejection systolic murmur upper right sternal border, radiation into carotids

Question 8

what changes occur to the fetal circulation at birth?

Answer 8

• pumonary vascular resistance falls
• pulmonary blood flow rises
• systemic vascular resistance is increased
• ductus arteriosus closes
• foramen ovale closes
• ductus venosus closes

Question 9

what causes patent ductus arteriosus (PDA)?

Answer 9

• the ductus arteriosus connects the pulmonary artery with the aorta, allowing blood to bypass the lungs.
• it usually stops functioning within 3 days of birth and closes entirely within the first three weeks of life.
• PDA occurs when it fails to close after birth.
• more common in premature babies, may be related to genetic condition e.g. Down’s syndrome or maternal condition e.g. diabetes or rubella.

Question 10

Patent ductus arteriosus (PDA) management

Answer 10

• echo confirms diagnosis
• pre-term infants: medical closure with indomethacin, ibuprofen or paracetamol (works by inhibiting prostaglandins)
• closure of PDA can be achieved by endovascular procedures or open surgery

Question 11

coarctation of aorta management

Answer 11

• reopen PDA with prostaglanding E1 or E2
• resection with end-to-end anastamosis
• subclavian patch repair
• balloon aortoplasty

Question 11

what does transposition of the great arteries mean?

Answer 11

• Transposition of the great arteries involves swapped attachments of the aorta and the pulmonary trunk. - - The right ventricle pumps blood into the aorta and the left ventricle pumps blood into the pulmonary vessels. Blood from the systemic venous system drains into the right side of the heart and is pumped straight back into the aorta.
• Blood from the pulmonary veins drains into the left side of the heart and is pumped straight back into the pulmonary arteries. These two separate circulations do not mix.

Question 12

transposition of great arteries clinical presentation

Answer 12

• defect often diagnosed during pregnancy with antenatal US scans
• when defect is not detected antenatally, it presents with cyanosis.

Question 13

Transposition of great arteries management

Answer 13

• prostaglanding E2 infusion used to maintain the ductus arteriosus, this allows blood to flow from the aorta to the pulmonary arteries and lungs for oxygenation.
• balloon septostomy: involves inserting catheter into foramen ovale via the umbilisus and inflating a balloon to create a connection between the atria, allows blood flow between both atriums
• definitive management > arterial switch operation, usually performed within a few days of birth

Question 14

Tetraology of Fallot is a congenital condition involving which four coexisting pathologies?

Answer 14

• ventricular septal defect (VSD)
• overriding aorta
• pulmonary valve stenosis
• right ventricular hypertrophy

Question 15

tetralogy of fallot management

Answer 15

• identified with echo
• in neonates: prostaglandin infusion to maintain ductus arteriosus, or stenting
• Blalock-Taussig shunt involves creating a connection between the systemic artery (e.g. left subclavian artery) and a pulmonary artery, increasing blood flow to the lungs, TEMPORARY MEASURE in neonates too small for surgical repair
• total surgical repair by open heart surgery is the definitive treatment