Paediatric cardiology

Question 1

What is this murmur?

Answer 1

PDA

Question 2

Why might VSD and patent ductus arteriosus only become clinically apparent (murmur + signs) several weeks later post birth?

Answer 2

decreasing pulmonary vascular resistance

Question 3

What is this murmur?

Answer 3

ASD

Question 4

what is important to advise a parent who has a clinically well child with a VSD and normal ECG?

Answer 4

VSD usually closes spontaneously

regular followup and monitoring of murmur is needed

good dental hygiene is paramount due to increased risk of bacterial endocarditis

Question 5

what happens if we leave a L-R shunt congenital heart defect untreated?

Answer 5

development of right sided heart failure, also known as eisenmenger syndrome

Question 6

What is this murmur?

Answer 6

VSD

Question 7

What is this murmur?

Answer 7

pulmonary stenosis

Question 8

tell me the characteristics of an ASD murmur?

Answer 8

ejection systolic murmur usually heard left sternal edge

fixed widely split 2nd heart sound

sometimes may be pansystolic if partial ASD

Question 9

what cause of heart failure usually presents in the first week of life?

Answer 9

coarctation of the aorta

(severe obstructive lesion_

Question 10

what type of murmur is VSD?

Answer 10

pansystolic or no murmur if very large

Question 11

What is this murmur?

Answer 11

Aortic stenosis and regurgitation

Question 12

What is this murmur?

Answer 12

ASD

Question 13

what is the most common form of ASD? What is the other form of ASD

Answer 13

Secundum ASD most common- hole between atria in the centre of the atrial septum, involving the foramen ovale

other form of ASD is known as partial AVSD where the hole between the atria as at the BOTTOM of the atrial septum, often involving abnormal atrioventricular leaflets

Question 14

where exactly is the ductus arteriosus in the fetal heart?

Answer 14

between the pulmonary artery and the aorta

Question 15

What is this murmur?

Answer 15

bicuspid aortic valve

Question 16

what are the two types of VSD?

Answer 16

small and large VSD

Question 17

What is this murmur?

Answer 17

innocent murmur and S3

Question 18

why might you get pulmonary valve regurgitation post TOF surgery?

Answer 18

often occurs because the surgery shaves off a bit of the hypertrophied valve, and overtime the PV can become incompetent and leak. requires replacement usually

Question 19

when does the ductus arteriosus normally close in a newborn?

Answer 19

within hours to 1 day

Question 20

what are some clinical signs of heart failure to look for on cardiovascular examination in an infant?

Answer 20

sacral oedema

central cyanosis and at the end of exam during crying

signs of respiratory distress

enlarged liver

feel for right ventricular hypertrophy

listen for any pathological murmurs, loud s2

is the baby clammy?

palpate brachial artery and assess volume

failure to thrive

Question 21

what are some clinical features of heart failure in a young to older child on CV examination?

Answer 21

SOBOE- so assess exercise tolerance

Assess growth using centiles

look for peripheral oedema/periorbital oedema

look for signs of cyanosis

is the child squatting?- may indicate TOF

Question 22

what is the most common type of innocent murmur?

Answer 22

still’s vibratory murmur

typically heard between 2-6 years age

early to mid systolic

loudest at left lower sternal edge

Question 23

what are the ddx for pulmonary flow innocent mumur?

Answer 23

ASD

Pulmonary stenosis

Question 24

what murmur is typically seen ONLY in an infant?

Answer 24

branch pulmonary stenosis

Question 25

tell me about a venous hum

Answer 25

innocent murmur low pitch continuous murmur caused by turbulence in the SVC junction

Question 26

what manouevers could we do to see whether a murmur is innocent?

Answer 26

Innocent murmur dynamics usually involve: variation with respiration--\> increase with inspiration variation with posture--\> audible when lying down and disappears with standing up so get the child to breathe in and out while listening, and repeat auscultation with the child standing up

Question 27

when should you be worried about a murmur enough to refer to a cardiologist

Answer 27

Pansystolic murmur added sounds subjective intensity greater than 3 Upper sternal border location child less than 1 yrs + symptomatic/clinical judgement

Question 28

most common cause of cyanosis AT BIRTH?

Answer 28

transposition of the great arteries

Question 29

what cardiac structural change is associated with large VSD?

Answer 29

volume loading of the LEFT HEART--\> left ventricle dilation

Question 30

why would ace inhibitors be of any use to a child with VSD?

Answer 30

VSDs become haemodynamically apparent when pulmonary vascular disease occurs Ace inhibitors reduce the systemic vascular system and this matches the pulmonary vascular system --\> so short term management only

Question 31

what are some medical short term options for large VSD?

Answer 31

diuretics like spironolactone and Lasix Aceinhibitors

Question 32

what structural change of the heart is associated with ASD?

Answer 32

volume loading of the right heart (right ventricular dilation)

Question 33

what is the key clinical implication of weak femoral pulses?

Answer 33

coarctation of the aorta

Question 34

which gender is more predisposed to transposition of the great arteries?

Answer 34

male gender

Question 35

what are the options for management of PDA (pulmonary ductus arteriosus)

Answer 35

Indomethacin for preterm Surgery for symptomatic infant Transcatheter closure for other child

Question 36

where best on the praecordium can we hear VSD murmurs?

Answer 36

left lower sternal edge

Question 37

where best on the praecordium can we hear a ASD murmur?

Answer 37

left upper sternal edge

Question 38

how does inspiration/expiration change the second heart sound?

Answer 38

with inspiration= splitting of S2 with expiration= split narrows and becomes harder to hear

Question 39

what causes the widely 'fixed' split S2 typical of ASD murmurs?

Answer 39

normally, S2 is split during inspiration as increasd systemic venous return overloads the right ventricle, thus delaying the closure of the pulmonary valve. In ASD, there is a left to right shunt. This means that the right ventricle is always overloaded regardless of respiration and thus the pulmonary valve has a delayed closure every time--\> fixed wide S2 split heart sound

Question 40

Generally pathological murmurs do not change in intensity when the child stands up. Which pathological murmur does NOT follow this rule? Why is this?

Answer 40

hypertrophic cardiomyopathy. Murmur increases as the child stands up. Venous return decreases as the child stands up, leading to reduced left ventricular end diastolic volume. This narrows the left ventricular outflow tract (due to reduced blood volume) and consequently, systolic outflow obstruction increases --\> increased intensity of murmur

Question 41

where best on the praecordium may we hear the murmur of a PDA?

Answer 41

left upper sternal edge

Question 42

how might we keep the pulmonary ductus arteriosus open?

Answer 42

with prostaglandins (E2) in the short term

Question 43

what is this?

Answer 43

tetralogy of fallot

Question 44

what might delay the presentation of coarctation of aorta?

Answer 44

may be delayed as the ductus remains open