Paediatric Cardiology

Question 1

What are the causes of congenital heart disease?

Answer 1

Genetic susceptibility (6-10% of CHD have underlying chromosomal problem) - environmental hazard
+
Teratogenic insult

Environmental factors which can contribute include drugs, infections eg rubella, cmv,
Maternal factors which can contribute include diabetes, lupus

Question 2

What are the 8 common congenital heart lesions?

Answer 2

Ventricular septal defect
Patent ductus arteriosus
Atrial septal defect
Pulmonary stenosis
Aortic stenosis 
Coarctation of the aorta
Transposition of great arteries
Tetralogy of fallot

Question 3

How do these 8 conditions present and how are they treated?

Answer 3

VSD
Presentation: pansystolic murmur at left sterna edge, may have signs of cardiac failure in large VSDs
Treatment: vsd closure (amplatzer or other occlusion device, transcatheter, patch closure, open heart heart surgery)

PDA
Presentation: usually pre term infants
Treatment: fluid restriction/diuretics, prostaglandin inhibitors, surgical ligation

ASD
Presentation: wide fixed splitting on 2nd HS, pulmonary flow murmur, few signs in childhood
Treatment: asd closure

Pulmonary stenosis
Presentation: asymptomatic in mild, worsening gives exertion all dyspnoea and fatigue, ejection systolic murmur upper left sternal edge with radiation to back
Treatment: balloon valvoplasty

Aortic stenosis
Presents: mostly asymptomatic, if severe reduced exercise tolerance, exertional chest pain, syncope, ejection systolic murmur upper right sternal border, radiation into carotid
Treatment: balloon aortic valvuloplasty

Coarctation
Present: neonates with tachypnea, tachycardia, increased work of breathing, absent pulses
Treatment: reopen DA, resect with end to end anastomosis, subclavian patch repair, balloon aortoplasty

Transposition
Presents: cyanosis at birth, ventricular septal defect, left ventricular outflow tract obstruction
Treatment: atrial septistomy, switch procedure

Tetralogy of fallot
Presents: VSD, pulmonary valve stenosis, misplaced aorta, right ventricular hypertrophy
Treatment: open heart surgery

Question 4

How do you differentiate between innocent and organic heart murmurs?

Answer 4

Innocent murmurs:

• systolic
• no other signs
• soft murmur, grade 1/6 or 2/6
• vibratory, musical
• localised
• varies with position, respiration, exercise

Question 5

What are the causes and presentation of cardiac failure in childhood?

Answer 5

Heart enlargement 
Valvular heart disease
Arrhythmia 
Chronic lung disease
Anaemia
Viral infection
Hypertension 
Haemorrhage 
Overactive thyroid
Postoperative complications 

Presentation: failure to thrive, trouble feeding, shortness of breath, tachycardia, central cyanosis, weight loss, sweating whilst feeding, cough and congestion in lungs

Question 6

What are the causes of cyanotic heart disease in childhood?

Answer 6

TGA 
Tetralogy of fallot 
TAPVD
hypoplastic left heart syndrome 
Tricuspid atresia
Truncus arteriosus 
Pulmonary atresia