Paediatric Cardiology

Question 1

How many seconds does a small ECG square correspond to?

Answer 1

0.04 s (40ms)

Question 2

How many seconds does a large square on an ECG correspond to?

Answer 2

0.2 seconds (200ms)

Question 3

What is the normal PR interval in:
A) young children
B) adolescents?

Answer 3

A)0.16 ms

B) 0.18 ms

Question 4

What conditions do a widely split second heart sound correspond to?

Answer 4

ASD/PAPVR - volume overload
PS- pressure overload
RBBB - conduction delay
MR- shorten LV ejection time, aorta closes earlier than normal

Question 5

What causes narrow splitting of the second heart sound?

Answer 5

AS- delayed aortic closure

Pulmonary HTN- pulmonary valve closes early

Question 6

What conditions correspond to a single S2?

Answer 6

Truncus arteriosis
TGA
TOF
Severe PS or AS

Question 7

What is the equation for pulmonary to systemic blood flow ratio (QP:QS) used when calulating a shunt?

Answer 7

Qp:Qs= sa(Ao) - sa(SVC) / sa(pul vein)- sa (Pul A)

Question 8

How do you calcuate pulmonary vascular resistance (PVR)?

Answer 8

PVR= Pa(pul A) - Pa(LA) / pulmonary flow

Question 9

What is the management of SVT? (3 steps)

Answer 9

1. Simple vagal manoeuvres- ice to cheeks, dip head in cold water, valsalva
2. Adenosine given as a rapid push
   Note: do NOT give verapamil- dangerous in kids
3. Synchronised DC cardioversion

Question 10

What pathology corresponds to the “snowman sign” on CXR?

Answer 10

TAPVR

Question 11

What is scimitar syndrome?

Answer 11

Characteristically curved anomalous R pul vein that drains into IVC. Sword like appearance on CXR

Question 12

What does an egg shaped heart on CXR correspond to?

Answer 12

TGA

Question 13

What conditions is hypoplastic left heart syndrome associated with?

Answer 13

Turners
T13 downs
T18 edwards
Jacobsen syndrome (deletion of distal 11q)

Question 14

What is the mechanism of action of NO used in PPHN?

Answer 14

Binds to cytosolic guanylate cyclase > increases cyclic guanosine monophosphate (cGMP)> vasodilation

Question 15

Which syndromes are pulmonary stenosis associated with?

Answer 15

Noonan syndrome
William syndrome 
Alagille syndrome 
Ehlers danlos syndrome 
Russel silver syndrome 
Congenital rubella syndrome

Question 16

What are 4 examples of diastolic mumurs?

Answer 16

1. Mitral stenosis
2. Tricuspid stenosis
   - AV valves need to open properly during diastole for ventricular filling- stenosed AV valves cannot open properly in diastole causing a murmur
3. Aortic regurgitation
4. Pulmonary regurgitation
   - SL valves need to close during diastole, in regurgitation blood flows backwards into ventricles as doesn’t close properly causing a murmur

Question 17

What are 4 examples of systolic murmurs?

Answer 17

1. Mitral regurgitation
2. Tricuspid regurgitation
3. Aortic stenosis
4. Pulmonary stenosis

Question 18

What are ECG findings for biventricular hypertrophy?

Answer 18

Tall R wave in V1, V6

Tall R and deep S in V5

Question 19

ECG findings for RVH?

Answer 19

• R axis deviation
• tall R in V1, deep S in V6
• upright T wave in V1 between 4 days and 4 years

Question 20

ECG findings for LVH?

Answer 20

• L axis deviation

- tall R in V6, deep S in V1