Paediatric cardiology

Question 1

How would heart sounds change in pulmonary stenosis?

Answer 1

Ejection systolic murmur upper left sternal border with radiation to back

Question 2

How would mild pulmonary stenosis present?

Answer 2

Asymptomatic

Question 3

How would moderate-severe pulmonary stenosis present?

Answer 3

Exertional dyspnoea

Question 4

How would aortic stenosis present?

Answer 4

Mostly asymptomatic

If severe, reduced exercise tolerance, exertional chest pain, syncope

Question 5

How would aortic stenosis change heart sounds?

Answer 5

Ejection systolic murmur upper right sternal border, radiation into carotids

Question 6

How is coarctation of the aorta managed?

Answer 6

Re-open PDA with Prostaglandin E1 or E2
Resection with end-to-end anastomosis
Subclavian patch repair
Balloon Aortoplasty

Question 7

What is the PDA?

Answer 7

Patent Ductus Arteriosus

Question 8

What is transposition of the great vessels?

Answer 8

Aorta and PA switch

Question 9

How do you manage transposition of the great arteries?

Answer 9

Switch procedure

Question 10

What is Fallot’s tetralogy?

Answer 10

VSD
Pulmonary valve stenosis
Misplaced aorta
Right ventricular hypertrophy

Question 11

What are some consequences of Fallot’s tetralogy?

Answer 11

Blue-tinged skin due to poor oxygen flow
SOB
Syncope
Clubbing
Poor weight gain
Fatigue
Irritability
Heart murmur

Question 12

What are the 3 main types of ventricular septal defect?

Answer 12

Subaortic
Perimembranous
Muscular

Question 13

What is the direction of shunt in VSD?

Answer 13

Left to Right shunt

Question 14

How does VSD change heart sounds?

Answer 14

Pansystolic murmur lower left sternal edge

Sometimes with thrill

Question 15

How do heart sounds in very small vs very large VSD differ?

Answer 15

Very small - early systolic murmur

Very large - Diastolic rumble due to relative mitral stenosis

Question 16

What is a consequence of very large VSD?

Answer 16

Signs of cardiac failure in large VSDs, eventually leading to biventricular hypertrophy and pulmonary hypertension

Question 17

What is Eisenmenger syndrome?

Answer 17

Condition that results from abnormal blood circulation caused by a defect in the heart
Usually VSD

Question 18

What is an Amplatzer device?

Answer 18

Occlusion device used to close VSD

Question 19

Can surgery be used to close a VSD?

Answer 19

Yes
Patch closure
Open heart surgery

Question 20

How might an ASD present in adulthood?

Answer 20

AF
Heart failure
Pulmonary hypertension

Question 21

How might ASD change heart sounds?

Answer 21

Wide fixed splitting of 2nd heart sound, pulmonary flow murmur

Question 22

What are some other names for AVSD?

Answer 22

Endocardial cushion defect

AV canal defect

Question 23

Which genetic condition is associated with AVSD?

Answer 23

Trisomy 21

Question 24

What is an ostium primum ASD?

Answer 24

Atrial septum near the atrioventricular valves has a communication between the two atrium causing a left to right shunt

Question 25

What is ostium secundum ASD?

Answer 25

Usually arises from an enlarged foramen ovale, inadequate growth of the septum secundum, or excessive absorption of the septum primum

Question 26

What is the fate of septum primum?

Answer 26

Eventually fuses with the endocardial cushion, closing the ostium primum off completely Eventually forms part of fossa ovalis

Question 27

What are some changes in foetal circulation at birth?

Answer 27

``` Pulmonary Vascular Resistance Falls Pulmonary Blood Flow Rises Systemic Vascular Resistance is Increased Ductus Arteriosus Closes Foramen Ovale Closes Ductus Venosus Closes ```

Question 28

How do we treat patent ductus arteriosus?

Answer 28

Fluid resuscitation/diuretics Prostaglandin inhibitors Surgical ligation

Question 29

What are some prostaglandin inhibitors used for PDA?

Answer 29

Indomethacin | Ibuprofen

Question 30

Can PDA spontaneously close?

Answer 30

Yes

Question 31

What group is PDA very common in?

Answer 31

Pre-term infants

Question 32

What is an umbrella device used for?

Answer 32

Closing PDA

Question 33

Which syndrome is associated with co-arctation of the aorta?

Answer 33

Turner

Question 34

Which syndrome is associated with pulmonary stenosis?

Answer 34

Noonan

Question 35

Which syndrome is associated with supravalvular aortic stenosis?

Answer 35

Williams