Paeds - cardiac anomalies

Question 1

Coarctation of the aorta: location of murmur and associated condition

Answer 1

• Best heard on back below left shoulder blade- systolic murmur
• Associated with Turner’s syndrome

Question 2

Coarctation of the aorta: PC and management

Answer 2

-Weak femoral pulses (4 limb BP), tachypnea, decreased feeding and underdeveloped arms/legs

Management

• Mild: W&W
• Critical: prostaglandin E to keep DA open before corrective surgery

Question 3

TGA: pathophysiology and presentation

Answer 3

• 2 separate circuits formed that pump in parallel to each other due to malformation of aortic arch
• Cyanotic heart defect - may rely on open PDA/VSD
• Resp distress, tachycardia, decreased feeding/wt loss and sweating

Question 4

TGA: management

Answer 4

• If VSD or PDS present —> prostaglandin E
• Balloon septostomy to create ASD
• Definitive management: open heart surgery

Question 5

What are the 4 features of tetralogy of fallout?

Answer 5

• VSD
• Over-riding aorta
• Pulmonary valve stenosis
• RV hypertrophy

Question 6

Name some risk factors for TOF

Answer 6

• Rubella
• Alcohol consumption
• Increased maternal age
• Diabetic mother

Question 7

Give some signs for TOF

Answer 7

• Cyanosis
• Decreased feeding/failure to thrive
• Ejection systolic murmur (pulmonary area)
• Clubbing
• Tet spells: increase vascular resistance to overcome pulmonary resistance

Question 8

Management for TOF

Answer 8

• Total surgical repair is definitive management

- Prostaglandin E to keep DA open

Question 9

What is Ebstein’s anomaly?

Answer 9

• Low set tricuspid valve (towards apex) leading to big RA and small RV
• Associated with poor flow to RV and pulmonary vessels
• Associated with R-L shunt across atria via ASD, which leads to cyanosis

Question 10

Name a drug and a condition which are associated with Ebstein’s anomaly?

Answer 10

• Lithium

- Wolff-Parkinson-White syndrome