Paeds Cardio

Question 1

Outline foetal circulation

Answer 1

Placenta –> Umbilical Vein –> IVC –>RV–>FO–>LA–>Aorta–>Umbilical arteries–>Placenta
(OR RV>PA>DA>Aorta>UA>Placenta)

Question 2

What is the purpose of the foramen ovale and ductus arteriosus in foetal circulation?

Answer 2

Used to bypass non-functioning lungs

Question 3

What 4 CHD can cause a L–>R shunt?

Answer 3

1) VSD
2) ASD
3) AVSD
4) PDA

Question 4

What are the main signs of a VSD?

Answer 4

1) Poor feeding and FTT
2) Tachypnoea
3) Thrill
4) Hepatomegaly
5) Pan-systolic murmur

Question 5

What would you see on a CXR for VSD?

Answer 5

1) Cardiomegaly
2) Pulmonary oedema
3) Enlarged pulmonary arteries

Question 6

Why are ASD’s often asymptomatic?

Answer 6

ASD’s are often asymptomatic because the blood flow in the atria is low pressure and so breathlessness etc is uncommon.

Question 7

What are the main signs of ASD?

Answer 7

1) Palpitations
2) Ejection-systolic murmur in pulmonary arteries
3) S2 sound

Question 8

Which chromosomal abnormality is AVSD usually found in?

Answer 8

Trisomy 21 (Down’s)

Question 9

What are the main S/S of PDA?

Answer 9

Poor feeding, FTT.
Tachypnoea.
Active precordium.
Thrill.
Continuous machinery murmur.

Question 10

What is the overall management for CHD for people with R>L shunts?

Answer 10

Stabilise the patient.
Increase calorie intake.
NG tube.
Diuretics and ACEi to prevent HF symptoms.
Surgical repair

Question 11

Which shunt would cause a patient to appear cyanotic?

Answer 11

R–>L shunt

Question 12

Name 2 congenital heart problems that can cause a R -> L shunt.

Answer 12

1) Tetralogy of Fallot
2) Transposition of the Great Arteries

Question 13

What 4 components make up Tetralogy of fallot?

Answer 13

1) Pulmonary Stenosis
2) RVH
3) Overriding aorta
4) VSD

Question 14

What are the main S/S of TOF?

Answer 14

1) Cyanosis
2) Collapse
3) Acidosis

Question 15

Define coarctation of the aorta

Answer 15

Arterial duct tissue encircles the aorta at the point of insertion of the duct. When the duct closes, the aorta constricts, this causes severe obstruction to LV outflow.

Question 16

What are the main S/S of Coarc of Aorta?

Answer 16

Radio-femoral delay.
Weak femoral pulses.
Difference in pre and post-ductal saturations.

Question 17

What are the main S/S of aortic stenosis?

Answer 17

1) Palpable thrill
2) Ejection systolic murmur
3) LVH

Question 18

Name 3 congenital heart problems that are often associated with Down’s syndrome.

Answer 18

1) AVSD
2) VSD
3) TOF

Question 19

What are the main signs of pulmonary stenosis?

Answer 19

1) Ejection systolic murmur (Radiates to the back)
2) RV heave if severe

Question 20

What is a possible consequence of persistent pulmonary hypertension?

Answer 20

Eisenmenger syndrome: ^ Pa, Pul BF damages pul. vasc. -> ^ Resistance (PHT)->RV pressure increase –> Shunt reverses and mixes

Question 21

What is the PP behind Eisenmenger syndrome?

Answer 21

Persistent pulmonary hypertension -> high pressure pulm. blood flow damages pulmonary vasculature -> increased resistance (pulm. hypertension) -> RV pressure increase -> shunt direction reverses -> CYANOSIS!