Paeds Cardio

Question 1

In fetal circulation the lungs have a high resistance and serve little function as they will not oxygenate the blood. Give 2 ways in which the fetal circulation by passes the lungs and what type of shunt is this?

Answer 1

Foramen ovale RA-LA
Patent ductus arteriosus PA-A

R-L shunt

Question 2

What does the ductus venousus do?

Answer 2

It allows oxygenated blood to flow from the umbilical blood into the IVC back to the fetal heart
It becomes the ligamentum venousum

Question 3

Why does the foramen ovale normally close at birth?

Answer 3

Due to sudden rise in LA pressure compared to the RA
When first breaths happen, the resistance in the lungs greatly reduces allowing for a huge increase in BF to the lungs causing ta rise in LA pressure.
The volume going to the RA falls due to the placenta being excluded from the circulation.
This change in pressure causes the flap to be closed

Question 4

How might a congenital heart disease present?

Answer 4

Antenatal cardiac USS Dx
detection of a heart murmur 
HF 
Shock 
Cyanosis

Question 5

What are the causes of HF for:

a) neonates
b) infants
c) young children

Answer 5

a) neonates = obstructed outflow in the systemic circulation: Coarction of the aorta, critical aortic valve stenosis, hypo plastic left heart syndrome
b) infants = High pulmonary flow - left to right shut: VDS, ASD, large PDA
c) young children = L/R HF: Eisenmenger syndrome, Rheumatic heart disease, cardiomyopathy

Question 6

Are L-R shunts breathless or cyanosed?

Give examples of L-R shunts

Answer 6

Breathless

VSD, ASD, PDA

Question 7

What murmur would you hear with PDA?

Answer 7

Continuous murmur beneath the left clavicle

Pressure in the PA is continuously lower than that in the aorta so is not dependant on the contraction to occur

Question 8

Give 2 types of ASD and which is the most common?

Answer 8

Secundum 80%

Partial atrioventriculoseptal defect

Question 9

Ejection systolic murmur head best at the upper left sternal edge with fixed, widely split s2 heart sound

a) VSD
b) PDA
c) ASD
d) Tetrollogy of fallot
e) AS
d) PS

Answer 9

Ejection systolic murmur head best at the upper left sternal edge with fixed, widely split s2 heart sound
= ASD

ES murmur due to BF over the pulmonary valves due to blood flowing from the LA to the RA

Question 10

Pansystolic murmur

a) VSD
b) PDA
c) ASD
d) Tetrollogy of fallot
e) AS
d) PS

Answer 10

Pansystolic murmur = VSD

Loud & @ lower sternal edge is small

with Apical mid diastolic murmur if loud

Question 11

CXR: cardiomegaly, enlarged pulmonary arteries, increased vascular makings and pulmonary oedema

a) VSD
b) PDA
c) ASD
d) Tetrollogy of fallot
e) AS
d) PS

Answer 11

CXR: cardiomegaly, enlarged pulmonary arteries, increased vascular makings and pulmonary oedema
ASD
VSD

Question 12

Ejection systolic murmur at the right sternal edge - delayed soft aortic sounds and carotid thrill

a) VSD
b) PDA
c) ASD
d) Tetrollogy of fallot
e) AS
d) PS

Answer 12

Ejection systolic murmur at the right sternal edge - delayed soft aortic sounds and carotid thrill
= AS

Question 13

You have a very sick neonate who appears to be shocked and have HF.
What are your differentials for the causes of this?

Answer 13

Sick neonate obstruction causes

1) coarction of the aorta
2) interruption of the aorta
3) hypo plastic left heart syndrome

Question 14

What is rheumatic fever caused by?

Answer 14

Group A haemolytic strep

Question 15

Describe the features of an innocent murmur

Answer 15

InnoSent murmur 
AsSymtomatic patient 
Soft blowing murmur 
Systolic 
Left Sternal Edge