Pediatric Cardiology

Question 1

Why is a cardiology referral indicated for Trisomy 21?

Answer 1

For the concern of ASD

Question 2

What are the complications of ASD?

Answer 2

leads to constant overfilling of the right side of the heart

increased blood flow to lungs

pulmonary HTN

Question 3

What are the critical CHDs?

Answer 3

coarctation of the aorta

hypoplastic left heart

pulmonary atresia

TOF

Total anomalous pulmonary venous return

d-Transposition of the great arteries

tricuspid atresia

truncus arteriousus

Question 4

What are some ductal dependent lesions that are screened for in the Nursery?

Answer 4

hypoplastic left heart

pulmonary atresia

TOF

TAVR

Transposition

tricuspid atresia

truncus arteriosus

Question 5

What are the five cyanotic congenital heart defects?

(Remember 1, 2, 3, 4, 5)

Answer 5

1-big trunk-Truncus Arteriosus

2-interchanged vessles-Transposition of the great vessels

3-Tri-cuspid atresia

4-Tetra-logy of Fallot

5-words-TAPVR

Question 6

when should you refer to cardiology?

Answer 6

grade 4+ murmur

diastolic murmur

increased murmur with standing

sx with murmur

femoral pulses are weak

clicks

hyperactive precordium

hx of sudden death in family

abnormal heart sounds (S3 excluded)

congenital/predisposing conditions

“that” feeling

Question 7

What are the seven S’s of Innocent Murmurs?

Answer 7

Sensitive to position/respiration changes

Short duration

Single

Small

Soft

Sweet (not harsh)

Systolic

Question 8

Most pathologic murmurs do not change with standing with the exception of what?

Answer 8

Hypertrophic cardiomyopathy

increases with standing and Valsalva

(<> at apex and LSB)

Question 9

What is a venous hum and does it require a referral?

Answer 9

Functional hum (innocent)

It is the only sound in diastole that does not warrant a referral to cardiology

Question 10

What do diastolic murmurs sound like?

Answer 10

low pitch, rumbling

listen with bell

Never normal on it’s own

Question 11

How to describe a murmur?

Answer 11

Grade 1-6(4-thrill)

Timing

Character

Location

Change with position

Radiation

Question 12

S2 has a physiologic split when?

Answer 12

With inspiration

Associated with closure of pulmonic and aortic valves

Fixed split assx with ASD

Question 13

If S1 is inaudible, what is the likely underlying pathology?

Answer 13

VSD

AV regurg.

PDA

Pulmonary valve stenosis

Question 14

A fixed split S2 is indicative of what condition?

Answer 14

ASD

Question 15

What is increased precordial activity?

Answer 15

increased RV or LV SV from (ASD, VSD, PDA), anememia, anxiety, hyperthyroid or fever

Question 16

What is a thrill caused by?

Answer 16

caused by blood flowing from high pressure to lower pressure

Grade 4 and above have thrills

Question 17

Who should get a complete cardiac exam?

Answer 17

children with heard murmurs

children with hx of cardiac disease

infants with feeding intolerance, FTT, Resp, sx, or cyanosis

Children with chest pain, syncope, exercise intolerance, fmhx of sudden death

Question 18

What are the murmurs associated with TOF?

Answer 18

Grade 3-4/6 long SEM heard at LUSB

may have holosystilic murmur at LLSB

Systolic thrill at LUSB if grade 4/6

Single S2

Question 19

Trisomy 21 is assx with what abnormalities

Answer 19

1/3 have CHD

VSD, ASD, AVSD, PDA

Question 20

Trisomy 18 is assx with what CHD?

Answer 20

VSD

ASD

PDA

Question 21

CHD assx with DiGeorge?

CHD assx with Turner’s?

Answer 21

pulmonary atresia with VSD

Bicuspid aortic valve, coarctation of aorta

Question 22

What structures close at birth?

Answer 22

Foramen ovale

Ductus arteriosus (ligamentum arteriosum)

Ductus venosus (ligamentum venosum)