Peds: Cardiology

Question 1

Blue Child. There is dyspnea with respiratory distress. Holosystolic murmur at the left sternal border with a diastolic rumble at the apex Loud Pulmonic S2. Dx? What do the Test show Rx?

Answer 1

VSD ( Most common congenital heart defect in children) Echo. (Left to Right shunt causes R ventricular Strain - RVH and Esigmmenger syndrome). Rx: Spontaneous Closure.

Question 2

Blue Child. Widely fixed split S2 at the left upper sternal border. Dx? Best diagnostic test? What do the test show? Name a common complication. Rx?

Answer 2

ASD. Echo. RVH and R atrial enlargement can cause RBBB, RAD. Emboli can cause paradoxical embolus ( from R side of heart and goes to left side.) Rx: Spontaneous closure.

Question 3

Machine like murmur, wide pulse pressure, bounding pulses. Dx? Best diagnostic test? Rx?

Answer 3

PDA. Echo. Rx: Indomethacin to close PDA ( vasoconstriction)

Question 4

Systolic Ejection Murmur at the left upper sternal border. Dx? Best diagnostic Test? Rx?

Answer 4

Pulmonary stenosis. Echo (RVH, RAD, RBB). Rx: Valvulomty/Valve replacement (Always replace a important stenotic valve.)

Question 5

Severe CHF and respiratory distress within first few months of life. Decrease lower extremity pulse, acidosis. Child with upper extremity HTN and leg weakness/pain. Dx? What do the test show? Rx?

Answer 5

Coarctation of the aorta. Echo. CXR: Rib NOTCHING. Rx: Resection of the Coarctation. Ballon dilatation.

Question 6

FTT, variable cyanosis (tet spells), Right ventircular impulse. Dx? What do the test show? Rx?

Answer 6

Tetrology of Fallot. Echo. (RAD and RVH) CXR: Boot-shaped heart, decrease pulmonary vascular markings. Rx: Surgery.

Question 7

Cyanosis first week. Left AXIS DEVIATION. Left ventricular impulse displaced laterally. Single S2 and ASD and VSD usually present. Dx? Test? Rx?

Answer 7

Tricupsid Atresia. Echo. Rx: PGE1 keep PDA open until surgery.

Question 8

Blue babies. Absent pulse with single S2. R ventricular Heave. Pt survives due to persistent PDA and Foremen ovale. Dx? Test? Rx?

Answer 8

Hypoplatisc Left Heart Syndrome. Echo. CXR: Globular shaped heart with increased vascular markings. Rx: Heart transplant - high mortality.

Question 9

Blue babies. Blood from lungs goes to R atrium and not left atrium. The pulmonary and systemic systems come back to the R side of the heart. Name the 2 types. What is the difference. Dx? Rx?

Answer 9

Total Anomalous Pulmonary Venous Return. CXR shows Snow Man sign. Both need surgery.

Question 10

Never diastolic, never greater than 2/6. Dx? Rx?

Answer 10

Innocent murmur. Reassurance.

Question 11

Name 3 heart diseases associated with Holosystolic Murmur ?

Answer 11

TR (Adult- Endocarditis, Carcinoid syndrome, Heart failure) , MR and VSD (child)

Question 12

Blue babies. Single S2 because a single trunk emerges from both the right and left ventricles. Complication? Test? Rx?

Answer 12

Truncus Arterious. Echo. CXR will show cardiomegaly with increased pulmonary vasvular markings that can lead to pulmonary HTN. Sugery.

Question 13

Boy presents with LOC. Had hearing loss as a baby. Family hx of sudden cardiac death. Dx? Rx?

Answer 13

Congeintal QT syndrome (Jervel Nelson Syndrome) Give Propanolol + Pacemaker.

Question 14

1. Down Syndrome? 2. Edward? 3. Turner? 4. Infant of diabetic mother?

Answer 14

1. ASD and Cushion defect 3. VSD 4. Coarctation 5. Transposition of the great vessels.