The Child with a Heart Murmur

Question 1

What kind of management can a child with Tetralogy of Fallot expect, acutely and in the longer term?

Answer 1

• Sedate, intubate, IV propranolol (open PAs), HCO3- to correct acidosis
• Staged surgery from around 6/12

Question 2

When does transposition of the great arteries tend to present? Why?

Answer 2

• During first few days of life as PDA and FO begin to close - deepening cyanosis, breathlessness, metabolic acidosis

Question 3

How is transposition of the great arteries diagnosed? What is the management?

Answer 3

• Diagnosis
  
  • Echocardiogram. Characteristic “boot-shaped” heart on CXR
• Management
  
  • PGE infusion to keep PDA open, surgical opening of FO

Question 4

What is truncus arteriosus?

Answer 4

Combined pulmonary artery and aorta. Huge valve and always with a VSD

Question 5

What is total anomalous pulmonary venous connection?

Answer 5

No venous return to the L heart, only to the RA. Requires ASD to be compatible with life

Question 6

What is the difference between primum and secudum atrial septal defects?

Answer 6

• Secundum - defect in middle of atrial septum (e.g. PFO persisting)
• Primum - inferior margin of atrial septum missing

Question 7

What kind of murmur might you expect in a child with a patent ductus arteriosus? How is this condition managed acutely and in the long-term?

Answer 7

• Continuous machinery murmur under L clavicle (aortic pressure always > PA)
• NSAIDs close PDA, surgery within 12/12