The Heart

Question 1

What is the incidence for congenital heart disease?

Answer 1

8:1000 in the UK 6.3:1000

Question 2

What are risk factors for congenital heart disease relating to first degree relatives

Answer 2

Mother: 5-12%
Father. 1-3%
1 Sibling: 2-4%
2 siblings: 10%

Question 3

What are the other risk factors?

Answer 3

Trisomy: Patau’s: 90%, Edwards’: 85%, Down: 40-60%
USS suspected
Consanguinity (parents related)
Maternal rubella
Type 1 diabetes (2-5%), epilepsy, lupus
Smoking/alcohol/obesity
Drug teratogens: sodium valporate, NSAIDS

Question 4

Describe what you assess when observing

Answer 4

Tone, colour, size and shape of chest, symmetry of chest movements, RR, signs of respiratory distress, link with feeding

Question 5

Describe what you assess when palpating

Answer 5

Femoral and brachial pulses, capillary refill time, position of cardiac apex, heptomegaly

Question 6

What are the 5 auscultation sites

Answer 6

Aortic, pulmonic, tricuspid and mitral and mid scapula

Question 7

Where are the 5 auscultation sites?

Answer 7

Aortic - 2nd intercostal space right
Pulmonic - 2nd intercostal space left
Tricuspid - 4th intercostal space left
Mitral - 5th intercostal space left

Question 8

What are the outcomes for a screen negative test

Answer 8

Referred to healthy child programme and repeat SPEN at 6-8 weeks

Question 9

What are the outcomes for a screen positive test

Answer 9

Refer for neonatal review, time sensitive depending on the severity

Question 10

Why would a baby screen positive for a congenital heart disease

Answer 10

Antenatal diagnosis or postnatal of trisomy 21
Tachypnoea at rest
Episodes of apnoea
Recession (intercostal and subcostal), nasal flaring
Central cyanosis
Visible pulsations, heaves, thrills
Absent or weak femoral pulses
Murmurs and/or extra heart sounds