Cardiac

Question 1

Cyanosis in congenital heart disease

Answer 1

Murmur = Continuous, pansystolic or diastolic

ToF:
Occurs at 6-12 months
Intermittent cyanosis +/- LOC, floppiness, especially on exertion
Harsh ejection systolic, LLSE to the back
Mx = surgery

TGA:
Most common cause of cyanosis in first day
70% male
May have normal clinical examination: if murmur, as per VSD (25%) and ASD (5%)
Lower preductal sats
Mx = PG, surgery

Question 2

Features of VSD

Answer 2

Murmur = high pitched pansystolic LLSE, radiates to back and axilla

Symptoms if large: from 2-6w
Tachypnoea, increased WOB, FTT, sweating, tachycardia = CCF
Associated thrill
Mx = frusemide/spironolactone, ACEI then surgery

If small, asymptomatic murmur
Usually close spontaneously

Question 3

Features of ASD

Answer 3

Generally asymptomatic

Ejection systolic, in pulmonary area
Fixed S2 splitting

Most close in first 2 years, if large close before school age

Question 4

Features of PDA

Answer 4

Small: asymptomatic, continuous murmur at LUSE

Medium: 2-6mo
FTT, slow growth, full pulses

Large: 4wo
FTT, collapsing pulses, murmur often only systolic

Mx =
Indomethicin if prem
Surgery if small and symptomatic, catheter device closure if older

Question 5

Features of CoA

Answer 5

Present in first few days of life: shock from reduced perfusion
Decreased femoral pulses, radiofemoral delay and continuous murmurs due to associated lesions