Paediatric Cardiology

Question 1

You are called to see a 1 day old neonate who developed central cyanosis (mum had not had any antenatal care) and shock. What is your differential diagnosis?

Answer 1

1. Cyanotic CHD: TOF, TGA, tricuspid or pulmonary atresia
2. Respiratory: RDS, meconium aspiration, pulmonary hypoplasia
3. Sepsis: GBS or other organisms
4. Inborn errors of metabolism (causing metabolic acidosis and shock)

Question 2

Name 4 features of heart failure in children.

Answer 2

1. SOB and sweating on exertion/feeding
2. poor feeding
3. recurrent chest infections
4. failure to thrive
5. tachypnoea and tachycardia
6. heart murmur, gallop rhythm
7. hepatomegaly
8. cool peripheries

Question 3

A neonate presents with features of HF. What is your differential diagnosis? What if this was an infant? An adolescent?

Answer 3

Neonate - obstructed (duct-dependent) systemic circulation:

1. hypoplastic L heart syndrome
2. severe coarctation of the aorta
3. interruption of the aortic arch
4. critical aortic valve stenosis

Infant - L to R shunt presenting in weeks following birth as pulmonary vascular resistance falls causing increase in L to R shunt and increased pulmonary oedema and SOB:

1. VSD
2. ASD
3. large PDA

Adolescent (R or L heart failure):

1. Eisenmenger syndrome (R heart failure only)
2. rheumatic heart disease or viral myocarditis
3. cardiomyopathy

Question 4

A 2 day old neonate is cyanosed and in shock. He is diagnosed with severe coarctation of the aorta. How would you manage him acutely?

Answer 4

Prostaglandin infusion

Question 5

How would you manage a 5 week old with failure to thrive, who is diagnosed with a moderate VSD?

Answer 5

Medical management

1. diuretics e.g. furosemide (to decrease preload and improve pulmonary oedema)
2. ACEi e.g. captopril (to reduce afterload)
3. +/- digoxin (to increase contractility)
4. NG feed