Case Study: Cardio

Question 1

An 8 week old baby boy presents for routine examination to his GP. He is noted to have a murmur.

1. What history features should you ask about?
2. What should you look for on examination?
3. investigation and Management

Answer 1

1. (Inc. Symptoms of cardiac failure)
   Breathlessness (feeding or exertion)/ colour changes
   Poor feeding +/- weight gain
   Sweating
2. Examination: (Inc. Signs of cardiac failure)
   Tachycardia/ Tachypnoea
   Hepatomegaly
   Peripheral pulses (femorals/ brachials) , Gallop rhythm
3. Refer to paediatrics if any uncertainty
   May need Sats, 4 limb BP, Echo, ECG +/- CXR
   Measurements and centiles

Question 2

what are the feature of an innocent murmur?

Answer 2

Vibratory
Soft- Grade I to II
Systolic
Localized (Left Sternal edge common)
Vary with activity, position and respiration

Asymptomatic

SSS

Question 3

A 12h old baby girl is noted on routine post delivery examination to be blue (face, tongue and limbs). Peripheral pulses are present. A loud systolic murmur is present

1. Differential diagnosis?
2. Management?

Answer 3

1.Differential diagnosis:(Cyanotic heart disease)
Transposition of the great arteries (mixing via VSD/ PDA/ PFO)!!!

Pulmonary Atresia/ Tricuspid Atresia
Truncus Arteriosus
Obstructed Total Anomalous Pulmonary Venous Drainage (TAPVD)
Tetralogy of Fallot

2.
Admit to neonatal unit and discuss with cardiac centre
Sats, Gas, 4 limb BP, CXR and Echo
May need volume expansion, correction of acidosis/ hypoglycaemia, inotropes
IV Prostaglandins and potential ventilation (specialist use)

Question 4

What is the associated cardiac abnormality for Down’s

Answer 4

AVSD

Question 5

What is the associated cardiac abnormality for Turner’s

Answer 5

Coarctation

Question 6

What is the associated cardiac abnormality for Noonan’s

Answer 6

Pulmonary Stenosis

noon has pulmonary sten

Question 7

What is the associated cardiac abnormality for William’s

Answer 7

Supravalvular Aortic Stenosis

WS

Question 8

aetiology of congenital heart disease?

Answer 8

Maternal antenatal health (Diabetes, SLE)
Maternal substances (Alcohol, phenytoin, lithium
Congenital infections (TORCH)
30% of chromosomal problems have CHD

Most common group of structural malformations in children
8 per 1000 live births

Question 9

8 commonest of lesions

Answer 9

Ventricular Septal Defect 			(VSD)
Patent Ductus Arteriosus      		(PDA)
Atrial Septal Defect              		(ASD)
Tetralogy of Fallot
Pulmonary Stenosis
Coarctation of the Aorta
Aortic Stenosis
Transposition of the Great Arteries 	 (TGA)