Questions and Answers
What is the most common congenital cardiac lesion?
Pulmonary hypertension can be a complication of large Ventricular Septal Defects (VSDs).
True
Which of the following is a common complication of Atrial Septal Defect (ASD)?
What condition arises from a right-to-left shunt due to uncorrected left-to-right shunt?
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Match the following cardiac conditions with their related facts:
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The ductus arteriosus allows blood to flow from the __________ to the aorta during fetal life.
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What syndrome is associated with Ebstein anomaly?
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A subclavian artery-to-pulmonary shunt is part of the treatment for Tricuspid atresia.
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Which condition is characterized by a 'snowman' appearance on X-ray?
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Kawasaki disease leads to coronary artery aneurysm.
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What is the most common manifestation of Acute Rheumatic Fever (ARF)?
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What is the most common affected valve in Rheumatic heart disease?
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Study Notes
Signs of Cardiac & Respiratory Disease
- Easy fatigue, sweating during feeding, and feeding difficulties may indicate underlying cardiac issues.
- Rapid respirations can signify respiratory or cardiac disease.
Fetal Circulation
- Understanding fetal circulation is essential for diagnosing congenital heart defects.
Ventricular Septal Defect (VSD)
- Most common congenital cardiac lesion; 67% are perimembranous VSDs.
- 33% of VSDs close spontaneously; small defects often do.
- Large VSDs may require closure via cardiac catheterization.
- Diagnosis involves holosystolic murmur, chest X-ray (enlarged heart, pulmonary edema), ECG (LVH), and echocardiogram.
- Complications include pulmonary hypertension, endocarditis, and heart failure.
- Surgery indicated for failure to thrive or large defects with pulmonary artery hypertension in infants.
Eisenmenger Syndrome
- Develops when an uncorrected left-to-right shunt (VSD, ASD, PDA) leads to right-to-left shunting due to pulmonary arterial hypertension.
- Results in late cyanosis, clubbing, and polycythemia.
Atrial Septal Defect (ASD)
- Characterized by a defect in the interatrial septum; can lead to paradoxical emboli.
- Ostium secundum is the most common type.
- Diagnosis involves ECG, CXR, and echocardiogram; wide fixed splitting of S2 observed.
- Complications include dysrhythmias; low-flow lesions typically do not need endocarditis prophylaxis.
- Significant shunts usually require closure by age three.
Endocardial Cushion Defect
- Consists of ASD + VSD + abnormal valves; most common in Down syndrome.
- Diagnosis includes chest X-ray (heart enlargement), ECG (right-axis deviation, RVH), and echocardiogram.
- Treatment includes diuretics and surgery for heart failure; without surgery, death can occur.
Patent Ductus Arteriosus (PDA)
- Allows blood flow from pulmonary artery to aorta during fetal life; results in left-to-right shunting.
- More common in girls, linked to maternal rubella infection and premature infants.
- Presents with a machinery sound and wide pulse pressure.
- Indomethacin used to close it; prostaglandins keep it open.
- Complications include congestive heart failure and infective endocarditis.
Pulmonary Stenosis vs Aortic Stenosis
- Pulmonary Stenosis: Systolic murmur, RV hypertrophy, decreased pulmonary vascular markings on CXR; treated with balloon valvuloplasty.
- Aortic Stenosis: Often due to a bicuspid aortic valve; balloon valvuloplasty is the common treatment.
Coarctation of the Aorta
- BP discrepancy between lower (femoral) and upper (radial) extremities.
- Risk factor includes Turner syndrome; diagnosis shows notching of lower ribs.
- Preductal coarctation presents in infancy with cyanosis in lower body.
- Treatment involves prostaglandin E1 and surgery; complications include cerebral hemorrhage and aortic rupture.
Tetralogy of Fallot
- Most common cyanotic congenital heart defect involving 4 anatomical anomalies.
- Symptoms include "tet spells" leading to syncope; treated with oxygen and knee-chest position.
- CXR shows a boot-shaped heart; complications include brain abscess and cerebral hemorrhage.
Tricuspid Atresia
- Relies on ASD size for pulmonary blood flow; associated with a hypoplastic RV.
- Holosystolic murmurs present along the left sternal border.
- Treatment includes PGE1 and surgical procedures to reroute blood flow.
Total Anomalous Pulmonary Venous Return
- All pulmonary veins abnormally return blood to the right side of the heart; "snowman" appearance on X-ray.
- Management includes PGE and surgical intervention.
Hypoplastic Left Heart Syndrome
- Leading cause of death from cardiac defects in the first month of life due to underdeveloped left ventricle.
- Treatment includes multiple staged surgeries: Norwood procedure, bidirectional Glenn, Fontan procedure.
Ebstein Anomaly
- Associated with lithium exposure; more blood passes through ASD.
- CXR shows decreased pulmonary markings; murmur of tricuspid regurgitation is present.
Transposition of Great Arteries (TGA)
- Causes early cyanosis in newborns, particularly common in infants of diabetic mothers.
- Requires PFO and PDA; managed with PGE1 to keep PDA open.
- Balloon atrial septostomy can improve circulation; arterial switch surgery typically performed within 2 weeks.
Truncus Arteriosus
- Results from failure of truncal septation; associated with CATCH syndrome.
- Both ventricles maintain the same pressure.
Hypertension in Pediatrics
- Renal stenosis due to fibromuscular dysplasia is a common cause in children.
- Diagnosis includes renal ultrasound and angiography; neurofibromatosis can also cause renal hypertension.
Kawasaki Disease
- Acute mucocutaneous lymph node syndrome featuring fever, conjunctivitis, rash, and strawberry tongue.
- Can lead to coronary artery aneurysms and myocardial infarction; treated with high-dose aspirin and IVIG.
Acute Rheumatic Fever
- Diagnosis based on recent streptococcal infection and presence of major/minor criteria.
- Treatment includes antibiotics and corticosteroids for carditis; aspirin for arthritis.
Rheumatic Heart Disease (RHD)
- Most common form of acquired heart disease; common manifestation is arthritis.
- Affects mitral valve primarily, followed by the aortic valve.
Long QT Syndrome
- A significant concern in pediatric cardiology, often diagnosed through family and personal history.
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Description
Test your knowledge on pediatric cardiology focusing on the signs of cardiac and respiratory diseases, fetal circulation, and ventricular septal defects. This quiz covers essential concepts, including common congenital cardiac lesions and their management. Ideal for students and practitioners in the field of pediatrics.
