Title: Pediatric Cardiology / Acyanotic Chd
Tags: acyanotic-chd peds-cardio high-yield vsd coarctation treatment genetics murmur aortic-stenosis asd pda presentation pulmonary-stenosis avsd diagnosis epidemiology hemodynamics prognosis shunt

Q: What is the most common congenital heart defect?
A: VSD (Ventricular Septal Defect) - 30-35% of all CHD

Q: What is the classic murmur of VSD?
A: Holosystolic murmur at LLSB, may have thrill; smaller VSD = louder murmur (more turbulence)

Q: When does a large VSD typically present with heart failure?
A: 4-8 weeks of age (as PVR drops, L→R shunt increases)

Q: Which type of VSD has the highest spontaneous closure rate?
A: Muscular VSD - 80-90% close by age 2

Q: Which VSD type does NOT close spontaneously and risks aortic valve prolapse?
A: Outlet (supracristal/doubly-committed subarterial) VSD

Q: What is the classic auscultatory finding in ASD?
A: Fixed split S2 - does not vary with respiration

Q: Which ASD type can be closed with a device?
A: Secundum ASD (if adequate rims)

Q: What is the classic murmur of PDA?
A: Continuous "machinery" murmur at left infraclavicular area, loudest at end-systole continuing through S2

Q: What clinical findings suggest significant PDA?
A: Bounding pulses, wide pulse pressure, active precordium, continuous murmur

Q: What CHD is strongly associated with Down syndrome?
A: AVSD (Atrioventricular Septal Defect) - 40-50% of Down syndrome patients have CHD

Q: What is the 4-extremity BP finding in coarctation?
A: Upper extremity BP >20 mmHg higher than lower extremity BP

Q: What is the classic presentation of critical coarctation in a neonate?
A: Shock when ductus closes (usually 1-2 weeks of life), absent femoral pulses, metabolic acidosis

Q: What is the most common valve abnormality associated with coarctation?
A: Bicuspid aortic valve (50-80% of coarctation patients)

Q: What syndrome is associated with coarctation?
A: Turner syndrome (45,X) - screen all Turner patients with echo

Q: What is the murmur of aortic stenosis?
A: Systolic ejection murmur at RUSB radiating to carotids, +/- ejection click

Q: What syndrome is associated with supravalvar aortic stenosis?
A: Williams syndrome (7q11.23 deletion) - also has branch PA stenosis

Q: What is the gradient threshold for severe pulmonary stenosis?
A: Peak gradient >50 mmHg (or symptoms at lower gradient)

Q: What treatment is first-line for significant pulmonary valve stenosis?
A: Balloon valvuloplasty (catheter-based intervention)

Q: What defines hemodynamically significant left-to-right shunt?
A: Qp:Qs ratio ≥1.5:1 (significant pulmonary overcirculation)

Q: At what size VSD is intervention typically recommended?
A: Large VSD with heart failure symptoms, or Qp:Qs ≥2:1, typically repaired at 3-6 months