Fcps

1. Toacs for IMM
Dr. Abdul Ahad
Trainee fellow Paeds cardiology
LNH

2. Toacs 1
• You got called from Gynae resident that they
are delivering a baby, gestational age 35
weeks. Mother had some rheumatological
problem. ECG was done.

3. Questions
• 1. interpret ECG
• 2. What is management plan?
• 3. What advice would you give for next
pregnancy?

5. ANSWERS
• 1. Complete heart block
• 2. Counsel for PPM
• 3. Fetal Echo and monitor heart rate on fetal
Echo

7. Toacs 2
• 2 months old male baby came with history of
SVT at 15 days of life. SVT corrected at that
time. Now ECG was advised.

8. Questions
• 1. Interpret ECG
• 2. What will you advice?
• 3. What are treatment options?

10. Answers
• 1. WPW syndrome, Delta wave on ECG, LBBB?
• 2. Avoid precipitating factors, Fever, caffeine,
anxiety, Drugs causing tachycardia
• Advice Echo
• 3. Propranolol, catheter ablation of accessory
pathway

11. Toacs 3
• 2 years old male baby presented in OPD with
complaint of fever for 3 days, flue and nasal
discharge of for 3 days.
• On examination: baby is conscious, Colour is
Pink with normal respiration

12. Questions
• 1. What is initial assessment according to
PALS?
• Do primary assessment according to PALS?
• Give 2 treatment options?

14. Answers
• 1. Non-Acute life threatening event
• Call for help, O2, IV line, attach monitor
• 2. Primary assessment: Airway, breathing,
circulation, Disability, Exposure
• 3. Adenosine stat, if not aborted then can
repeat twice. If refractory, then add
amiodarone bolus in 1 hour then infusion

15. Toacs 4
• In er you call from some peripheral hospital
that there is 4 years old male baby had history
of fever for 5 days, cough and and difficulty in
breathing for 2 days. In morning mother
noticed, child had abnormal breathing
pattern.
• When baby arrived, you noticed, child is
lethargic, pale and tachypneic. They had ECG
done in peripheral hospital.

16. Questions
• 1. Do initial assessment according to PALS?
• 2. Do primary assessment according to PALS?
• 3. What is management according to PALS?

18. Answers
• 1. Acute life threatening event
• 2. Primary assessment: A B C D E
• 3. VT with pulse or with out pulse
• Synchronized cardioversion in VT with pulse
• Un synchronized shock in VT with out pulse

19. Toacs 5
• 5 years old male baby with history of
developmental delay, ophthalmoplegia,
pigmentary retinopathy, cerebellar ataxia,
proximal myopathy, deafness, delayed puberty
and endocrine dysfunction.
• CSF shows increase CSF protein.
• He had history of Syncope
• ECG, fundoscopy and MRI advised.

20. Questions
• 1. What is diagnosis?
• 2. interpret ECG?
• 3. What does fundoscopy shows and give 3
differential diagnosis?
• 4. Describe important MRI finding?

24. • 1. Kearns sayre syndrome
• 2. Sinus Rhythm, normal PR, Left axis
deviation, RBBB
• 3. Retinitis pigmentosa. D/D Bardet-Biedl
syndrome, Abetalipoproteinemia, Refsum
Disease, toxoplasmosis
• 4. Hyperintense signal at Basal ganglia, Brain
atrophy?

25. Toacs 6
• 10 years old male patient came with chief
complaint of 2 syncopal episodes while
playing.
• He had family history of sudden cardiac death.

26. • 1. What is your approach for this child?
• 2. Interpret ECG?
• 3. Describe management of syncope?

28. Answer
• 1. take history about syncopal episodes, rule out
non-cardiac causes, fits or other
neuropsychiatric problem. Metabolic workup,
EEG, baseline ECG, ambulatory ECG, Holter,
HUTT, Exercise stress
• 2. Sinus rhythm, prolong PR interval, LBBB,
Atrial hypertrophy, Strain pattern
• 2. Treat according to cause. If Heart block or
arrhythmia, refer to p-cardiology, in case of
autonomic causes maintain volume, salt or
florinef. Treat metabolic cause

29. Toacs 7
• 9 months old male baby known case cyanotic
CHD, presented with complaint of severe
cyanosis and lethargy. He had history of loose
stools and vomiting 2 days ago.
• ECG was done in some periphery hospital

30. Questions
• 1. Interpret ECG?
• 2. What is your approach for this child?
• 3. What is your differential diagnosis?

32. • 1. RAD, RVH
• 2. Admit, vital, Knee chest position , calm baby
oxygen, i/m or i/v morphine, iv bolus 10-20
mg/kg, iv soda bicarb 1-2 meq/kg, iv
propranolol or iv phenylephrine, mechanical
ventilation
• 3. BT shunt

33. Toacs 8
• 7 years old male child presented with chief
complaint of difficulty in breathing since last 6
months, functional class 3. He also had history of
cough and difficulty in breathing.
• On examination: Heart rate 125/minute,
Saturation 96%, Blood pressure 123/75 mm Hg.
• On CVS: Normal volume pulses, S1 and S2
normal with ESM grade 2-3/6 at left sternal
border

34. Questions
• 1. Interpret ECG?
• 2. 3 D/D,s?
• 3. Describe management?

36. Answer
• 1. LAD, BVH
• 2. Myocarditis, DCMP, CAVSD
• 3. Get detailed history, examination, baseline
workup, Echo
• If reduce function, start anti failure medication