Acyanotic Congenital Heart Defects

Question 1

Atrial Septal Defect (ASD) has what type of shunt?

Answer 1

LA to RA shunt

Defect in interatrial septum

Question 2

in Atrial Septal Defect (ASD) there is Pulmonary venous return from ____ atria to ____ atria.

Answer 2

LA→RA

Question 3

how are the atrial pressures in a small ASD?

Answer 3

LA pressures> RA pressures

Question 4

how are the atrial pressures in a large ASD?

Answer 4

LA pressures= RA Pressures

Question 5

in Atrial Septal Defect (ASD), the Smaller the defect, the more of a ________

Answer 5

pressure gradient

Question 6

which side of the heart is always under more pressure?

Answer 6

left side

Question 7

the right atrium pushes blood to ______

Answer 7

lungs

Question 8

the left atrium pushes blood to ______

Answer 8

the whole body

Question 9

Atrial Septal Defect (ASD), Once the pressures start equalizing you stop having the _____.

Answer 9

shunt

Question 10

Chronic LA → RA shunting results in what?

Answer 10

diastolic overload

Question 11

When a patient develops R to L shunting, overtime it causes too much load on the right side and can result in right sided ______.

Answer 11

hypertrophy

Question 12

eventually when the pressure becomes to high, what happens to Right to left shunts?

Answer 12

it will become a left to right side shunt

Question 13

o Types of ASD:

Answer 13

o Ostium secundum, sinus venosus: major types (10% of all congential heart dz, 20-40% of all congenital heart dz presenting in adulthood
o Ostium primum
o Coronary sinus

Question 14

is ASD more common in males or females?

Answer 14

females

F:M 2:1

Question 15

in a child with asymptomatic ASD, what is one physical exam finding you might find?

Answer 15

May hear a systolic murmur coming from the pulmonic valve (in the upper left intercostal space)

Question 16

By 40, 90% with untreated ASD will be symptomatic. what are some of these symptoms?

Answer 16

dyspnea (DOE), fatigue, palpitations, arrhythmia, HF

Question 17

at what age will patients with ASD become 100% symptomatic?

Answer 17

50

Question 18

ASD Associated Etiology (4)

Answer 18

o Holt Oram Syndrome 100% have ASD
o Ebstein’s anomaly 50% will have ASD or PFO
o Fetal Alcohol Syndrome
o Down Syndrome

Question 19

in ASD, Due to subtle PE findings, dx can be delayed into adulthood, majority detected in their ____ (age)

Answer 19

40s

Question 20

In ASD, Because you are increasing the amount of blood by having blood coming from the left to right and therefore causing more pressure, you eventually will have __________

Answer 20

pulmonary arterial hypertension

Question 21

in ASD, All patients beyond ____ (age) are symptomatic if untreated

Answer 21

50

Question 22

in ASD, If there is decreased LV compliance, then the shunt is ________.

Answer 22

increased

Question 23

arrhythmias that can be associated with ADS

Answer 23

Atrial arrhythmia, afib, flutter, PAT, RV failure

Question 24

Almost always a left atrium thrombi causes a _____.

Answer 24

stroke

Question 25

ASD PE heart sounds/murmer

Answer 25

o S1 split: forceful RV contraction & delayed closure of tricuspid leaflets
o S2 Split (wide): delayed pulmonic valve closure
o Systolic Ejection Murmur from pulmonic valve from lg L-R shunt (2nd ICS L sternal border)

Question 26

ASD is Acyanotic and pt is normally saturated unless they have _______

Answer 26

Eisenmenger Syndrome

Question 27

if patient has Eisenmenger Syndrome with ASD, what signs might they have?

Answer 27

cyanosis, clubbing

this is due to atrial shunt reversal
If it develops RIGHT to left then it would lead to cyanosis

Question 28

what might you see on a chest x ray for ASD?

Answer 28

cardiomegaly if RVH, vascular congestion increased markings

Question 29

what might you see on an ECHO for ASD?

Answer 29

It typically shows a biphasic (systolic and diastolic) pattern with a small right-to-left shunt at the beginning of systole.

In the beginning, it’s a left to right shunt

Question 30

what might you see on a MRI for ASD?

Answer 30

has successfully been used to identify the size and position of ASD. Limited for small defects. Can quantify right ventricular size, volume, and function along with the ability to identify the systemic and pulmonary venous return.

Question 31

When might Cardiac Catheterisation be useful in a pt with ASD?

Answer 31

May be useful if the clinical data inconsistent, if pulmonary arterial hypertension is suspected