Acyanotic Defects Flashcards

(34 cards)

1
Q

What direction does blood shunt when there are holes in the heart?

A

Left to right!

PVR

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2
Q

What is the most common type of ASD?

A
Secundum type 
(at the site of foramen ovale)
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3
Q

What are the effects of an left to right shunt ASD?

A

Volume overload of RA, RV, and Lungs

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4
Q

What determines the magnitude of the shunt?

A

Size of the defect
Relative compliance of ventricles
-RV more compliant

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5
Q

What are the Physical findings in ASD?

A

Soft Pulmonary Ejection murmur -flow across normal valve
Soft Diastolic Murmur– flow across tricuspid valve
2nd Heart sound is widely split, fixed
No murmur from flow across defect

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6
Q

What are the EKG findings in ASD?

A

RA enlargement
R Axis Dev
RV Hyp

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7
Q

What are the CXR findings in ASD?

A

Inc Pulm Vascularity
Enlarged Heart size
Large Pulm Artery segment

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8
Q

What is the Intervention for ASD?

A
Open heart surgery
-prosthetic patch
-Patients own pericardium
Device closure in cardiac cath lab
-Amplatzer Septal Occluder
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9
Q

What are the features of a VSD?

A
Most common form of congenital HD
Can co-exist with other defects which may dominate the physiology
Septum divided into parts 
-small membranous portion
-large muscular portion
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10
Q

What are the qualities of a Perimembranous VSD?

A

Most common
Located just below the Aortic Valve (left of septum)
Adjacent to septal leaflet of the tricuspid valve
Shunt may e limited by Tricuspid tissue

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11
Q

What is unique about an inlet VSD?

A

Low chance of closing spontaneously

Posterior and inferior to perimembranous VSD

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12
Q

What is the pathophysiology of a VSD?

A

Defects vary in size

L to R shunt at ventricular level (PVR

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13
Q

What is used as a Pulm Artery Dilator?

A

O2 and Nitric Oxide

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14
Q

What are history findings in VSD?

A
Small VSD Pt is asymptomatic
Large VSD
-delayed growth
-dec exercise tolerance
-freq pulm infections
-CHF
Long standing Pulm HTN Cyanosis may be present
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15
Q

What murmurs can be heard in a VSD?

A

P2 heard more with a large VSD
Systolic Regurgitant murmur
Diastolic Rumble with large shunt

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16
Q

What is the medical management of VSD?

A

Digoxin(more kick in the heart)
Diuretic
ACE inhibitor
High Cal formula

17
Q

What is the surgical management of VSD? Contraindications?

A

Growth failure not improved by meds
Not for long standing L to R shunt
Not if Cyanosis from R to L shunt (Eisenmenger: Deox blood to circulation)

18
Q

What kind of shunt if seen in a Patent Ductus Arteriosus?

A

Left to Right bc PVR

19
Q

Waht are EKG and CXR findings in PDA?

A
EKG:
Similar Findings as VSD
Small PDA-nothing
Large PDA- Possible LVH, LAE
CXR:
Small: normal
Large: Cardiomegaly and inc pulmonary vascularity
20
Q

What are the medical and surgical Tx of PDA?

A

Indomethacin to Constrict Vessels in Preterm infants
Device closure in cath lab

Litigation and division via left thoracotomy

21
Q

What pathology is associated with AVSD?

A

Down Syndrome

22
Q

Which shunt is dominant in AVSD?

A

Ventricular Shunt

23
Q

What are the EKG and CXR findings in ASD?

A

EKG: Left superior axis
CXR: Cardiomegaly
Increased Pulm Vascularity

24
Q

What are the causes of Pulmonary stenosis?

A

Valvar: Thick valve with fused or absent commisures, small orifice, associated with Noonan Synd.
Subvalvar, Supravalvar rare

25
What are the EKG and CXR findings in Pulmonary Stenosis?
``` EKG: normal in mild cases RAD + RVH in mod to severe cases LVH CXR: Heart Size normal Vasc Normal ```
26
What is the natural history of PS?
Mild does not progress Moderate DOES Progress Sudden death possible
27
What is the Medical management of PS?
Baloon Valvuloplasty preferred to surgical repair | RV severely hypertrophied may develop 2ndary dynamic subvalvar obstruction
28
What are the features and therapies associated with Aortic Stenosis?
LV Hypertrophy Avoid Sustained Strenuous activity Anti Congestives Baloon Valvuloplasty Aortic Valvotomy Aortic Valve replacement Excision of membrane or myectomy for subvalvar stenosis Patch Augmentation of supravalvar area.
29
What is the Ross procedure?
Pulmonic valve replaces Vent valve | Cadaver valve replaces Pulm valve.
30
What causes Coarctation of the Aorts?
Indenting of the Aorta by Ductus Arteriosus
31
What are PE findings in Coartation of the Aorta?
Infants pale and dyspneic Weak peripheral Pulses Murmur is variable
32
What is the natural history of Coarctation of the Aorta?
CHF by 3 months Renal Impairment Re-stenosis possible after repair HTN
33
What is the Medical Management of Coarctation?
IV Prostaglandins to maintain ductal patency Anti Congestion meds Baloon angioplasty
34
What is the Surgical Management for Coarctation?
Resection and end to end anastamoses Conduit insertion Fix Coarctation, VSD repair later