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Cardiology 2 > Acyanotic Defects > Flashcards

Acyanotic Defects Flashcards

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
Q

What are the EKG and CXR findings in Pulmonary Stenosis?

A 
EKG: normal in mild cases
RAD + RVH in mod to severe cases
LVH
CXR: Heart Size normal
Vasc Normal
26
Q

What is the natural history of PS?

A

Mild does not progress
Moderate DOES Progress
Sudden death possible

27
Q

What is the Medical management of PS?

A

Baloon Valvuloplasty preferred to surgical repair

RV severely hypertrophied may develop 2ndary dynamic subvalvar obstruction

28
Q

What are the features and therapies associated with Aortic Stenosis?

A

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
Q

What is the Ross procedure?

A

Pulmonic valve replaces Vent valve

Cadaver valve replaces Pulm valve.

30
Q

What causes Coarctation of the Aorts?

A

Indenting of the Aorta by Ductus Arteriosus

31
Q

What are PE findings in Coartation of the Aorta?

A

Infants pale and dyspneic
Weak peripheral Pulses
Murmur is variable

32
Q

What is the natural history of Coarctation of the Aorta?

A

CHF by 3 months
Renal Impairment
Re-stenosis possible after repair
HTN

33
Q

What is the Medical Management of Coarctation?

A

IV Prostaglandins to maintain ductal patency
Anti Congestion meds
Baloon angioplasty

34
Q

What is the Surgical Management for Coarctation?

A

Resection and end to end anastamoses
Conduit insertion
Fix Coarctation, VSD repair later

Cardiology 2 (16 decks)

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