Acyanotic heart disease Flashcards
what are the left to right shunt defects?
ASD
VSD
PDA
AVSD
why do holes in the heart create left to right shunts?
pulmonary vascular resistance is less than systemic vascular resistance
LV is not working efficiently - oxygenated blood is directed back to lungs
which type of ASD is most common? where does it occur, specifically?
secundum type
foramen ovale
what is the pathophysiology of ASD?
left to right shunt at atrial level causes volume overload of RA, RV, and lungs
which ventricle is more compliant in ASD? what is the significance / result?
RV
easier left to right shunting
what are the auscultation findings (3) of ASD?
- soft pulmonary ejection murmur from increased flow across normal valve
- soft diastolic murmur from increased flow across tricuspid valve
- second heart sound widely split, fixed
what are the EKG findings of ASD?
right atrial enlargement
right axis deviation
possible right ventricular hypertrophy
what are the CXR findings of ASD?
increased pulmonary vascularity
enlarged heart size
large pulmonary artery segment
what is the most common form of congenital heart disease?
VSD
what is the most common type of VSD?
perimembranous
what is the pathophysiology of VSDs?
volume overload to pulmonary artery, lungs, LA, and LV
large defects cause pressure overload of lungs
which chambers / vessels are volume loaded in VSD?
pulmonary artery
LA
LV
what can cath data show for VSD risk (3)?
- size and pressure gradient
- pulmonary and systemic blood flow (QP/QS) - ratio greater than 1 is bad
- pulmonary vascular resistance
what is the reason for delay in auscultation of a murmur in VSD?
depends on ratio of PVR to SVR - could develop over first two weeks
what are the findings of a small VSD on EKG?
normal
what are the findings of a large VSD on EKG?
LVH, LAE
what are the findings of VSD on CXR?
cardiomegaly
increased pulmonary vasculature
what are the treatment options (3) for CHF seen during VSD?
digoxin
diuretic (lasix)
ACE inhibitor
what is the pathophysiology of PDA?
left to right shunt because PVR less than SVR
what are the sequalae of a large PDA?
CHF, poor weight gain, respiratory problems
what are the physical exam findings for PDA?
tach
bounding peripheral pulses with wide pulse pressure
machinery murmur at LUSB
what agent is used to close PDAs?
indomethacin (PG synthase inhibitor)
what is the anatomical defect in AVSD?
lower portion of atrial septum and inlet portion of ventricular septum are missing
which CHD is associated with down syndrome?
AVSD
patients with down syndrome have what major congenital heart defect?
AVSD
what EKG finding is highly suggestive of AVSD?
left superior axis at birth
when are ventricular outflow obstruction murmurs present?
at birth
what is the pathophysiology / findings (4) of pulmonary stenosis?
- elevated RV pressure to force blood across stenotic valve
- RV hypertrophy
- possible tricuspid regurgitation
- right sided heart failure
what is the preferred surgical repair for pulmonary stenosis?
balloon valvuloplasty
what is the pathophysiology of aortic stenosis?
elevated LV pressure to force blood across stenotic valve
LV hypertrophy
possible mitral rergurg
left sided heart failure
what are the features of auscultation for aortic stenosis?
systolic thrill at RUSB
systolic click heard toward apex
ejection murmur heard at midsternal border
what is the pathophysiology of coarctation of the aorta?
obstruction of flow distal to origin of right and sometimes left subclavian artereis
LV generates increased pressure to force blood across stenosis
which BP is higher in coarctation of the aorta - arm or leg?
arm
what are the EKG findings of coarctation in adults?
LVH
what are the EKG findings of coarctation in children?
RVH
what is the medical management for coarctation of the aorta?
- IV infusion of PGs to maintain ductal patency
2. anti-congestive medications
