adult congenital heart disease

Question 1

most common adult congenital heart disease

Answer 1

Bicuspid aortic valve
myxotmatous degeneration
ASD
VSD

Question 2

how do you detect patent foramen ovale

Answer 2

bubble studies

TEE

Question 3

bubble studies

Answer 3

inject w/agitated saline
can see bubbles cross R->L
if PFO is larger L->R shunt will clear bubbles on R side of septum

Question 4

complications of ASD

Answer 4

atrial arrhythmias
paradoxical embolus
cerebral abscess (due to paradoxical septic embolism)
right heart failure
pulmonary HTN -> Eisenmenger syndrome

Question 5

types of ASD

Answer 5

secundum
primum
sinus venosus

Question 6

secundum ASD

Answer 6

middele of septum, defects in foramen ovalis
70% of ASDs
more common in females
usually not associated w/other cardiac defects

Question 7

primum ASD

Answer 7

large
15-20%
almost always associated w/defects in AV valves or VSDs
AV canal or endocardial cushion defect is complete form

Question 8

sinus venosus ASD

Answer 8

5-10%
often associated w/anomalous pulmonary vein insertion (can see into RA)
2 types: superior (SVC), inferior (IVC)
surgical correction

Question 9

scimitar syndrome

Answer 9

triad:

1. partial anomalous venous return
2. hypoplasia of a lobe of right lung
3. throacic aorta -> pulmonary a collaterals

Question 10

ASD size cut off for being asymptomatic

Answer 10

<8mm

Question 11

clinical manifestations of ASD

Answer 11

atrial arrhythmias
20% atrial fibrillation or flutter, increases w/age
at risk for embolic events
migraine cephalgia 
pulmonary HTN 
eisenmenger syndrome (>2.5:1)

Question 12

atrial contraction contribution

Answer 12

normally 5% CO

can be up to 30% in elderly or CHF

Question 13

PE findings dependent on

Answer 13

size and location of defect
size of shunt
pulmonary artery pressure (depend on resistance)

Question 14

ASD typical PE findings

Answer 14

RV heave
palpable PA at upper LSB
wide fixed split S2
increased P2 w/pulmonary HTN
S1 slpit w/increase in tricuspid involvement

Question 15

paradoxical S2 split

Answer 15

severe aortic stenosis or RBBB

Question 16

Murmurs in ASD

Answer 16

SEM upper LSB from increased flow

early DM, upper LSB from PI secondary to pulmonary HTN (if this present call cardiologist)

Question 17

muscular VSD

Answer 17

overloads RV

less common

Question 18

membranous VSD

Answer 18

dumps into base of PA missing RV -> lungs -> overloads LV

Question 19

VSD murmurs

Answer 19

larger the hole quieter the murmur
holosytolic/pansystolic murmur at 3rd ICS, LSB
common in neonates bc small and loud, usually closes on its own, usually a thrill

Question 20

types of VSD

Answer 20

infundibular
membranous
inlet
muscular

Question 21

infundibular

Answer 21

below aortic and pulmonic valves, elading to progressive aortic regurg

Question 22

inlet

Answer 22

av canal, Downs

Question 23

small VSD

Answer 23

aka restrictive
< or  = 25% of aortic annulus diameter
small L -> R shunt w/no LV volume overlaod
no pulmonary HTN
asymptomatic

Question 24

moderate VSD

Answer 24

25-75% of aortic annulus diameter
mild-moderate volume overload of PA, LA, LV
no pulmonary HTN
usually gets smaller w/growth

Question 25

Large VSD

Answer 25

> or = 75% of annulus
moderate to large L -> R shunt w/LV overload leading to PHTN w/pulmomary arterial obstructive disease
usually presents w/CHF in infancy or eisenmengers in late childhood/early adulthood

Question 26

Eisenmenger complex

Answer 26

eisenmenger syndrome w/VSD

Question 27

VSD PE

Answer 27

loud holosystolic LSB, 2-3 ICS

thrill

Question 28

tests for VSD

Answer 28

EKG usually normal
Echo is test of choice
CT/MRI for complex lesions
cath-less important now due to other test

Question 29

tetralogy of fallot

Answer 29

RVOT obstruction
VSD
aorta overrides IVS
Concentric RVH