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CV 2 Exam 2 > ASD, VSD, Tetralogy > Flashcards

ASD, VSD, Tetralogy Flashcards

1
Q

primum ASD

A

incomplete fusion of septum primum & the AV endocardial cushions

common in down syndrome

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2
Q

secundum ASD

A

most common

excessive resorption of septum primum or interrupted septum secundum development

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3
Q

patent foramen ovale

A

incomplete fusion of septum secundum & septum primum

  • those in hypercoagulable state at increased risk for stroke d/t emboli being pushed into systemic circulation
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4
Q

sx & PE findings with ASDs

A

sx: exertional dyspnea, heart failure
PE: systolic ejection murmur, fixed split S2

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5
Q

what do you see on ECG with ASDs?

A
  • incomplete or complete RBBB
  • RAD in secundum ASD (LAD in primum)
  • RVH
  • R atrial enlargement
  • Afib or flutter
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6
Q

what do you see on CXR with ASDs?

A
  • enlarge pulmonary arteries
  • increased pulmonary vascularity
  • enlarged R ventricle
  • enlarged R atrium
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7
Q

transthoracic echo with ASDs

A

saline injection w/ bubble contrast can demonstrate R to L shunt ; pulsed & color flow doppler

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8
Q

TEE

A

transesophageal echo
-used if transthoracic echo quality is not optimal

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9
Q

who should be treated with ASDs?

A
  • left to right shunts over 1.5:1
  • leads to RV volume overload if left untreated
  • pulm HTN precludes closure if pulm systolic pressure > 2/3 of systemic systolic pressure
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10
Q

complications of untreated septal defects

A
  • Afib
  • heart failure
  • paradoxical systemic embolization
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11
Q

Down’s Syndrome & heart defects

A
  • AtrioventricularSD 45%
  • VSD 35%
  • ASD 8%
  • patent ductus arteriosus 7%
    -Tetralogy of Fallot 4%
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12
Q

type A, outflow tract VSD

A

rare; in ventricular septum directly below the pulmonary valve

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13
Q

type B, membranous VSD

A

in membranous septum, in upp ventricular septum, near valves ; most commonly operated on

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14
Q

type C, inlet VSD

A

near atrioventricular canal

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15
Q

type D, muscular VSD

A

in the lower muscular portion of ventricular septum; most common VSD; large # of them close spontaneously

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16
Q

complete AVSD

A

central endocardial cushion defect allows blood to flow b/n all 4 heart chambers / one common atrioventricular valve instead of separate valves

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17
Q

most commonly occurring congenital heart defect

A

VSD

18
Q

VSD in a baby presentation

A

poor eating, failure to thrive, fast tachypnea, dyspnea, easy tiring

19
Q

VSD in a child presentation

A

dyspnea on exertion, not gaining weight, dyspnea when eating or crying

20
Q

VSD in adult presentation

A

dyspnea on exertion, orthopnea, irregular heart beat, fatigue/weakness

21
Q

small shunt VSDs

A

loud, harsh holosystolic murmur in left 3rd & 4th interspaces along the sternum

22
Q

large shunt VSDs

A

RV volume & pressure overload, pulmonary regurg
- late finding of cyanosis

23
Q

what do you see on ECG with VSDs

A

right, left or biventricular hypertrophy

24
Q

what do you see on CXR with VSDs

A

LVH, left atrial enlargement, enlarged pulmonary arteries & increased pulmonary vascularity

25
Q

what pressure makes a VSD inoperable?

A

PA pressure/systemic pressure greater than 0.67 is inoperable

26
Q

large VSD prognosis

A

heart failure / survival beyond 40 years is unusual without tx

27
Q

surgical management of VSD

A
  • left to right shunt greater than 1.5 & pulm systolic pressure less than 2/3 of systemic systolic pressure
28
Q

list some cyanotic heart diseases

A
  • tetralogy of fallot
  • transposition of the great arteries
  • truncus arteriosus
  • tricuspid atresia
29
Q

transposition of the great arteries

A

aorta & pulmonary artery switch places
-detected prenatally or shortly after birth
-prompt surgical correction

30
Q

truncas arteriosus

A

normal mitral & tricuspid valves but only 1 valve b/n aortic & pulmonic valves
- needs prompt surgical correction

31
Q

tricuspid atresia

A

hypoplastic R ventricle
- tx w/ prostaglandin to maintain patent ductus arteriosis to supply blood to the lungs

32
Q

Tetralogy of Fallot

A

VSD with R ventricular outflow obstruction secondary to infundibular stenosis
- RVH
- overriding aorta in 50%

33
Q

Tetralogy severities

A
  • lesser obstruction: left to right shunt, allows for oxygenation
  • great obstruction: right to left shunt, cyanosis
34
Q

congenital disorders associated with Tetralogy

A
  • Down’s syndrome
  • DiGeorge syndrome
    -velocardiofacial syndromes
35
Q

PE findings with Tetralogy

A
  • crescendo-decrescendo harsh systolic ejection murmur
  • loudest at left mid to upper sternal border
  • radiates posteriorly
  • normal S1 & single S2 d/t diminished P2
  • cyanosis of lips & nail beds
36
Q

Tet spells

A
  • hypercyanotic episodes precipated by sudden increase in R to L shunting of blood elicited by feeding/crying
  • squatting releases this
37
Q

what do you see on ECG with Tetralogy

A

-RVH
-RAD
-RBBB after repair
-QRS > 180 msec

38
Q

what do you see on CXR with tetralogy

A
  • boot shaped heart
  • prominent R ventricle
  • concave R ventricular outflow tract
  • enlarged R sided aorta sometimes
39
Q

Tetralogy echo pre repair

A
  • unrestricted VSD
  • R ventricular infundibular stenosis
  • enlarged aorta
40
Q

Tetralogy echo post repair

A
  • pulm valve regurg
  • R ventricular & L ventricular function
  • aortic regurg
41
Q

types of repair for Tetralogy

A
  • VSD patch
  • RV outflow tract patch
  • takedown of arterial-pulmonary artery shunt
42
Q
A

CV 2 Exam 2 (2 decks)

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