CABS Cardiac Malformations and Pericarditis

Question 1

Ductus Arteriosus connects

Answer 1

the aorta with the pulmonary artery, further shunting blood away from the lungs and into the aorta

Question 2

Fetal Development: Most of the RV output gets into systemic circulation via the

Answer 2

ductus arteriosus

Question 3

After birth - Increased O2 leads to decreased _______ which leads to ductal _________

Answer 3

prostaglandins
closure

Question 4

When premature and prostaglandins are too high you can give _______ to promote closure of the ductus arteriosus

Answer 4

anti inflammatories - indomethacin usually

Question 5

What is a patent ductus arteriosus

Answer 5

when the connection between the aorta and the pulmonary artery remains open

Question 6

What will happen to the pressures if there is a patent ductus arteriosus?

Answer 6

increased blood to the lungs - pulm edema
increased pressure on RV - right side will dilate

Question 7

Increased risk of Patent Ductus Arteriosus with maternal ______

Answer 7

rubella

Question 8

Fetal Development: Cardiac septation is when

Answer 8

the atria and ventricles divide into 2

Question 9

Fetal Development: Heart begins to develop around _______ gestation

Answer 9

3 wks

Question 10

Fetal Development: Heart begins to beat around

Answer 10

day 28

Question 11

Atrial septal defect is when

Answer 11

there is a piece of missing tissue in the septum that separates the R and L artium

Question 12

Atrial septal defects allow for

Answer 12

blood flow coming from LA into the RA –> leads to increased filling of the right side - dilated RA

Question 13

3 types of Atrial septal defects

Answer 13

(m/c) ostium secundum
ostium primum
sinus venosus

Question 14

_______ may be associated with cardiac malformations - m/c ASD

Answer 14

down syndrome

Question 15

Patent foramen ovale is not considered an atrial septal defect because

Answer 15

there is no missing tissue

Question 16

There should not be shunting under normal conditions with a Patent foramen ovale because

Answer 16

the LA pressure should be > than RA pressure (so the PFO will be kept shut)

Question 17

Foramen Ovale typically closes in

Answer 17

the first week of life

Question 18

What study can be done to test for PFO shunting

Answer 18

bubble study (can see R -> L shunting)

Question 19

If you have a DVT with a PFO what can it lead to

Answer 19

stroke

Question 20

If you have a DVT and then have a stroke you should consider

Answer 20

PFO and getting a bubble study

Question 21

Ventricular septal defects allow for

Answer 21

Inappropriate passing of blood across the ventricular septum (m/c L -> R shunting)

Question 22

Fetal Development: Ventricular septal defects are common at

Answer 22

birth and typically spontaneously close

Question 23

Ventricular septal defects are most common in what area

Answer 23

perimembranous area of the septum typically below the LVOF

Question 24

Findings when a ventricular septal defect is present

Answer 24

enlarged/ misshapen heart
atrial dilation
Pulm edema (vascular markings/ vascular congestion)

Question 25

Tetralogy of fallot is hallmarked by

Answer 25

large ventricular septal defect pulmonary stenosis overriding aorta that straddles VSD RV hypertrophy

Question 26

Most common congenital cause of cyanotic neonates is

Answer 26

Tetralogy of fallot

Question 27

Two syndromes that carries increased risk are

Answer 27

DiGeorge syndrome Down syndrome

Question 28

In tetralogy of fallot what is happening with the blood flow

Answer 28

Large amount of deoxygenated blood is flowing from the RV into the aortic outflow tract leading to cyanosis

Question 29

Tet spells (hypercyanotic spells) occur when

Answer 29

there is an increased obstruction of the RV outflow tract (increasing intrathoracic pressure) when kids are upset (crying), agitated, feeding, straining

Question 30

Tetralogy of flow presentation in adults

Answer 30

increased erythrocyte mass (compensating for hypoxia) clubbing central cyanosis arrhythmia arthropathy

Question 31

Coarctation of the aorta is

Answer 31

narrowing of the aorta, typically distal to the subclavian artery near the ductus arteriosus (has a pinched look)

Question 32

Coarctation of the aorta leads to

Answer 32

increased pressure proximal to the lesion and hypotension distal to the lesion

Question 33

ABI =

Answer 33

ankle brachial index

Question 34

what will the BP in the arms be compared to the BP in the ankles in coarctation of aorta

Answer 34

BP in the arms will be higher than the BP in the ankles

Question 35

Coarctation of the aorta is genetically associated with

Answer 35

tuner syndrome (typically have webbed neck and broad chest - is a partial or complete loss of chromosome x)

Question 36

On x-ray you can see what looks like a _______ in coarctation of the aorta

Answer 36

number 3

Question 37

Coarctation of aorta: pts are at risk for

Answer 37

HF Hypertensive encephalopathy Aortic dissection rupture (dilated cardiomyopathy)

Question 38

Pericardium is

Answer 38

fluid filled structure that encases the heart lubricated to reduce friction as heart moves

Question 39

Pericarditis is an

Answer 39

inflammatory disorder involving the parietal and visceral layers of the pericardium causing inflammation and discomfort

Question 40

Parietal pleura is

Answer 40

outer fibrous later

Question 41

Visceral pleura is

Answer 41

inner serosal layer

Question 42

Between parietal and visceral layer there is typically about ______ mL of fluid

Answer 42

20-60

Question 43

Pericarditis: Dx can be made with the following

Answer 43

pericardial friction rub (scratchy sound not affected by respiration) ECG changes (diffuse ST elevation not correlated with specific coronary) Pericardial effusion (ECHO)

Question 44

Pericarditis presentation

Answer 44

pain typically sharp chest discomfort not linked to exertion will not improve with vasodilation (nitro) worse lying down, improves leaning forward pulsus paradoxus may have fever, elevated inflammatory markers, elevated troponin

Question 45

What is pulsus paradoxus?

Answer 45

with inspiration they will lose their pulse (during inspiration the negative pressure will pull blood from the venous system to increase how much filling occurs within the RV)

Question 46

Pulsus paradoxus is more severe in

Answer 46

pericarditis or tamponade

Question 47

Pericarditis/ tamponade presentation on ECG

Answer 47

low voltage (decreased QRS voltage)