Cardiac Defects

Question 0

Normal pressure curve but reduced overall with increased atrial pressure (but overall increased)

Answer 0

Mitral stenosis

Question 1

aortic pressure curve follows decreased trajectory (similar pattern but less extreme and lower over all) ejection happens with greater velocity

Answer 1

aortic stenosis

Question 2

Normal ventricular and atrial pressure curve but aortic pressure curve drops sharply after ejection

Answer 2

Aortic regurgitation

Question 3

Decreased overall pressure curve, left atrial pressure spikes in systole

Answer 3

Mitral regurgitation

Question 4

Murmurs that enhance on inspiration

Answer 4

• originate from right heart

- increased venous return delay pulmonic valve closure and increase tricuspid regurgitation

Question 5

Murmurs that increase upon expiration

Answer 5

• increase mitral or aortic regurgitation (prolonging systole increases ventricular filling?)

Question 6

Aortic valve closure -> pulmonic valve closure -> opening snap -> long decrescendo -> short crescendo -> S1

Answer 6

Splitting of the second sound in mitral stenosis
- mitral stenosis causes opening snap due to blood rushing in at higher velocity and hitting the residual volume in ventricle

Question 7

Delay between aortic and pulmonic valve closure

Answer 7

• accentuated during inspiration

- may be seen in expiration due to right bundle branch block

Question 8

Pulmonic valve closing before the aortic typically heard on expiration

Answer 8

• delayed LV systole (left AV brand block)
• prolonged left ventricular systole (aortic stenosis, severe HTN, left sided HF)
• early right ventricular systole (WPW syndrome)

Question 9

Murmurs that increase on inspiration

Answer 9

• originate from rt heart

- decrease in intrathroacic pressure increases venous return delaying polmonic valve closure widening split

Question 10

Crescendo-decrescendo systolic murmur

Answer 10

Aortic stenosis

Question 11

Late crescendo systolic murmur

Answer 11

Mitral prolapse

Question 12

HR of 30-40 BPM

Answer 12

• purkinje fiber overdrive suppression

- in this case won’t normally see atrial depol

Question 13

HR of 40-60 BPM

Answer 13

AV node overdrive suppression

Question 14

Mid systolic click

Answer 14

• mitral valve prolapse: myxoid degeneration

Question 15

Crescendo-decrescendo: pan systolic murmur

Answer 15

• aortic stenosis
• may be associated with rheumatic heart disease (commissure fusion)
• most commonly assoc with age wear and tear (no commissural fusion)

Question 16

Eisenmenger syndrome

Answer 16

• left to right shunting
• result of large VSD
• usually silent at birth-> eventually flow reverses and you end up with lower ext cyanosis

Question 17

Most common ASD

Answer 17

• osteum secondum

- osteum primum: associated with downs

Question 18

ASD assoc. with Down syndrome

Answer 18

• Ostium primum ASD

Question 19

Babies who develop cyanosis early in life, boot shaped heart on X-ray

Answer 19

• ToF
• right to left shunts
• patients may end up squatting to alleviate symptoms

Question 20

Condition resulting in right to left shunting (early cyanosis) assoc with maternal diabetes

Answer 20

• transposition of great vessels

- trt with PGE to keep DA open

Question 21

Truncus arteriosis

Answer 21

• common outflow tract
• ## DO2/O2 blood mixing -> early cyanosis

Question 22

Coarctation of the aorta: two forms

Answer 22

• lower extremity cyanosis
• associated with Turner syndrome
• adult form HTN in UEX, weak pulses and LEX in LUX

Question 23

Weak peripheral pulses and orthostasis

Answer 23

• aortic stenosis

Question 24

Classic finding of ASD

Answer 24

Promenet right ventricular impulse, systolic ejection murmur, and fixed splitting of S1

Question 25

Additionally generally present in truncus arteriosis

Answer 25

• VSD

Question 26

Sinus Venarium

Answer 26

• smooth part of r atria

- derived from sinus venosus

Question 27

Newborn with high arched palpate, broad chest, widely spaced nipples, pedal edema

Answer 27

• coarctation of the aorta

Question 28

Embryology of osteium primum defect

Answer 28

• septum primum fails to fuse with endocaridal cushions

Question 29

Congenital defect assoc with rubella

Answer 29

• PDA