Cardiac malformation, pericardial disorders

Question 1

what are atrial septal defects

Answer 1

defects within the atrial septum that allows for left to right flow of blood
lead to increase filling of the right side - dilated RA

Question 2

what is the most common type of atrial septal defect

Answer 2

ostium secundum
within the mid aspect of the atrial septum
isolated anomaly

Question 3

what are the types of atrial septal defect

Answer 3

ostium secundum
ostium primum
sinus venosus along the SVC

Question 4

what genetic condition is often associated with ASDs

Answer 4

down syndrome
typically not genetically linked - if familiar, typically ostium secundum associated with autosomal dominant alternation

Question 5

what are the typical symptoms of ASD

Answer 5

right sided heart enlargement
afib
fatigue
exertional SOB
pulmonary outflow murmur, splitting S2
murmur may be louder, and involve diastolic tricuspid murmur if large defect

Question 6

when does the patent foramen ovale typically close

Answer 6

within the first week of life

Question 7

what does a patent foramen ovale increase the risk of

Answer 7

cyptogenic stroke
paradoxical embolism: venous to arterial emboli
- will occur if the RA pressure > LA
- this can occur during normal circumstances that increase venous return

Question 8

What is the difference between PFO and ASD

Answer 8

missing tissue

Question 9

What are ventricalar septal defects

Answer 9

allows for inappropriate passage of blood across the ventricular septum
most commonly will produce L to right shunt
common at birth and typically spontaneously close

Question 10

What are the VSD types

Answer 10

perimembranous - typically isolated cardiac abnormality, just below the LVOF
Muscular - often will spontaneously close within the lower/anterior septum
Supracristal - RVOF, below pulmonary valve

Question 11

what is the presentation of VSD

Answer 11

more noticeable here than ASD
Holosystolic loud or palpable murmur
moderate left to right shunts will lead to LV overload and pulmonary hypertension
large shunts will have murmur and may lead to HF, failure to thrive as infant - may see pulmonary HTN

Question 12

what are the affects of VSD

Answer 12

increased blood to the pulmonary circulation
increased preload LV
LV hypertrophy, pulmonary over circulation

Question 13

what is tetralogy of fallot hallmarked by

Answer 13

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

Question 14

what is the most common cause of cyanotic neonates

Answer 14

tetralogy of fallot

Question 15

what conditions are tetralogy of fallot associated with

Answer 15

genetic anomaly, Digeorge syndome
down syndrome also carries increased risk

Question 16

what is the pathophysiology of tetralogy of fallot

Answer 16

infundibular septum deviates anterior and cephalad during development
this will push the outflow tracts so that the pulmonary is being partially obstructed by the overriding aortic root
RV hypertrophy associated with RV pushing against the outflow obstruction as well as VSD

tend to be singular and large defects

Question 17

what are tet spells (hypercyantoic spells)

Answer 17

occurs with tetralogy of fallot at times when there is increased obstruction of RV outflow tract
typically occurs when kiddo is upset, agitated, feeding, straining
will have progressive cyanosis, be consolable and have deep and rapid breathing pattern

Question 18

what is the presentation in adults with tetralogy of flow

Answer 18

increased erythrocyte (trying to compensate for hypoxia associated with heart defect)
clubbing
central cyanosis
arrhythmia
arthropathy

Question 19

What is coarctation of the aorta

Answer 19

narrowing of aorta, typically distal to the subclavian artery
near the ductus arteriosus
leads to increased pressure proximal to the lesion and hypotension distal to it - increased outflow pressure will lead to early onset HF

Question 20

what is the genetic condition that coarctation of the aorta associated with

Answer 20

turner syndrome
also seen disproportional rate with aortic stenosis, parachute mitral valve, VSD, cerebral aneurysms

Question 21

what are the effects of coarctation of the aorta

Answer 21

narrowing will cause increased pressure on the LV
decreased ability to exert themselves
HTN in UE > LE
- HA, chest pain, leg weakness, cool extremities, leg claudication, radial to femoral pulse delay, systolic or continuous murmur

Question 22

what are patients with coarctation of aorta at an increased risk for

Answer 22

HF
Hypertensive encephalopathy
Aortic dissection
Rupture (increased risk during pregnancy)

Question 23

what is the pericardium

Answer 23

anchors the heart within the mediastinum
consists of: parietal and visceral layer
contains lubricating fluid between the layers

Question 24

what is pericarditis

Answer 24

inflammatory disorders involving the parietal and viscueral layers of the pericardium
will cause fibrosis, loss of elasticity, decreased stretch during diastole -constrictive pericarditis

Question 25

what is the pathophysiology of pericarditis

Answer 25

may be associated with infection or noninfectious etiology
autoimmune (SLE, RA)
meds
renal failure

Question 26

what occurs with pericarditis

Answer 26

decreased stretch during diastole
RV will have hard time filling
evidence of RV failure
Decrease CO
SOB, particularly with exertion or when supine

Question 27

what is pulsus paradoxus

Answer 27

normally when we inhale, the pressure within the thoracic cavity decreases
during inspiration the negative pressure will pull blood from the venous system to increase how much filling occurs within the RV
may have slight redistribution of pressure - septal bowing into the LV (allowing more filling to the RV)