Cardiac malformation, pericardial disorders Flashcards
what are atrial septal defects
defects within the atrial septum that allows for left to right flow of blood
lead to increase filling of the right side - dilated RA
what is the most common type of atrial septal defect
ostium secundum
within the mid aspect of the atrial septum
isolated anomaly
what are the types of atrial septal defect
ostium secundum
ostium primum
sinus venosus along the SVC
what genetic condition is often associated with ASDs
down syndrome
typically not genetically linked - if familiar, typically ostium secundum associated with autosomal dominant alternation
what are the typical symptoms of ASD
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
when does the patent foramen ovale typically close
within the first week of life
what does a patent foramen ovale increase the risk of
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
What is the difference between PFO and ASD
missing tissue
What are ventricalar septal defects
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
What are the VSD types
perimembranous - typically isolated cardiac abnormality, just below the LVOF
Muscular - often will spontaneously close within the lower/anterior septum
Supracristal - RVOF, below pulmonary valve
what is the presentation of VSD
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
what are the affects of VSD
increased blood to the pulmonary circulation
increased preload LV
LV hypertrophy, pulmonary over circulation
what is tetralogy of fallot hallmarked by
large ventricular septal defect
pulmonary stenosis
overriding aorta that straddles VSD
RV hypertrophy
what is the most common cause of cyanotic neonates
tetralogy of fallot
what conditions are tetralogy of fallot associated with
genetic anomaly, Digeorge syndome
down syndrome also carries increased risk
what is the pathophysiology of tetralogy of fallot
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
what are tet spells (hypercyantoic spells)
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
what is the presentation in adults with tetralogy of flow
increased erythrocyte (trying to compensate for hypoxia associated with heart defect)
clubbing
central cyanosis
arrhythmia
arthropathy
What is coarctation of the aorta
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
what is the genetic condition that coarctation of the aorta associated with
turner syndrome
also seen disproportional rate with aortic stenosis, parachute mitral valve, VSD, cerebral aneurysms
what are the effects of coarctation of the aorta
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
what are patients with coarctation of aorta at an increased risk for
HF
Hypertensive encephalopathy
Aortic dissection
Rupture (increased risk during pregnancy)
what is the pericardium
anchors the heart within the mediastinum
consists of: parietal and visceral layer
contains lubricating fluid between the layers
what is pericarditis
inflammatory disorders involving the parietal and viscueral layers of the pericardium
will cause fibrosis, loss of elasticity, decreased stretch during diastole -constrictive pericarditis
what is the pathophysiology of pericarditis
may be associated with infection or noninfectious etiology
autoimmune (SLE, RA)
meds
renal failure
what occurs with pericarditis
decreased stretch during diastole
RV will have hard time filling
evidence of RV failure
Decrease CO
SOB, particularly with exertion or when supine
what is pulsus paradoxus
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)
