Cardiac Patho

Question 1

Name the left to right shunts and their impact on blood flow.

Answer 1

1. ASD
2. VSD
3. PDA
   - left to right shunt inc pulmonary flow and can lead to pulm HTN
   - sometimes leads to tardive cyanosis but not directly

Question 2

Which defect is most commonly diagnosed at birth?

Answer 2

VSD

Question 3

Which defect is most commonly diagnosed in adulthood?

Answer 3

ASD

Question 4

Describe ASD

Answer 4

-foramen ovale doesn’t close at birth
-higher pressure in LA flows to lower pressure in RA = shunting which causes RA and RV enlargement (inc volume)
-leads to pulm HTN and reverse shunt to R to L
(R to L shunt causes cyanosis and CHF)
-associated w/ MITRAL REGURGE
-murmur @ LSB b/n 2nd/3rd ICS

Question 5

Describe VSD

Answer 5

• many close spontaneously in childhood
• can cause severe L to R > pulm HTN and CHF and infective endocarditis
• surgery for large VSD

Question 6

Describe PDA

Answer 6

• normally closes at birth d/t inc O2, dec pulm resistance, and dec PGE2
• doesn’t close and causes L (aorta) to R (PA) shunting
• l/t pulm HTN and cyanosis (mixed blood) and CHF (big lesions), and infective endocarditis

Question 7

What effect does R to L shunt have?

Answer 7

• dec pulm flow = cyanosis at birth

- mixing of deoxy blood into circulation

Question 8

What is the most common cause of cyanosis at birth? What does it do?

Answer 8

-TOF causes R to L shunting
= dec pulm flow and inc aortic flow
*all depending on degree of RV obstruction

Question 9

What are the 4 components of TOF?

Answer 9

1. overriding aortic root (over VSD)
2. VSD
3. RVH
4. RV obstruction (pulm stenosis)

Question 10

What occurs d/t chronic cyanosis?

Answer 10

• clubbing
• erythrocytosis
• inc bl viscosity
• inf endocarditis
• systemic emboli
• brain abcess

Question 11

What is another R to L shunt?

Answer 11

• transposition of great vessels
• aorta arises from RV
• PA from LV
• occurs with ASD, VSD, or PDA if pt survives after birth
• causes cyanosis

Question 12

What is COA? What types? Which is more common?

Answer 12

• stenosis (coactation) of the aorta
• preductal (infants) or postductal (children/young adults) r/t ductus arteriosus
• postductal is most common
• male more than female

Question 13

What path effect does COA have?

Answer 13

-inc pressure before COA and dec pressure after COA

Question 14

What common defect occurs w/ COA?

Answer 14

-50% have bicuspid aortic valve; mostly postductal

Question 15

Describe preductal COA.

Answer 15

• RV act as pump sending DEoxy blood thru DA into aorta below the COA
• cyanosis of LE
• weak femoral pulse
• CHF
• surgery to survive

Question 16

Describe postductal COA.

Answer 16

• RV cannot pump enough thru DA
• systolic pressure inc in AA/LV and dec in aorta after COA
• collaterals develop into aorta to bypass COA and supply LE
• dec renal perfusion = activates RAAS
• HIGH pressure in UE, LOW pressure in LE
• intermittent claudication can occur
• can l/t LVH and HF
• surgery