Cardio

Question 1

What is the most common congenital heart disease?

Answer 1

VSD

Question 2

Describe the classifications of congenital heart disease (cyanotic and non-cyanotic)

Answer 2

NON-CYANOTIC
L-->R shunts
1. VSD
2. ASD
3. PDA
Obstructive
1. Coarctation
2. Pulmonary stenosis
3. Aortic stenosis

CYANOTIC
R-->L shunts
1. Transposition of great vessels
2. Truncus arteriosis
Obstructive
1. Tetralogy of Fallot
2. Pulmonary and tricuspid atresia

Question 3

What murmur is heart with VSD?

Answer 3

Pansytolic murmur at left sternal edge

- Louder with a smaller hole

Question 4

What is Eisenmenger’s syndrome?

Answer 4

When a left to right shunt becomes a right to left shunt

• L->R shunt –> increased blood flow into pulmonary arteries –> increased pressure in the pulmonary system –> RV hypertrophy –> eventually pressure in right heart is greater than left –> right to left shunting
• Create hypoxia through septal defect or patent FO

Question 5

Describe the cycle of ductus arteriosus

Answer 5

During gestation the DA is kept open through continued PGE2 from the placenta –> after birth (and removal of placenta) –> drop PGE2 plus the sudden oxygenation –> ductus closes
- Usually complete by 1 day, completely shut at 3 weeks

Question 6

What are the complications of VSD?

Answer 6

Increased blood flow to lungs –> increasing lung stiffness and WOB
- RV hypertrophy –> Pulmonary hypertension –> Eisenmenger’s (L–>R becomes R–>L shunt)

Question 7

What murmur is heard with ASD?

Answer 7

Fixed murmur at left sternal border

S2 splitting

Question 8

Explain the closure of the foramen ovale

Answer 8

First breath –> increased oxygen in alveoli –> arteries begin to dilate –> decreased pulmonary pressure –> decreased pressure in R heart –> oxygenated blood now flowing back into LA –> high L press and low R press –> foramen ovale snaps closed

Question 9

What is the usual cause of ASD?

Answer 9

Failure of septum secundum to fuse during FO closure

Question 10

What is a complication of untreated ASD?

Answer 10

Paradoxical embolism

- DVT can cross over to L side and cause stroke rather than PE

Question 11

What murmur is heard with a patent ductus arteriosus?

Answer 11

Continuous murmur, wide pulse pressure and bounding pulse

Question 12

How is PDA treated?

Answer 12

NSAIDs (indomethacin) - inhibit PGE2 (normally keeps DA open)

Question 13

What infection is commonly associated with PDA?

Answer 13

Congenital rubella syndrome

Question 14

What are the clinical features of coarctation of aorta?

Answer 14

High blood pressure in arms (pink), low blood pressure in legs (blue)
>20 discrepancy
Impalpable femoral arteries

Question 15

What murmur would you hear for AS? PS?

Answer 15

Ejection systolic at aortic area

Ejection systolic at pulmonary area

Question 16

What are the 4 components that make up Tetralogy of Fallot?

Answer 16

CYANOTIC: Obstructive

1. VSD (R–>L shunt)
2. Pulmonary stenosis
3. RV hypertrophy
4. Overriding aorta

Question 17

How will Tetralogy of Fallot present?

Answer 17

• Harsh ejection systolic murmur (due to RV outflow obstruction) radiating to back
• Gradually appearing cyanosis in first 6-12mo
• Hypoxic spells ‘tet spells’
  
  • children squat to increase TPR –> decreased R–>L shunt
• Clubbing

Question 18

Explain the pathophysiology of Tetralogy of Fallot

Answer 18

CYANOTIC: Obstructive
Obstruction to flow into lungs –> blood diverted through VSD –> Right to left shunt –> Reduced blood flow to lung –> cyanosis

Question 19

What is pulmonary atresia?

Answer 19

CYANOTIC: Obstructive
Malformation of pulmonary valve complete obstruction of pulmonary outflow –> total diversion of blood from RV into the aorta
- ASD or VSD may be present to shunt blood
- Cyanosis develops early

Question 20

What needs to remain open in pulmonary atresia? Why?

Answer 20

Usually have a VSD (rarely ASD - FO) PLUS

Need PDA so that blood from R heart can still reach the lungs

Question 21

What is tricuspid atresia?

Answer 21

CYANOTIC: Obstructive
Congenital absence of tricuspid valve: NO outflow from RA –> RV
ASD/VSD required to allow oxygenation and pumping
Murmur not usually heard but can be holosystolic (VSD)
Requires PGE1 to keep PDA open!

Question 22

What is truncus arteriosis?

Answer 22

CYANOTIC - R–>L shunt
1 single blood vessel comes out of RV and LV instead of pulmonary artery and aorta - receives blood from both ventricles –> passes across VSD into single arterial trunk
**VSD is always present
Holosytolic murmur from VSD

Question 23

What is the most common cause for a cyanotic baby in the first 24hrs?

Answer 23

Transposition of great vessels
*Baby becomes blue immediately after birth
Requires PGE1 urgently to keep PDA open!

Question 24

What is transposition of great vessels?

Answer 24

CYANOTIC - R–>L shunt
Failure of twisting of great vessels –> aorta attached to RV and pulmonary artery attached to LV
*Baby becomes blue immediately after birth
Has PDA, VSD, ASD

Question 25

What is the treatment for transposition of great vessels?

Answer 25

URGENT PGE1 to keep PDA open

• Can enlarge FO with catheter in first few days of life
• Arterial switch in week 1/2 of life
• 100% O2

Question 26

What are the non-cyanotic congenital heart conditions?

Answer 26

L–>R shunts

1. VSD
2. ASD
3. PDA

Obstructive

1. Coarctation
2. Pulmonary stenosis
3. Aortic stenosis

Question 27

What are the cyanotic congenital heart conditions?

Answer 27

R–>L shunts (4 T’s)

1. Transposition of great vessels
2. Truncus arteriosis

Obstructive

1. Tetralogy of Fallot
2. Pulmonary and tricuspid atresia