Cardio Final Exam Flashcards
L –> R Shunts
(Late Cyanotic)
ASD
VSD
AVSD
PDA
R –> L Shunts
Early Cyanotic
Tetralogy TGA Truncus TV Atresia TAPVR
Atrial Septal Defect
- what are the 3 types?
3 types:
- Secundum = (90%) at fossa ovalis
- Primum = (5%) adjacent to AV valves
- Sinus Venosus = (5%) near SVC entrance
What are some characteristics of Patent Foramen Ovale (vs ASD)?
- common = present in 1/3 of people
- small remnant opening
- no shunting
- associated with paradoxical emboli, decompression sickness, migraines
Features of Ventricular Septal Defect
- most occur where?
- how common?
90% occur at membranous septum
- most common congenital anomaly
- 70% assoc with other anomalies
Muscular VSD
- size?
- does it close?
- treatment?
– Defect is usually small
– Spontaneous closure by fibrous adhesions occurs in >60% of cases by 1 year of age
– Most do not need surgery
– Multiple muscular VSDs = “swiss cheese septum”
Perimembranous VSD
- size?
- does it close?
- treatment?
– Defect is usually large
– Spontaneous closure by septal TV leaflet occurs in <10% of cases
– Requires surgical closure, usually around 1 year of age
Patent Ductus Arteriosus
- features of normal closure
- PE finding (upon auscultation)
- other features
• Normal ductal closure
– Functional (~12 h)
– Structural (~3 mo)
– Delayed by prostaglandin E
– Closes later in preemies and at high altitude
• Classic physical exam finding
– Harsh, continuous, “machinery-like” murmur
• Other features
– Usually seen in isolation (90%)
– Necessary for survival in AV or PV atresia, others
Atrioventricular Septal Defect
- definition
- types
- other features
• Definition – Deficient AV septum, associated with MV and TV anomalies • Two Types – Partial:primumASD&cleftMV with MR – Complete: AVSD & common AV valve (5 leaflets) • OtherFeatures – Down syndrome (40%) with complete AVS – Needsearlysurgicalcorrection
Tetralogy of fallot
-definition and characteristics
• Most common form of cyanotic congenital heart disease
• Anteriosuperior displacement of the infundibular septum leads to
– Ventricular septal defect
– Subpulmonary stenosis
– Overriding aorta
– Right ventricular hypertrophy
• Clinical outcome depends on severity of subpulmonary stenosis.
Tetralogy of Fallot
-anatomy and physiology, PE findings
- Heart may appear boot-shaped due to right ventricular hypertrophy
- R-L shunt does not damage lungs because subpulmonary stenosis restricts pulmonary blood flow
- Pulmonary outlet does not grow with child, so effects are worse with age
- Surgery required
Transposition of the great arteries
- Definition
- Sequelae
- Types
• Definition
– Aorta arises from RV
– Pulmonary artery arises from LV
• Sequelae
–Aorta lies anterior and to the right of the pulmonary artery
– Separate pulmonary and systemic circulations
–Right ventricular hypertrophy develops
– Pulmonary hypertension develops unless pulmonary stenosis is present
• Two types
– Intact ventricular septum (65%): unstable, needs prompt surgical intervention
– With VSD (35%): stable
Truncus arteriosus
- definition
- etiology
- clinical sequelae
• Definition
– Origin of aorta & pulmonary artery from truncal artery
– Most have large VSD
• Etiology
– Developmental failure of separation of the embryologic truncus into the aorta and pulmonary artery.
• Clinical sequelae
– Mixing of blood
– Increased pulmonary blood flow & pulmonary HTN
Tricuspid atresia
- Complete occlusion of the tricuspid valve orifice
- Results from unequal division of the AV canal – mitral valve is enlarged
- Needs coexisting ASD/PFO and VSD
- Causes right ventricular hypoplasia
- Symptomatic with high mortality
Total anomalous pulmonary venous return
- Pulmonary veins do not directly drain into left atrium; left atrial hypoplasia
- Instead, they connect via left innominate vein or coronary sinus
- ASD/PFO allows oxygenated blood to enter systemic circulation
- Occurs when common pulmonary vein fails to develop or regresses
Aortic coarctation
- definition
- types
- clinical presentation
• Definition
– Constriction/narrowing of aorta
• Two types
– Preductal/infantile
– Tubular hypoplasia
with PDA
– Postductal/adult
– Ridgelike infolding at ligament without PDA
• Clinical presentation
– Bicuspid AV (50%)
– Preductal
– Lower body cyanosis
– Requires surgery in neonatal period
– Postductal
– Symptoms depend on degree of narrowing
– Surgically treatable HTN, upper > lower
– Rib notching (CXR)Pulmonary Stenosis
- Definition
- Isolated PV stenosis
- other type of pathology…what is it? and describe?
• Definition – Pulmonary valve obstruction due to hypoplasia, dysplasia, or abnormal number of cusps • Isolated PV stenosis – RV dilatation & hypertrophy – Post-stenotic injury to PA – May be asymptomatic until adulthood • PV atresia with intact VS – Hypoplastic RV and TV – PDA needed to get blood to lungs
Aortic Stenosis
- Definition
- characteristics
• Definition – Aortic valve obstruction due to hypoplasia, dysplasia, or abnormal number of cusps • Isolated AV stenosis (80%) – LV hypertrophy and LA dilatation – AS may range from mild to critical – Systolic murmur
AS- Hypoplastic Left Heart Syndrome
• Aortic valve atresia with intact VS
– Hypoplastic mitral valve and left ventricle
– Dependent on PDA for survival
– Requires staged surgical correction
Ebstein’s Anomaly
- Definition
- Secondary effects
- Other Features
• Definition – Inferiorly displaced and adherent septal and posterior leaflets – Redundant anterior leaflet – Dilated annulus with TR • Secondary effects – RV and RA dilatation • Other features – Arrhythmias, including WPW syndrome – May be asymptomatic until adulthood
Morphology of HTN
- Large/medium arteries
- small arteries/arterioles
• Large/medium arteries - Accelerated atherogenesis - Degenerative changes in vascular walls - Increased risk of aortic dissection & cerebrovascular hemorrhage • Small arteries/arterioles - Hyaline arteriolosclerosis - Hyperplastic arteriolosclerosis
Hylaine Arteriolosclerosis
• Elderly patients
• Similar change in diabetics (microangiopathy)
• “Benign” nephrosclerosis
• Homogeneous pink, thickening of vessels with narrowing of lumen
▫ Leakage of plasma across endothelium due to HTN
▫ Excess matrix production by the smooth muscle cells occurs secondarily

Hyperplastic arteriolosclerosis
– Characteristic of malignant hypertension
– Onion-skinning, concentric laminated walls with luminal narrowing
• Due to reduplicated basement membrane and smooth muscle cells
Malignant HTN
– Necrotizing arteriolitis: term used when these changes are associated with fibrinoid necrosis
