Cardiology Flashcards
embryology is not included
most congenital heart defects are a result of problems with ..
either septation, rotation, or migration
two classification of congenital heart dz
- acyanotic (left to right shunt)
2. cyanotic (right to left shunt)
2 broad categories of cyanotic CHD
- intra-cardiac defects and obstruction to pulmonary flow
2. admixture of pulmonary and systemic venous return
Physical findings for CHD
1.cyanosis (need 5 mg/dl of de ox blood
2. if anemic, it might be hidden
3. check both upper and lower extremities saturation
4. arterial pulse - absent, bounding, delayed
5-heart sound-S2 split or not, fixed split, murmurs
innocent murmur
- Still’s murmur is a musical/vibratory systolic LSB, not in back, decreased w/expiration/standing
- Physiologic peripheral pulmonic stenosis which is a soft harsh SEM best heard in axillae bilaterally and disappears by 12 MONTHS
- venous hum
Phyisiologic peripheral pulmonic stenosis is a soft harsh SEM best heard in
axillae BILATERALLY
venous hum is a/w
innocent murmur
…is a musical/vibratory systolic LSB, not in back, decreased w/expiration/standing
Still’s murmur
List acyanotic CHD.
PDA, ASD, VSD, atrioventricular canal, coarctation of aorta
most common of all CHD
VSD
murmur in VSD
holosystolic @LLSB, loud if restrictive
PE findings in large VSDs
failure to thrive, tachypnea, GERD
most common defect in down syndrome
VSD
lab findings in VSD
ECG: LVH
CXR: cardiomegaly, increased pulmonary vascular markings
Echo: location, size. pressure gradient, other defects
Cath: if unclear of size and sx , indications for surgery
VSD medical managements
diuretic, ACE, digoxin
indication for surgery in VSD
- unmanageable HF
- failure to med mostly due to failure to thrive, URI, pneumonia
- shunt greater than 1.5-2 w/wo sx
most common type of ASD
secundum ASD
2nd most common CHD
ASD
risk of paradoxical emboli is a/w
ASD
sx of ASD
usually asx, fatigue, palpitation, exercise intolerance
never leave ASD open in … pts
young girls approaching puberty
development of eisnmenger’s is a risk for what CHD
ASD
synonyms of Atrioventricular Septal Defects (AVSD)
endocardial cushion defects, atrioventricular canal defects (AVCD)
types of AVSD
- complete : a.common AV valve b. primum ASD c. inlet VSD
2. Partial: MOST FREQUENT FORM = primum ASD +cleft anterior MV leaflet
most common prenatal dx of CHD
AVSD
AVSD is very common with …what trisomy
21 -down syndrome —usually the complete form
AVSD with Tetralogy almost unique to what trisomy
21-down syndrome
complete AVSD usually results in
PA HTN, CHF
complete AVSD vs Partial AVSD
Complete: Large ASD & Large VSD
Partial: Large ASD & no VSD
repair of partial VSD at what age?
delayed until after 18-24 mos old
problems a/w partial VSD
subaortic stenosis and LAVV regurgitation or stenosis
PDA leads to enlarged …
RA, RV, LV
PDA signs and sx
Continuous machinery murmur, wide pulse pressure, hyperdynamic precordium
PDA closure approaches
medical: indomethacin, ibuprofen
catheter based: coil, device
surgical: left thoractomy
three surgical method for closure of PDA
- clip-premees
- ligate-neonates, infants, young children
- divide and oversew-toddlers and older
coarctation of aorta
juxtaductal just distal or at left subclavian artery
signs and sx a/w coarctation of aorta
proximal hypertension-pressure differential
murmur- systolic, LUSB and left interscapular may be continuous
murmur in coarctation of aorta
systolic, LUSB and left interscapular may be continuous
coarctation of aorta is a/w what syndrome
turner’s syndrome
presentation of coarctation of aorta in infants
irritability, tachypnea, poor feeding, FTT, CHF
presentation of coarctation of aorta in older children and teens
HA, nosebleed, absent/diminished femoral pulses, unexplained HTN
rib-notching is a/w
coarctation of aorta
lab findings in coarctation of aorta
ECG: LVH
CXR: cardiomegaly, rib-notching (takes several years to develop)
Echo: useful but difficult to visualize but diagnostic
CT-angio/MRA : gold standard
gold standard dx for coarctation of aorta
CT-angio/MRA
tx of coarctation of aorta
surgical (stent is reserved for recurrent coarctations)
cyanotic CHD
truncus arteriosus, transposition, tetralogy of fallot, TAPVR
truncus arteriosus
- common truncus-failure to septate into aorta and pulmonary artery
- large VSD with right to left shunt
- CHF with diastolic runoff
DiGeorge syndrome is a/w
truncus arteriosus
when to repair truncus arteriosus?
first 2 weeks of life
transposition of great vessels (dTGA)
aorta and PA did not rotate
transposition of great vessels (dTGA)
cyanotic, coronary anomalies,
PGE started BAS performed - need adequate mixing
gold standard for dTGA repair
arterial switch operation-true anatomic repair done in first 2 weeks of life
“egg on a string appearance “ on CXR is a/w
dTGA
tetralogy of fallot
- Right Ventricular Outflow Tract obstruction -infundibular often with valvar and supravalvur stenosis
- VSD
- overriding aorta
- RVH
when to fix TOF?
by 3-6 months or sooner if blue
TAPVR
Total Anomalous Pulmonary Venous Connection
most common cyanotic heart anomaly
TOF
murmur in TOF
crescendo-decrescendo holosystolic at LSB radiating to back
murmur in d-TGA
systolic if associated VSD
cyanosis that alleviated with squatting is a/w
TOF
differences btw arterial pulses and BP in UE and LE is pathognomonic for …
coarctation of aorta
boot shaped heart (coeur en sabot) is a/w
TOF
most common site of coarctation of aorta
ligamentum arteriosum
wide fixed split SD is a/w
ASD
loud S2 is a/w
dTGA
