Cardiology Flashcards
MC birth defect
congenital heart disease
Left to Right shunts → acyanotic
the “D”s → ASD, VSD, PDA, AVSD
Right to Left shunts → cyanotic
the “T”s → ToF, TGA, TA, TA, TAPVC
obstructive lesions that cause congenital heart defects
coarctation of aorta pulmonary stensosis pulmonary atresia aortic stenosis aortic atresis (HLHS)
when there is a defect or communication between the left and right heart blood usually shunts _____
from left to right
why is cyanosis not typical in left to right shunts?
Pulmonary vascular resistance is less than systemic → increase in pulmonary blood flow occrs
Pulmonary vascular bed (after being exposed to excessive flow and pressure) undergoes vasoconstriction that becomes irreversible → increased pulmonary vascular resistance and shunt reversal
Eisenmenger Syndrome
MC type of atrial septal defect
secundum ASD → at fossa ovalis
endocardial cushion defect just above the AV valves associated with cleft mitral valve
Primum ASD
located near the SVC and often associated with anomalous pulmonary vein
Sinus venosus ASD
Atrial septal defect is often seen in
Holt-Oram Syndrome
How may large ASD present?
murmur
Treatment for Secundum ASD
heart cath to close the defect with plug like device
when in the cardiac cycle will shunting occur in ASD?
diastole
MC common congenital heart defect
Ventricular Septal Defect
Three types of VSD
membranous MC (below aortic valve)
muscular (often small and self limited)
infundibular
How will small VSD present?
loud blowing systolic murmur
How will moderate VSD present?
murmur and HF due to excessive pulmonary blood flow
Large VSD can cause ___ if not surgically closed during infancy
pulmonary hypertension
when is blood shunted with a VSD?
systole → excess blood goes directly to the lungs since RV in contracting
how are VSD surgically repaired?
patched
persistence of a normal fetal structure → commonly seen in premature infants and produces machine like murmur
Patent Ductus Arteriosus [PDA]
If an infant with PDA is cyanotic or has obstructive heart disease, what can you use to maintain the patency of PDA?
prostaglandin E
Treatment for PDA
close with coil or occluder in cath lab
Infants with PDA have continous left to right shunt but when does it increase?
systole
what patient population is atrioventricular septal defect commonly seen in?
Down Syndrome
due to failure of superior and inferior endocardial cushions to fuse and related to primum ASD
atrioventricular septal defect
when do you routinely repair AVSD?
6 months of age
deoxygenated blood gets into systemic circulation
right to left shunt
Three ways that Right to Left Shunt occurs
septal defect and obstruction to pulmonary blood flow (ToF) obligate right to left shunt (transposition of great arteries) obligate mixing (TAPVC)
cyanosis + complications (sterile or septic embolization) + hypertrophic osteoarthropathy (clubbing) and polycythemia
right to left shunt
5 “T”s of Right to Left shunts
Tetralogy of Fallot Transposition of Great Arteries Truncus Arteriosus Tricuspid Atresia Total Anomalous Pulmonary Venous Connection
Four classic features of Tetralogy of Fallot
- VSD
- obstruction right ventricular outflow (pulmonary valve and/or subpulmonic stenosis)
- Right ventricular hypertrophy on EKG
- Overriding aorta
MC cyanotic lesion → 3 or 4 year old who is squating
Tetralogy of Fallot
Severity of Tetralogy of Fallot is based on…
severity of subpulmonic stenosis
CXR reveals “boot shaped” heart
Tetralogy of Fallot
results from abnormal septation of truncal and aortopulmonary septa → atrioventricular concordance and ventriculoarterial discordance
d-TGA (transposition of great arteries)
If your patient has D-TGA, what do you hope they also have?
Having this allows the blood to mix so you aren’t circulating deoxygenated blood in the body and oxygenated blood stays circulating in the lungs
VSD
For TGA, what do you look for on fetal ultrasound?
pulmonary artery and aorta are running parallel
[normal → pulmonary artery crosses over aorta]
How do you manage newborn with TGA without VSD presenting with profound cyanosis?
palliation with prostaglandin and possibly balloon atrial septostomy
failure of separation of embryologic pulmonary artery and aorta
truncus arteriosus
100% of truncus arteriosus also have
VSD
result from unequal division of AV canal
tricuspid atresia
three things also seen with Tricuspid Atresia
ASD
VSD
small right ventricle
Name of procedure used for Tricuspid Atresia and patients with only one ventricle
Fontan Procedure
common pulmonary vein fails to connect to left atrium + ASD
total anomalous pulmonary venous connection (TAPVC)
3 types of total anomalous pulmonary venous connection
infracardiac
cardiac
supracardiac
location of coarctation of aorta that presents in infant
proximal to PDA
location of coarctation of aorta that presents in adult
paraductal or postductal
increased incidence of coarctation of aorta in patients with
Turner Syndrome
Treatment for pulmonary valve stenosis
balloon dilation → may leak and get SOB → replace valve with bovine jugular vein valve
intact ventricular septum + RV is hypoplastic + ASD is present + flow to lungs occurs through PDA or multiple aorta to pulmonary collateral vessels
pulmonary atresia
Three types of aortic stenosis
valvular
subvalvular
supravalvular
supra AS often seen in
Williams Syndrome
MC seen in hypoplastic left heart syndrome (HLHS)
Aortic atresia
benign, vibratory and low pitched murmur “groaning sound”
LLSB and radiates to aortic outflow tract
loudest at 5 months - 5/6 years
Still’s murmur
high pitch murmue that radiates all over the chest
common in babies
branch pulmonary stenosis
high frequency and blowing murmur
VSD
crunchy and medium pitched murmur
pulmonary and aortic stenosis
