Cardiology 8.3: Congenital heart defects Flashcards
What is the most common congenital heart defect?What causes it?
VSDfetal alcohol syndrome
VSD: A left to right or right to left shunt? Why?
left to right bc the pressure in the systemic circuit is greater than going back to the RV, so it does
large VSD –> increase in blood flow to pulm circuit –> _____ –> Eisenmenger syndrome –> cyanosis
pulm HTN
Why do pts with Eisenmenger Syndrome get RVH?
increased pressure in pulmonary vascular circuit
Why do pts with Eisenmenger Syndrome get polycythemia?
deoxygenated blood in the systemic circuit causes hypoxemia –> epo released
Why do pts with Eisenmenger Syndrome get clubbing?
systemic cyanosis
What is the most common type of ASD?
ostium secundum
Which ASD is associated with Down Syndrome?
ostium primum
What direction is the blood shunted in ASD?
L to R
What heart sounds are heard with ASD?
split S2
What is a complication of ASD?
paradoxical emboli
PDA is associated with ____.
congenital rubella
____ is associated with congenital rubella.
PDA
The ductus arteriosus connects the ____ to the _____.
pulmonary artery to the aorta
The _____ connects the pulmonary artery to the aorta in fetal life.
ductus arteriosus
Which way does blood flow in the fetal ductus arteriosus?
from L to R (aorta to pulm artery)
When will a PDA present? How?
later in life with lower extremity edema
What is the murmur for PDA?
machine-like holosystolic murmur
Why is the cyanosis in PDA in the lower extremities and not the upper?
bc the ductus arteriosus connects to the aorta after the aortic arch and its branches
What is the tx for PDA? How does it work?
indomethacindecreases PGE
What keeeeeps the PDA open?
prostaglandin E (PGE)
Which direction is the blood shunted in Tetrology of Fallot?
R to L
How and when does Tetrology of Fallot present?
cyanosis at birth (early)
Dx?Juv pt squats after running around
Tetrology of Fallot
Why does squatting help Tetrology of Fallot pts feel better?
it increases arterial vascular resistance, preventing blood from entering the aorta (decreased shunting) and pushes it instead into the lungs (increased afterload)
Dx?boot-shaped heart on CXR
Tetrology of Fallot
What is the tx for transposition of the great vessels?
create a shuntex: keep PDA open with PGE
What causes transposition of the great vessels?
maternal diabetes
How does transposition of the great vessels present?
early cyanosis
What problem in embryology causes truncus arteriosus?
the truncus fails to divide
How do pts with truncus arteriosus present?
early cyanosis
What is the problem in truncus arteriosus?
there is not separation of the pulm artery and aorta- there’s just one huge vessel coming off the ventricles
What causes tricuspid atresia?
failure of the tricuspid valve orifice to develop (and therefore the R ventricle, too)
What other problem is associated with tricuspid atresia?
ASD
How do tricuspid atresia pts present?
early cyanosis
What is coarctation of the aorta?
narrowing of the aorta
The infantile form of coarctation of the aorta is associated with _____.
a PDA (Turner’s Syndrome)
Where is an infantile coarctation of the aorta found?
distal to the aortic arch but proximal to the PDA
How does infantile coarctaton of the aorta present?
as lower extremity cyanosis
What heart findings are present in Turner syndrome?
infantile coarctation of the aortabicuspid aortic valvePDA
How does adult form coarctation of the aorta present?
HTN in upper extremities and hypotension in lower extremities
What is the adult form of coarctation of the aorta associated with?
bicuspid aortic valve
What is the CXR finding for the adult form of coarctation of the aorta?
notched ribs
