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Cardio > Cardiopatii Congenitale > Flashcards

Cardiopatii Congenitale Flashcards

1
Q

Etiologie cardiop cong

A 
De mediu:
Alcool-dsv
Cocaina 
Litiu-tricuspida
Aco 3lunininloc cu heparina
Thalidominde
Rubeola-dsa
Tixoplasmoza
Carbamazepina
Benzodiazepine
Aport scazut de folat

De genetica-risc 4-10%

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2
Q

Sunt stanga dreapta

A

Sange oxigenat trece degeaba iar in curc oulmonara
Hiperflyx pulmonar
Qp/qs>1

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3
Q

Sunt dreapta stanga

A

Sange neoxigenat contamineaza circulatia sistemica

Hipoperfuzie pulmonara qp/qs<1

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4
Q

Consecinte cpc

A 
Ic
Cuanoza
Policitemie
Embolii cerebrale
Endocardita
Criza hipoxica
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5
Q

Dsa

A

Sunt stanga dreapta
Vasculopatie pulmonara
Tipuri: ostium primum, secundum, sinus venos

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6
Q

Manifestari dsa

A

Asimptomatic
Fia
Eisenmenger

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7
Q

Clinic dsa

A 
Dispnee
Impuls vd crescut
Z2 dedublat fix!!!!!!
Brd incomplet
Ax dreapta
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8
Q

Tratament dsa

A

Operatie
Device ocluziv
Nu profilaxie endocardita

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9
Q

Dsv tipuri

A

Perimembranos
Muscular-svaiter
Canal av
Infundibular

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10
Q

Dsv fizpat

A

Sunt dr sta
Flux pulm crescut
Htp

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11
Q

Forme clinice dsv

A

Mic boala roger
Mare cu rez pulm normala
Mare cu rez pulm credcuta si inversare sunt

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12
Q

Cardiopatii congenitale

A

Boli orez de la nastere dar descoperite oricand dupa

Blocarea in embriogeneza a unor struct la stadiul fetal sau embrionar

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13
Q

Prevalenta cc

A

4-50/1000

Subestimata prin avorturi spontane si feti morti

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14
Q

Embriogeneza

A

Formare tub cardiac-embrionul se curbeaza se leaga emisferele dorsale pe mijloc si se formeaza un tub-tu endocardic(in spate coloana vert intre ele intestinul)

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15
Q

Tub cardiac

A 
Sinus venos
Atriu comun
Ventricul comun
Bulb cardiac=>tract de ejectie
Trunchi arterial

Se pliaza ca sa incapa
2 zone cardiogene din mezodermul splahbic ventral

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16
Q

Dc apare septum secundum

A

Ptc septum primum actioneaza ca o valva

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17
Q

Fosa ovalis

A

Zona lipsa din septul secundum acoperita de septum primum

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18
Q

Foramen ovale

A

Orificiul in fosa ovalis mic canal

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19
Q

Septum primuv vs ostium primum

A

Sept vs deschidere

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20
Q

Curculatie fetala

A

Placenta=>vena ombilicala(lig rotund)=>sange o2=>ad
1 vd=>art pulm=>nu merge in plaman ptc rez pul e f mare=> canal arterial=>aorta

2foramen ovale=>as=>vs=>aorta

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21
Q

Analiza anatomica secventiala

A

Atriuc ventr, artere mari
Cpc sunt rezultatul erorii de aliniere a dif segmente
=>
Imp fixiopatologic, hemodinamic, dirijare aport chirurgical

Concordan discordant iesire dubla iesire unica(truncus arteriosus atrezie pulm, atrezie aortica)9

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22
Q

Fiziopatologie boli cond

A

Circulatie sistemica si pulmonara sunt in serie

Dubit pulm=debit aortic

Pres vd=1/4-1/5 di ores vs (diferenta de rezistenta vasculara)

Rezistenta vasculara depinde de prop anatomo fct ale arterioleleor

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23
Q

Sunt stanga dr

A

Intra sange oxigenat in circ pulm
Qp/qs>1
(Din vs sau va in vd sau vd)
Cand qp/qs>1,5 il operez

24
Q

Sunt dr stanga

A

Sabge neoxigenat in corp
Cianoza
Qp/qs<1

Majoritatea bolilor evolueaza spre ea

25
Q

Boli necianogene

A

Dsv dsa pca dsav

Sao sp coao

26
Q

Cianogene

A

Terralogie fallot(vasc pulm scazuta)

Transp de vase mari si trunchi arterial conun (vasc pulm crescuta)

27
Q

Consecinte cardiopatii comgenitale

A

Ic

Cianoza(hb redusa>3mg/dl) sunt dr st la efort

Policitemie(risc tromboza) in bolile cianogene creste compensator hemoglobina

Embolii cerebrale paradoxala

Endocardita(nu in dsa)

Criza hipoxica(squatting)

28
Q

Dccse acc cianoza la efort

A

Rez vasc perrif scade la efort prin vasodil in muschi
Daca scade rez vasc in stanga o sa fie mai usor sa intre mai mult sange neox din dr
La squating inchide vasele din pic si scade rez vasc perif

29
Q

Dsa

A

Duce la dilatarea cavitatilor drepte si ap
Sunt st dreapta
Apare tardiv vasculopatie pulmonara

Ostium primum (langa valvele av)
Ostium secundum(in mij sept ia)
Sinus venos(langa cave) +-vene pulm aberante

Apare mai des la femei si nu trb conf cu foramen ovale parent care i mic si oblic si e un tubulet

30
Q

Dsa clinic

A

Asimptomatic
Fia(prin dilatare cav drepte si stangi)
S eisenmenger

Dispnee , infectii
(Ca e f greu de extins datorita hipervascularizatiei pulm)
Impuls vd crescut
Z2 dedublat fix(in focar pulm), ss pulm(dat de debitul mare care trece prin valva pulm), rt
Brd incomplet, ax la dr
Cardiomegalie, vasc pulm ceescuta-vezi mantaua(daca brusc n o mai vezi ins ca s a inversat suntul) a pulm proemineneta,
La eco se vede defectul, suntul, raport debite

La cateterism so2 mult in ad

31
Q

Umbrela dubla

A

Tratament dsa prin cateterism
2umbrele sa baga inchise
Se face la secundum pt ai nevoie de sept de care sa se prinda

32
Q

Dsav

A

=Canal av
Dsa tip op+dsv+valva av comuna

Ca si cum e un v mare si un a mare

33
Q

Dsv fizpat

A

Nu cavitatile drepte sunt dilatate, chit ca e sunt st dreapta
Ideea e ca artera oulm e f aproape de defect si intra repede sangele acolo=>plaman=> se intoarce prin vena pulm=>as=> se dilata cavitatile stangi

34
Q

Dsv clasif

A

Perimembranos-spre valve, mai des
Muscular-spre apex, svaiter, se inchide spontan ca creste muschiu

Canal av, inlet-pe langa valve av
Outlet=infundibular-se asociaza cu propaps de valva aortica si prob la la aorta

35
Q

Dsv severitate hemodinamica dep de

A

Marime dsv
Rezistenta pulmonara arteriolara(cu cat pres e mai mare cu atat suntul e mai mic)
Prezenta obstructiei la niv tractului de ejectie vd(creste pres)

36
Q

Forme clinice dsv

A

Mic=boala roger(asimpt, suflu holosistolic parasternal stang f intens cu iradiere in spita de roata peste tit)dif de pres f mare dar nu l afecteaza hemodinamic

Mare(nonrestructiv) cu rez pulm normala

Mare cu rez pulmonara crescuta si inversare sunt(nu mai ai dc sa l operezi ca arteriorele pulmonare sunt f afectate deja)-eisenmenger

37
Q

Dsv mare cu rez pulm normala

A

Dispnee infectii ic

Impuls apical hiperdinamic si deplasat(vs marit)

Suflu sustolic si suflu diastolic mitral(prin fkux crescut)

Hvs

Cardiomegalie(vs) si vasc crescuta pulm
Eco se vede defectul

Cateterusm sao2 crescut in vd, rez pulm n sub 7 wood

38
Q

Dsv mare cu rez pulmcresvuta(eisenmenger)

A

Boala vasculara pulmonara

Creste pres in artera pulm, hipertrofie medie, obliterare
Cianoza policitemie reactiva, deg hipocratice
Unda a crescuta (atriu drept)-ptc o sa se hipertrofieze vd la un mom dat si se hipertrofiaza si ad reactuv
Z4
Z2 accentaut+-reg pulm sau tricuspidiana
La eco se vede inversarea suntului
Z2 acc(se inchid cu putere valvele)
Ekg hvs si hvd
Daca plrez pulm e fixa >7 n ai ce sa i mai faci
LA RX ARTERE PULM CRESCUTE CU VASC PULM SCAZUTA

39
Q

Persistenta canal arterial

A

Incarcare de volum cavitati stangi si curc pulb(ca la dsv)
Ao=>ap=>vp=>as=>vs=>ao
Depinde de marimea defectului si dif de pres ao ap

40
Q

Pers canal art ckinic

A

Asimpt
Ic
Eisenmenger(asta apare cand e pres crescuta in artera pulmonara)=>cianoza mb inf; sangele neoxigentat trece in aorta dar sub energenta subclaviei deci bratiele si capul sunt vasc ok, picioarele nu

41
Q

Pers can art clinic

A 
Puls amplu tad scazuta
Ss si sd (continuu) de masinarie subvlavicular stang
Hvs
Cardiomegalie
Vasc pulm crescuta
Dilatare aorta si ap
42
Q

Tratament pers canal

A

La prematuri e deschis mereu si ii dau indometacin iv(anti prostaglandin)

Chir
Cateterism

43
Q

Coarct aorta

A

Apare fix in dreptul ductului arterial ca un tesut ductal
In tendinta de inchidere apare o restrictie care la adult e ca o obstr sub clavie
Inainte si dupa e dilatata aorta

44
Q

Coarct aorta clinic

A

Ta mare la brate ca i pres mare inainte de stenoza (si hvs)
Ta mica la picioare(puls femural absent)!!!!!!!
Se asociaza cu bicuspidie aorta si anervrisme cerebrale

45
Q

Ouls femural absent

A

Boala art periferica nasoala
Coarct aorta
Sdr leriche

46
Q

Coarc aorta clinic

A

Suflu sistolic posteror! Sp 4 stang(ca aorta desc e posterior)
Rx semnul cifrei 3!(dilatare subclavie stanga), erodare coaste
Hvs

Eco gradient de ores unaunte si dupa stenoza

47
Q

Coarct aorta trat

A

Prostaglandina

Chir dilatare balon

48
Q

Stenoza pulm

La fete tinere

A

Hvd si had concentruca
Debit cardiac scazut??????
Dilatatie poststenoza ap
Vascularizatie pulm redusa

49
Q

Stenoza aortica

A

Subvalvular(doafragn sau fibromusc)
Valvular(bicuspida)
Supravalvular->retard mintal

50
Q

Tetralogia fallot

A

Dsv
Aorta calare pe sept iv
St pulm
Hvd

Sunt dr stanga dependent de rez sist si pulm
Presiunea crescuta din vd e data direct de obstrusctia tractului de ejectie pulmonar
E dsv cu malaliniere si hv

51
Q

Hypoxic spell

A

Criza asfixica
Apare cand se contracta mai tare stenoza pulm
Cord in sabot

52
Q

Tratament fallot

A

Chir
Nu are voie efort
Profixaie endocardita
In criza betabloc o2 morfina

53
Q

Dsv fiziopat

A

Sunt st dr
Flux pulm crscut cu dilatare ap
Htp

Sdr eisenberg frecveny

54
Q

Dsv sechele

A

Sunt rezidual
Htp
Reg aortica
Disf vd sau vs

Ex ventr
Aritmii vebtr
Bav

55
Q

Clinic fallot

A

Dispnee
Cianoza policitemie hipocratice
Impuls vd acc

Ss pulm, z2 unic
Ekg hvd

Rx cord in sabot(hvd), ap scazut, Vasc pulm scazut

Cate pvd=pvs, o2 aorta scazut

Eco: dsv, ao calare gradient vd(arata gradul stenozei)

Cardio (25 decks)

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