CHD

Question 1

End stage L->R shunting in ASD

Management

Answer 1

pulmonary hypertension, RV failure, and Eisenmenger syndrome

Define structure first with imaging including MRI, then RHC

Question 2

CI for ASD closure

Answer 2

Severe pulmonary arterial hypertension

Question 3

PFO sequalae

Answer 3

stroke, migraine, platypnea-orthodeoxia, or provoked exercise desaturation
No or minimal shunting

Question 4

Anomalous coronary artery from opposite sinus

Left from right
Right from left+ ischemia or VT

Interarterial

Answer 4

High risk of SCD, Slit like orifice of ostium

Surgery

between aorta and pulm artery

Question 5

Screening of first degree relatives

Answer 5

Bicuspid aortic valve

familial form of thoracic aortic aneurysm and dissection

Question 6

Young woman with a bicuspid valve

Answer 6

Turner syndrome (XO)- short stature, a webbed neck, lymphedema, and premature ovarian failure.

Get CTA/ MRA to rule out coarctation -> CTA of head if there is coarctation

Question 7

ASD closure indicated in

Answer 7

symptomatic patients with a left-to-right shunt, pulmonary vascular resistance <1/3 of systemic vascular resistance, pulmonary arterial systolic pressure (PASP) of <50% systemic, and a large shunt (Qp:Qs >1.5

Question 8

Loud murmur equals

Answer 8

High gradient- restrictive

Question 9

Coarct echo

Answer 9

Diastolic forward flow in the abdominal aorta

Question 10

Congenital abnormalities with syndromes: 
Noonan 
Holt-Oram 
DiGeorge 
William
Trisomy 21

Answer 10

pulmonary stenosis 
atrial septal defects, 
tetralogy of Fallot
supra aortic stenosis
AV canal defect (AV valves at same levels, VSD, ASD)

Question 11

VSD management

Small with no significant shunt

Indications for surgery

Answer 11

Surveillance q 24 hrs

symptoms,
left heart enlargement from a volume overload (in adults this means evidence of at least a 1.5:1 shunt and enlarged left ventricle and left atrium),
pulmonary hypertension (as long as the pulmonary arterial systolic pressure is <50% systemic and the pulmonary vascular resistance is <1/3 systemic vascular resistance),
endocarditis

Question 12

Tetralogy of fallot

Answer 12

VSD, overriding aorta, right ventricular hypertrophy, and outlet obstruction.

Question 13

Early systolic click

Mid systolic click

Answer 13

Bicuspid valve

MVP

Question 14

Right heart enlargement without ASD

Answer 14

partial anomalous pulmonary venous return, sinus venosus defect, or unroofed coronary sinus.

Question 15

Ebstein anomaly

arrhythmia

Answer 15

apical displacement of the posterior/septal leaflet >20 mm (>8 mm/m2), and the presence of a redundant elongated anterior tricuspid valve leaflet-loud click-sail sound-billowing anterior leaflet

WPW

Question 16

platypnea-orthodeoxia syndrome (POS

Causes

Answer 16

dyspnea and hypoxemia in the upright position that resolve when lying supine

(PFO), atrial septal defect, or atrial septal aneurysm
ILD, hepatopulmonary syndrome, and pulmonary arteriovenous malformations.

Question 17

(bifid uvula, thin and velvety skin, easy bruising)

translucent skin, dystrophic scars, intestinal rupture)

Answer 17

Loeys-Dietz syndrome

Ehlers-Danlos syndrome

Question 18

Coarctation surgery follow up

Restenosis

Answer 18

Cardiac MRI or CTA every 3-5 years in asymptomatic patients

lower extremity blood pressure difference is >20 mm Hg, there is significant radiofemoral delay, and/or claudication

Question 19

Chronically large RV in young person

Answer 19

Look for shunting and Partial anomalous pulmonary venous return with echo, then cardiac MRI

Question 20

Holosystolic murmur+ palpable thrill

Answer 20

VSD. The smaller, the louder

Question 21

Fix coarctation if

Answer 21

CoA gradient >20 mm Hg, radiologic evidence of clinically significant collateral flow, systemic hypertension attributable to CoA, or heart failure attributable to CoA

Stent preferred over balloon angioplasty

Question 22

Tetralogy of fallot associated with

ICD if

Answer 22

Atrial and ventricular arrhythmias, increased in middle age

LV systolic or diastolic dysfunction, NSVT, QRS duration ≥180 msec, extensive RV scarring, or inducible sustained ventricular tachycardia at electrophysiologic study

Question 23

Differential cyanosis (toes, not fingers)

Answer 23

PDA (shunt is distal to subclavian arteries)

Question 24

Eisenmenger’s syndrome complications

Answer 24

secondary erythrocytosis, thromboembolic events, cerebrovascular complications (stroke and brain abscesses), hyper viscosity syndrome, hypertrophic osteoarthropathy, and renal dysfunction

Question 25

Eisenmenger’s treatment

Answer 25

supplemental oxygen therapy (if it increases arterial oxygen saturation), pulmonary vasodilator therapy, and iron supplementation when iron deficiency is present

Question 26

Sinus venosus associated with

Answer 26

Partial anomalous pulmonary venous return