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Clin med - Cardio 1 > CHD > Flashcards

CHD Flashcards

1
Q

What can cause Infectious Endocarditis?

A

**Any valve defect or regurgitation, or any obstruction anywhere in the vessels causes low grade pressure, increasing chances Infectious Endocarditis to occur.

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2
Q

Types of Atrial septal defect?

A

o Secundum ASDs
o Primum ASDs,
o Sinus Venosus ASD,
o Coronary Sinus ASD

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3
Q

What Is seen on CXR on a pt who has pulmonary artery blood volume reduction?

A

**Reduction of blood volume to pulmonary arteries, will present with Pulmonary vascular markings are typically diminished on CXR

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4
Q

Secundum ASDs

A

MC ASD and generally present as an isolated defect. It is a result of arrested growth of the secundum septum or excessive absorption of the primum septum resulting in an opening in the fossa ovalis.

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5
Q

Primum ASDs (15-20%)

A

Develop when the septum primum does not fuse with the endocardial cushions resulting in a defect at the base of the interatrial septum that typically is associated with atrioventricular (AV) canal defects (eg, anomalies of the AV valves and ventricular septal defects).

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6
Q

Sinus venosus defects

A

Malposition of the insertion of the superior or inferior vena cava in the atrial septum,

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7
Q

Coronary sinus ASDs

A

Part or entire wall between coronary sinus and left atrium is absent.

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8
Q

If not corrected ASD causes?

A

heart failure
atrial arrhythmias
pulmonary hypertension

Leading to RVH -> right-to left shunting of blood, resulting in cyanosis

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9
Q

Infants with a large ASD may present with symptoms of?

A

heart failure (eg, tachypnea and dyspnea),

recurrent respiratory infection, or

failure to thrive.

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10
Q

PE of ASD?

A

mid-systolic pulmonary ejection murmur accompanied by a fixed split second heart sound (S2), Cyanosis and clubbing accompany the development of a right-to-left shunt.

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11
Q

The diagnosis of isolated ASD?

A

Is suspected clinically by its characteristic cardiac (systolic murmur and fixed S2) and electrocardiographic findings,

It is confirmed by echocardiography.

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12
Q

What will Echo show in a pt with ASD?

A

Dialation of:
Pulmonary arteries
RV and RA dilatation.

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13
Q

Tx for ASD?

A

o Surgical Repair: prosthetic material or percutaneous transcatheter device closure in all patients with uncomplicated secundum ASD with significant left-to-right shunting
i.e., pulmonary-to-systemic flow ratios 1.5:1 - 2:1

o Anti-arrhythmic medications for A-Fib & SVT

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14
Q

VSD

A

o Most common of all cardiac birth defects

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15
Q

Types of VSD?

A

Subpulmonary

Membronous (heard whole of Systolic),

Muscular (short systolic not extending to S2)

AV Canal Type

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16
Q

Characteristics of VSD?

A

L-to-R shunt → increases Pulmonary arterial Pressure (causing obstruction) → Pulmonary HTN → Eisenmenger’s Syndrome (Large VSD)→ R-to-L shunt

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17
Q

Eisenmenger’s Syndrome

A

Has to be corrected early on in life

Symptoms in adults: 
        Exertional dyspnea, 
        CP, 
        Syncope
        Hemoptysis
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18
Q

When do you hear a Restrictive VSD?

A

Holosystolic murmer with normal S2 in 12 yo

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19
Q

When do you hear a Muscular VSD in 6 yo?

A

Short systolic not extending to S2 (small defect closes as muscle contracts).

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20
Q

When do you hear a Loud short systolic VSD murmur in infant?

A

Single S2 c/w pulmonary HTN

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21
Q

Tx for VSD?

A

Surgical trans-catheter closure recommended if pulmonary-to-systemic flow ratios of >1.5:1 to 2:1.

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22
Q

What is Patent Ductus Arteriosus (PDA)?

A

Vessel leading from the bifurcation of the pulmonary artery-to-aorta (L-to-R shunt) just distal to the left subclavian artery

This is normal before birth, should close off after birth

Sometimes it turns into Coarctation of Aorta

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23
Q

Characteristics of PDA?

A

THRILL and a continuous “machinery” murmur late systolic accentuation at the upper left sternal edge.

24
Q

What are some of the symptoms of PDA?

A

o Cyanosis & Clubbing of Toes (not fingers) → Called Differential Cyanosis

o Pulmonary vascular obstruction may cause:

      Aneurysmal dilatation, 
      Calcification, and
      Rupture of the ductus
25
Q

Tx for PDA?

A

Closure recommended in adults without severe pulmonary vascular disease & R to L shunt

26
Q

**Interscapular murmurs usually indicate?

A

PDA or Coarctation of Aorta

27
Q

What is Coarctation of aorta?

A

Narrowing of aorta, distal to the origin of the left subclavian artery (frequent in pt’s w/ Turner’s syndrome), proximal to PDA

28
Q

What is Coarctation of aorta associated with?

A

Commonly associated w/ anomalies such as bicuspid aortic valve, and can cause Circle of Willis aneurysms

29
Q

1st finding of Coarctation of aorta is?

A

Heart murmur and HTN in UE; low or delayed pulses in femoral arteries.

30
Q

What is a classic finding on CXR in a pt w/ Coarctation of aorta?

A

o May show (the “3” sign) → dilated left subclavian artery, dilated ascending aorta, & indentation of the aorta

o The”3” sign” is a pathognomonic for Coarctation of Aorta.

o Notching of inferior ribs erosion d/t dilated collateral vessels may be seen.

31
Q

Tx for Coarctation of aorta?

A

Catheter balloon dilatation with stent placement or Surgical resection and reanastomosis

32
Q

PE for Coarctation of aorta?

A

o Mid-systolic murmur over the left inter scapular

o Differential systolic blood pressure between the upper and lower extremities and/or delayed femoral pulses & upper extremities and thorax may be more developed than the lower extremities.

33
Q

What are the 4 Components TOF (Tetralogy of Fallot)?

A
  1. Mal-aligned VSD → superior region of Septum is shifted to the right
  2. RV outflow obstruction → Pulmonary Trunk Narrowing
  3. Overriding aortic (over VSD) → Aortic arch descends to the right (displacement of Aorta) of bifurcation of Pulmonary Trunk
  4. RV hypertrophy → due to the RV’s response to aortic pressure via the large VSD
34
Q

What is the importance of shunt in a pt w/ TOF?

A

A shunt has to be present in order for the pt to survive, surgical shunt creation, increases risk of Infectious Endocarditis.

35
Q

What happens when RV outflow obstruction is severe in in a pt with TOF?

A

Pulmonary blood flow is reduced markedly→ systemic venous blood shunts right-to-left across the VSD → Severe Cyanosis, Erythrocytosis.

36
Q

What is Tet Spell & how do you Tx it?

A

o Tet Spell → RV infundibular contractility, Catecholamine release Hyperventilation w/ increased WOB R to L shunt

o Treatment → Increase SVR Increase, R filling pressure Reduce catecholamine release, Supplemental O2

   o    Goal is mixing of blood → Surgical creation interatrial communication or artery anastomosis between Aorta & Pulmonary Artery
37
Q

Tx for TOF?

A

o Surgical destruction of fistula (between coronary artery & vain).
o Reoperation in adults is most commonly for severe pulmonary regurgitation
o Endocarditis remains a risk despite surgical repair

38
Q

Coronary arteriovenous fistula?

A

o A congenital defect where Coronary Artery is connected with a nearby vain, therefore low pressure of the vain causes blood to flow out the Coronary artery, leading to less perfusion to distal portions of the heart muscle.
o Can lead to: thrombus formation, Aneurisms, Pulmonary HTN, Infective Endocarditis.

39
Q

Types of Congenital Aortic Stenosis?

A

o Valvular aortic stenosis
o Subaortic stenosis
o Supravalvular aortic stenosis

40
Q

Congenital Aortic Stenosis?

A

o Most common ongenital Heart malfunction
o Harsh systolic murmur
o Bicuspid valves may develop stenosis or regurgitation (Endocarditis can form)
o Thickening and calcification → Rigid aortic valve

41
Q

Valvular aortic stenosis?

A

o Prophylaxis against infective endocarditis ?
o Surgical – aortic valve replacement
o Aortic balloon valvuloplasty

42
Q

Subaortic stenosis?

A

o Membranous diaphragm or fibromuscular ring encircling the LV outflow tract just beneath the base of the aortic valve
o Tx: Complete excision of the membrane/fibromuscular ring

43
Q

Supravalvular aortic stenosis?

A

o Narrowing of the ascending aorta just above the level of the coronary arteries.
o Coronary arteries are subjected to elevated systolic pressures
o Williams-Beuren syndrome (“elfin” facies, low nasal bridge, cheerful demeanor, mental retardation with retained language skills and love of music)

44
Q

Pulmonary Stenosis with Intact Ventricular Septum?

A

o MC form of isolated RV obstruction

                PS → pulmonary Pressure

Mild PS Moderate PS Severe PS
50mmHg

o Sound of pulmonary valve closure is delayed and soft
o Due to RVH, forceful RA contraction creates 4th heart sound, waves at JVP, & presystolic pulsations of the liver.
o Severe obstruction causes: Harsh systolic crescendo-to-decrescendo murmur & thrill, and Holosystolic murmur.
o CXR → Less vasculature going to the lungs BC stenosis will reduce blood flow to Pulmonary Artery.
o Tx: catheter technique of balloon

45
Q

Complete Transposition of the Great Arteries?

A

o Aorta is switched with Pulmonary arteries
o Aorta arises from the RV, Pulmonary artery from the LV
o Most have intra-atrial communication
o 2/3 have PDA
o 1/3 have associated VSD

46
Q

Tx for Complete Transposition of the Great Arteries?

A

o Atrial Baffle (Intra-Atrial Switch),
o Arterial switch,
o Rastelli Procedure → intracardiac ventricular baffle and extracardiac prosthetic conduit to replace the pulmonary artery

47
Q

Congenitally Corrected Transposition?

A

o LV is switched with RV

o RV is not designed for systemic circulation → RVH (bc its on the left side) → Complete Heat Block

48
Q

Truncus Arteriosus Type-1?

A

One trunk w/ bifurcation between Aorta and Pulmonary Arteries, w/ ASD & VSD defect

49
Q

Truncus Arteriosus Type-2-3?

A

No bifurcation, Pulmonary Arteries come straight off Aorta (Common Trunk), w/ ASD & VSD defect

50
Q

Truncus arteriosus type 4?

A

No bifurcation, Pulmonary Arteries come straight off Aorta distal to L.Subclavian, w/ ASD & VSD defect

51
Q

Total Anomalous Venous Return?

A

Atrial septal defect is necessary to allow partially oxygenated blood to reach the left side of the heart

52
Q

Partial Anomalous Pulmonary Venous Return?

A

Right Pulmonary veins enter Right Atrium

53
Q

Ebstein’s Anomaly?

A

Small Ventricles, Dilated Atriums, intra-atrial R-to-L shunting → Conduction problems…….

54
Q

Situs inversus totalis?

A

All organs are switched to the opposite side of body

55
Q

Kartagener‘s Syndrome?

A

Dextrocardia → Hyperinflation of the lungs

56
Q

Ectopia Cordis?

A

resulting in herniation of the heart through a sternal, pericardial and/or abdominal defect

Clin med - Cardio 1 (2 decks)

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