Congenital Heart Disease Flashcards
what is a possible cause of persistence vs transient patent foramen ovale symptoms?
persistent: chronic lung disease, tricuspid or pulmonary valve disease —> intracardiac shunt
transient: coughing, lifting, straining —> risk for paradoxical embolus (DVT can reach left side of heart and cause stroke, limb or bowel ischemia)
describe how Valsalva maneuver reverses interatrial pressure gradient
when clenching for Valsalva maneuver, venous return decrease to the heart
however, upon releasing Valsalva maneuver, there is a transient reverse in pressure gradient - R atrium is higher pressure than L atrium
Which of these are NOT associated with congenital heart defects?
a. Down Syndrome
b. congenital Rubella
c. maternal drug exposure (cocaine, alcohol)
d. vegan diet
e. diabetes
ARE associated with congenital heart defects:
a. Down Syndrome
b. congenital Rubella
c. maternal drug exposure (cocaine, alcohol)
e. diabetes
what kind of symptoms develop in adults with atrial septal defects? what is a key finding on PE?
with age, L—>R shunt worsens
in adults - exercise tolerance, fatigue, dyspnea, RV heave due to large RV
key finding: wide fixed splitting of S2 (delayed P2, no change with inspiration because of increased pulmonary blood volume)
explain Eisenmenger syndrome in ASD
reversal of shunt in congenital defect
ASD (atrial septal defect): chronic L—>R shunt causes pulmonary artery remodeling —> increased pulmonary artery pressure —> right side of heart develops higher pressure than left —> shunt reverses —> cyanotic
if you hear a murmur in a patient with ASD, what is it due to?
ASD = atrial septal defect
there is NO murmur across the ASD (pressure gradient isn’t high enough)
you may hear a flow murmur across normal PV (systolic) or TV (diastolic)
explain why ventricular septal defects can cause volume overload in the left atrium and left ventricle
blood is flowing from LV to RV (due to pressure gradient), which then enters pulmonary artery
pulmonary artery will see volume overload, but then so will LA and LV because the extra blood going to the lungs is coming back to the left side of the heart!
—> eccentric hypertrophy (sarcomeres in series) —> systolic HF
Pt is a 7 week old F presenting to the ER with tachypnea and a respiratory infection which mother reports have been recurrent. Mother says baby is easily fatigued and has been taking less volume in feeds. Baby is showing symptoms of CHF. Which of the following is most likely:
a. aortic stenosis
b. bicuspid aortic valve
c. ventricular septal defect
d. congenital Rubella
c. ventricular septal defect
if there is a large defect, heart failure an occur in 6-8 weeks - tachypnea, diaphoresis during feeds, fatigue, irritability, decreased volume of feeds, poor weight gain
failure to thrive and recurrent respiratory infections
LV—>RV shunt is placing too much pressure on pulmonary system —> systolic HF
what are the characteristic PE findings with VSD (ventricular septal defect)? (2)
- LV heave —> LV thrill
(LV pressure is high because the blood that gets shunted to pulmonary system comes back to left side of heart) - harsh, high frequency holosystolic murmur at L lower sternal border
how will oxygen tension be altered in the cardiac chambers in ASD vs VSD
ASD: higher O2 saturation in RA, RV, and pulmonary artery
VSD: higher O2 saturation in just RV and pulmonary artery
where does abnormal blood flow occur in an infant with patent ductus arteriosus?
blood flows from aorta to pulmonary artery (L->R shunt) —> pulmonary pressure approaches systemic pressure —> systolic heart failure (volume overload)
what does patent ductus arteriosus (PDA) feel like and sound like?
bounding pulses with wide pulse pressure (lower DBP due to lower aortic blood volume, due to flow into PDA)
continuous machine-like murmur best heart at left infraclavicular area
what is the use of indomethacin in congenital heart defects?
indomethacin an be used to induce closure of patent ductus arteriosus
You’re examining an infant for poor growth, sweating while feeding, and tachycardia/tachypnea. You notice a wide pulse pressure and a continuous machine-like murmur heard best at the left subclavicular region that is persistent throughout the cardiac cycle. What pharmacological agent can you give them to possibly fix the issue?
infant has PDA (patent ductus arteriosus): L—>R shunt from aorta into pulmonary artery
indomethacin can be given to induce closure of the PDA
without closure, pulmonary HTN and CHF will develop, and there is a major risk of infective endocarditis and pulmonary or systemic emboli
in tetralogy of Fallot, there is anterior displacement of _____
infundibular septum, aka aorticopulmonary septum
