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SEM 5: SAM 1 > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

Which congenital heart abnormality results in a continuous murmur?

A

PDA

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2
Q

Where is the PMI for PDA?

Systolic, diastolic, or continuous murmur?

A

PMI at left base
- often high grade continuous (IV-VI) murmur

(bc blood flowing from aorta back into pulmonary artery)

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3
Q

Cardiac exam findings on a dog with PDA?

A
  • Continuous murmur with PMI at left base
  • Often asymptomatic
  • Normal or high HR
  • Strong or “bounding” femoral pulses
  • LV eccentric hypertrophy due to vol overload
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4
Q

Treatment for PDA?

A

Curable by
- surgical ligation
or
- trans-catheter occlusion (minimally invasive)

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5
Q

What is a pathognomonic finding in a patient with reverse PDA?

A
  • Differential cyanosis

(cranial part of the patient is getting oxygenated blood, caudal half of the patient has cyanotic MM due to hypoxemia)

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6
Q

Treatment for right-to-left PDA?

A

(Reversed PDA)

  • Not correctable
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7
Q

What type of hypertrophy is seen with subaortic stenosis?

A
  • Concentric hypertrophy of LV

due to pressure overload to the left side of the heart

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8
Q

Subaortic stenosis is common in which breeds?

A

Large/giant breeds

  • Newfy
  • G. retriever
  • Rotty
  • GSD
  • Boxer

Dogs > cats

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9
Q

PMI for subaortic stenosis?

Systolic, diastolic, or continous murmur?

A

Left basilar systolic murmur

(Left 4th ICS)

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10
Q

What can be seen on thoracic rads in a patient with subaortic stenosis?

A
  • Prominent ascending aorta
  • L-sided cardiomegaly
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11
Q

What determines the severity of subaortic stenosis and what diagnostic test shows this?

A

The estimated pressure gradient on a continuous wave doppler

  • 4 x velocity squared
  • < 50mmHg = mild
  • < 50-80 = moderate
  • < 81-130 = severe
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12
Q

True or False: Subaortic stenosis can lead to sudden death due to lethal ventricular arrhythmias

A

TRUE

  • Can cause VPCs which can lead to V-tach, then V-fib… death
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13
Q

Treatment and Prognosis of subaortic stenosis?

A
  • No curative tx
  • Mild SAS: affected dogs are asymp and have normal lifespan (no tx indicated)
  • Severe SAS: Atenolol (Beta blocker) decreases myocardial O2 demand, improves perfusion (increases time of diastole), and may reduce arrhythmias
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14
Q

__________ is a risk factor for ___________ regardless of severity, and should be given antibiotics for any potentially bacteremic episode like surgery, or if the patient is immunosuppressed

A. PDA
B. VSD
C. Subaortic stenosis
D. Pulmonic stenosis

A

C. Subaortic stenosis

Endocarditis

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15
Q

Which of the following results in concentric hypertrophy due to pressure overload to the right side of the heart?
A. PDA
B. VSD
C. Subaortic stenosis
D. Pulmonic stenosis

A

D. Pulmonic stenosis

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16
Q

Which of the following results in concentric hypertrophy due to pressure overload to the left side of the heart?
A. PDA
B. VSD
C. Subaortic stenosis
D. Pulmonic stenosis

A

C. Subaortic stenosis

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17
Q

What type of hypertrophy is seen with PDA?

A

Eccentric hypertrophy due to volume overload to the left side of the heart

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18
Q

Which of the following results in eccentric hypertrophy due to volume overload to the left side of the heart?
A. PDA
B. VSD
C. Subaortic stenosis
D. Pulmonic stenosis

A

B. VSD

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19
Q

What is the PMI for pulmonic stenosis?

Systolic, diastolic, or continuous murmur?

A

Left basilar systolic murmur

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20
Q

Out of all of the following congenital heart diseases, which are more common in cats>dogs? Select all that apply.

A. PDA
B. TVD
C. VSD
D. MVD
E. SAS
F. Pulmonic stenosis
G. AVSDs
H. Tetralogy of Fallot

A

B. TVD (tricuspid valve dysplasia/regurg)

C. VSD (ventricular septal defect)

D. MVD (mitral valve dysplasia/regurg)

G. AVSDs (AV septal defects)

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21
Q

What is the most common cause of cyanotic heart disease in cats and dogs?

A

Tetralogy of Fallot

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22
Q

Tetralogy of Fallot is a complex congenital heart disease consisting of:

A
  1. Pulmonic stenosis (PS)
  2. Secondary concentric hypertrophy to the RV
  3. Overriding aorta
  4. Ventricular septal defect (VSD)
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23
Q

Which of the following congenital heart diseases has a risk of causing sudden death? Select all that apply

A. VSD
B. Pulmonic stenosis
C. Subaortic stenosis
D. AVSDs

A

B. Pulmonic stenosis
C. Subaortic stenosis
D. AVSDs

  • All 3 can cause sudden death, although PS and SAS patients are often asymptomatic
24
Q

Which congenital heart disease can lead to VPCs, V-tach, V-fib, or sudden death?

A

Subaortic stenosis (SAS)

25
Q

True or False: Balloon valvuloplasty has been shown to have more survival benefits for treating SAS than treatment with atenolol

A

False - no benefit

Atenolol is #1 choice for tx of SAS

26
Q

Pulmonic stenosis can lead to _____ sided heart failure if moderate or severe.

A

Right

(If R CHF- will see jug distension, ABD distension)

27
Q

SAS can lead to ________ sided heart failure if moderate or severe

A

Left

(If L CHF - P will have abnormal lung sounds due to pulmonary edema)

28
Q

Treatment and Prognosis for pulmonic stenosis?

A
  • Mildly affected dogs are asymp and have normal lifespan (no tx indicated)
  • Severe PS: balloon valvuloplasty (#1) > atenolol (#2)
  • Atenolol may reduce arrhythmias, syncope, and sudden death
29
Q

Where is a VSD usually located?

A
  • High in the perimembranous region of the IVS
30
Q

Explain the blood flow in VSD

A

Blood flows from LV through a hole in the IVS to the RV and directly out of the pulmonary artery back to the left side of the heart (LV eccentric hypertrophy due to vol overload)

31
Q

PMI for VSD?

Systolic, diastolic, or continuous murmur?

A
  • Systolic murmur loudest in the right parasternal region
32
Q

A large VSD defect can result in ______ sided heart failure

A

Left sided or biventricular

  • Can observe abnormal lung sounds if L CHF + jug and ABD distension if biventricular
33
Q

The smaller the defect the louder the murmur correlates with which of the following congenital heart diseases?

A. VSD
B. TVD
C. MVD
D. PDA

34
Q

Treatment and Prognosis for VSD?

A
  • Small VSDs don’t require tx
  • Moderate VSD: Cardioprotective drugs like ACE inhibitors (Benazepril, Enalapril) and spironolactone
  • Large defects require PA banding or open heart surgery (banding the PA decreases the lumen size and increases the pressure in the RV. This causes equal pressures between LV and RV and less of a shunt)
  • If CHF develops, HF drugs should be added
  • Good prognosis for small to moderate defects, poor prognosis for large defects if not closed/PA banded
35
Q

Tricuspid valve regurgitation results in _______ overload to the _____ side of the heart, resulting in _________ hypertrophy

A

Volume, Right, Eccentric

36
Q

Tricuspid valve regurgitation can result in _____ sided CHF

A

right

  • P can present with jug or ABD distention
37
Q

Which of the following congenital heart diseases would you expect to find bounding or abnormally strong femoral pulses?

A. VSD
B. TVD
C. MVD
D. PDA

38
Q

PMI for Tricuspid valve regurgitation?

Systolic, diastolic, or continuous murmur?

A

Right apical systolic murmur

**can be low grade murmur even with severe disease!!!!*

39
Q

If tricuspid valve dysplasia is due to stenosis, a __________ murmur may be heard

40
Q

How do the heart chambers appear on echo in a dog with severe tricuspid valve regurg?

A

LV is usually small (volume underloaded)

41
Q

How do the heart chambers appear on echo in a dog with tricuspid valve stenosis?

A

RA is dilated and RV is small

42
Q

Treatment and Prognosis for TVD?

A
  • Mild TVD does not req tx, normal lifespan
  • Moderate to Severe TVD: Cardioprotective drugs like ACE inhibitors (Benazepril, Enalapril)
  • Many patients with severe TVD develop R-CHF and have shortened lifespan

Severe TVD: Surgical valve replacement or balloon valvuloplasty for TV stenosis

43
Q

Mitral valve regurgitation results in _______ overload to the _____ side of the heart, resulting in _________ hypertrophy

A

volume, Left, eccentric

44
Q

PMI for Mitral valve regurgitation?

Systolic, diastolic, or continuous murmur?

A

Left apical systolic murmur

45
Q

If mitral valve dysplasia is due to stenosis, a __________ murmur may be heard

46
Q

How do the heart chambers appear on echo in a patient with mitral valve stenosis?

A

LA is dilated and LV is small

47
Q

Treatment and prognosis for MVD?

A
  • Mild MVD does not req tx, normal lifespan
  • Moderate to Severe MVD: Cardioprotective drugs like ACE inhibitors (Benazepril, Enalapril)
  • Many patients with severe MVD develop L-CHF and have shortened lifespan

Severe MVD: Surgical valve replacement or balloon valvuloplasty for MV stenosis

48
Q

PMI for AVSDs?

Systolic, diastolic, or continuous murmur?

A

Left or Right parasternal, diastolic or systolic murmur

49
Q

Treatment and Prognosis for AVSDs?

A
  • No surgical/interventional therapy available
  • CHF and sudden death are possible complications
  • Guarded prognosis
50
Q

Where is the defect located in a pet with AVSDs?

A

Complex congenital defects involving the AV septum, atrial septum, and ventricular septum

  • can be one or multiple
51
Q

Explain the blood flow in a patient with Tetralogy of Fallot

A

Pulmonic stenosis results in high P in RV, VSD allows blood to shunt from RV to LV

  • Results in deoxygenated blood being pumped out of aorta leading to hypoxemia and cyanosis
52
Q

List the congenital heart diseases that can result in a diastolic murmur

A
  • Tricuspid valve stenosis
  • Mitral valve stenosis
  • PDA (continuous in systole and diastole)
  • AVSDs (can be diastolic or systolic)
53
Q

List the congenital heart diseases that can result in a systolic murmur

A
  • Pulmonary stenosis
  • Aortic stenosis
  • PDA (continuous in systole and diastole)
  • AVSDs (can be diastolic or systolic)
54
Q

Stenosis of the semilunar valves is more common in _______ (dogs/cats)

A

Dogs

(PS and SAS)

55
Q

TVD and MVD are more common in _______ (dogs/cats)

56
Q

Which of the following congenital heart diseases is more common in smaller breed dogs?

A. TVD
B. MVD
C. Pulmonic stenosis
D. Subaortic stenosis

A

C. Pulmonic stenosis

57
Q

Which of the following congenital heart diseases is more common in large breed dogs?

A. TVD
B. MVD
C. Pulmonic stenosis
D. Subaortic stenosis

A

C. Pulmonic stenosis

SEM 5: SAM 1 (35 decks)

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