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Clin Med-Cardiology Exam 1 > Congenital heart Disease > Flashcards

Congenital heart Disease Flashcards

1
Q

Stills murmur
Location
Quality
Congential Heart Dz

A 
left midsternal border
Vibratory Quality
VSD
Subaortic Stenosis
Subpolmonic stenosis
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2
Q

Venous Hum
Location
Quality
Congenital Heart Dz

A

Neck and clavicle
Continuous loudest when sitting
PDA
Coronary AV malformation

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3
Q

Sinus Venosus

A

High in the atrial septum near the entry of the superior vena cava into the right atrium

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4
Q

Ostium primum ASDs

A

Lie adjacent to the atrioventricular valves which may be deformed/regurgitant
Common in Down syndrome; may be more complex with a common atrioventricular valve (endocardial cushion defect)

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5
Q

Ostium secundum ASD

A

Involves the fossa ovalis and is midseptal (as opposed to a patent foramen ovale)
“Probe patency” is common & trivial (functionally closed)
ASD denotes a true deficiency of the atrial septum and implies functional and anatomic patency

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6
Q

Magnitude of the left-to-right shunt is determined by

A

ASD size
Ventricular diastolic properties
Impedance in the pulmonary and systemic circulations

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7
Q

What is a result of a Left to right shunt created by ASD

A

Diastolic overloading of the right ventricle
Increased Pulmonary blood flow.
Causes Pulm HTN

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8
Q

ASD presentation in adults

A

usually asymptomatic early in life may have growth retardation and increased URI
Past 4th decade of life:
Atrial Arrhythmias
Pulm HTN
Bidirectional and then right to left shunting of blood
Right Heart failure
L to R shunting leads to progressive systemic HTN, CAD

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9
Q

ASD Physical Exam

A

prominent RV impulse and palpable pulmonary artery pulsation
1st Heart sounds is normal or split with accentuation of the tricuspid valve closure
midsystolic pulmonary outflow murmur due to increased flow across pulmonic valve
2nd heart is widely split and relatively fixed in relation to respiration
mid-diastolic rumblin murmur (4th L intercostal space) reflects increased flow across the tricuspid valve

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10
Q

What is a ostium primum ASD sound like

A

holosystolic murmur usually mitral or tricuspid regurgiatation or VSD

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11
Q

What happens with an ASD

A

increased pulmonary resistance leads to diminished L to R shunt
pulmonic component of the 2nd heart sound and a systolic ejection sound are accentuated
Cyanosis and clubbing accompany the development of right to left shunt

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12
Q

How do you treat ASD

A

patch of pericardium or of prosthestic material or percutaneous transcatheter device closure
pulmonary to systemic flow ratios 1.5-2

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13
Q

What is the most common of all cardiac birth defects

A

VSD

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14
Q

VSD presentation in adults

A

dysfunction depends on its size and on the status of the pulmonary vascular bed
Will only see small or moderate size VSD are seen in adulthood because most come to medical or surgical attention early in life

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15
Q

What determine clinical manifestation and feasibility of surgical repair

A

pulmonary vascular bed

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16
Q

what is Eisenmengers syndrome

A

large communication between the two circulations at the aortopulmonary, ventricular or atrial levels
Bi directional or predominantly right to left shunts because of high resistance and obstructive pulm HTN
Large VSD should be corrected surgically early in life when pulmonary vascular disease is still reversible or not developed

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17
Q

Symptoms of adults with Eisenmenger

A

exertional dyspnea, chest pain, syncope, and hemoptysis

R to L shunt leads to cyanosis and clubbing and erythrocytosis

18
Q

VSD presentation

A

Asymptomatic murmur may nor be present at birth develop in the 1st few months as the VSD constricts and disappear.
Restrictive VSD holosystolic murmur with normal S2

19
Q

PDA

A

is a vessel leading from the bifurcation of the pulmonary artery to the aorta just distal to the left subclavian artery
Normally, open in the fetus but closes immediately after birth

20
Q

What is the clinical presentation of PDA

A

pulmonary pressure are initially normal
A gradient shunt from aorta to pulmonary artery persists throughout the cardiac cycle
characteristis thrill and

21
Q

PDA clinical Pearls

A

machinery murmur with late systolic accentuation and upper left sternal edge
Toes but not the fingers become cyanotic and clubbed

22
Q

what is the treatment of PDA

A

closure recommended in adults without severe pulmonary vascular disease and a R to L shunt
Transcatheter closure, Thoracoscopic surgical

23
Q

What is a congenital aneurysm of an aortic sinus of Valsalva with fistula

A

separation or lack of fusion between the media of the aorta and the annulus of the aortic valve
Usually ruptures between 3rd or 4th decade of life

24
Q

congential aortic stenosis

A

obstructive malformations that cause obstruction to LV outflow
One of the most common congenital heart malformations
Harsh systolic murmur
Mitral valves may develop stenosis or regurgitation
LV hypertrophy

25
Q

what is the treatment of valvular aortic stenosis

A

medical- admin of digoxin, and diuretics, and sodium restriction while waiting for opertation
SX-aortic valve replacement
symptoms secondary to LV dysfunction
Aortic balloon valvuloplasty- asymptomatic children/adolescent/young adults with critical aortic stenosis

26
Q

Suprevalvular aortic stenosis

A

localized or diffure narrosing of the ascending aorta just above the level of the coronary arteries at the superior margin of the sinuses of Valsalva
Most patients have a genetic defect for the anomaly

27
Q

William-Beuren syndrom

A

elfin facies, low nasal bridge, cheerful demeanor, mental retardation with retained language skills and love music, suprevalvular aortic stenosis

28
Q

Coarctation of the aorta symptoms

A

H/A, epitstaxis, cold extremities, and claudication with exercise
1st finding may be heart murmur and HTN in upper extremities
ECG show LV hypertrophy
CXR- shows dilated left subclavian artery high on the left mediastinal border, dilated ascending aorta, indentation of the aorta
notching of the 3rd-9th ribs

29
Q

Pulmonic stenosis with intact ventricular septum

A

RV outflow obstruction localized to the supravalvular, valvular or subvalvular levels or occur in any combination

30
Q

what is the most common form of isolated RV obstruction

A

valvular pulmonic stenosis

31
Q

what determines the clinical course and symptoms of Pulmonary stenosis with intact ventricular septum

A

severity of the obstructing lesion

32
Q

How is pulmonary stenosis with intact ventricular septum diagnosed

A

left parasternal lift and harsh systolic crescendo-decrescendio murmur and thrill at the upper left sternal border

33
Q

how is tetralogy of fallot treated

A

Increase SVR Systemic vascular resistance
Increase R filling pressure
reduce catecholamine releas
Supplemental O2

34
Q

how does a CXR look like for a person with Tetralogy

A

normal sized boot shaped heart
prominent right ventricle
misaligned VSD

35
Q

how is tetralogy of fallot treatment

A

blade catheter or surgical interatrial communication
systemic pulmonary artery anastomosis (waterston-cooley shunt)
goretex graft

36
Q

what are the long term consequence of teralogy of fallot

A

reopertation in adults is most common
long term ventricle function
ventricle and arrhythmias occur endocarditis

37
Q

what is total anomalous venous return

A

oxygenated blood returning from the lungs is routed back into the SVC
Also their needs to be an ASD

38
Q

Tricuspid atresia

A

severe cyanosis due to obligatory admixture of systemic and pulmonary venous blood in the left ventricle

39
Q

what is ebsteins anomaly

A

downward displacement of the tricuspid valve into the right ventricle
RV hypoplastic

40
Q

what is the clinical presentation for a person with Ebstein anomaly?

A

progressive cyanosis from right to left atrial shunting

Due to tricuspid regurgitation and RV dysfunction

41
Q

What will Ebstein anomaly look like on CXR

A

cardiomegaly

RA enlargement

Clin Med-Cardiology Exam 1 (8 decks)

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