Congenital Heart Disease Flashcards
What is an opening in the atrial septum permitting free communication of blood between the atria?
ASD: Atrial Septal Defect
What are the three types of ASD?
Secundum ASD: at the fossa ovalis(most common); Primum ASD: lower in position & is a form of AVSD, MV cleft; Sinus Venosus ASD: high in the atrial septum, associated with partial anomalous venous return
True or False most ASD are asymptomatic but may tire easy and have mild growth failure.
TRUE
What are some s/s of ASD?
hyperactive precordium, RV heave, fixed widely split S2
What causes the systolic and diastolic murmurs of ASD?
s: caused by increased flow across the pulmonary valve
d: is caused by increased flow across the tricuspid valve
What is an abnormal opening in the ventricular septum, which allows free communication between the Rt and Lt ventricles?
VSD: Ventricular Septal Defect
What is the most common type of VSD? which usually closes up?
perimembranous; muscular
In VSD the left to right shunt occurs secondary to ______ being less than _________, not the higher pressure in the LV. Leads to what?
PVR; SVR
elevated RV and pul. pressures, vol. hypertrophy of LA and LV
True or False small- moderate VSD are asymptomatic and will close by 2 yrs of age.
TRUE
True or False harsh holosystolic murmur heard along the LSB, more prominent with Large VSD, may be absent with a small VSD
FALSE: prominent with a small VSD
True or False in VSD endocarditis prophylaxis is necessary.
TRUE
What results from incomplete fusion of the endocardial cushions?
AVSD: Atrioventricular Septal Defect
What genetic disease is AVSD more commonly seen in?
Down Syndrome
What is the most common incomplete form of AVSD?
Primum ASD, cleft in the MV & small VSD
What are some S/S of AVSD?
recurrent pul. infections, failure to thrive, tire easy, wide, fixed splitting S2, pul. systolic ejection murmur w. thrill, holosystolic murmur @ apex, cardiac enlargement
True or False AVSD may or may not require surgery.
FALSE: always does
What is persistence of the normal fetal vessel that joins the PA to the aorta?
PDA: Patent Ductus Arteriosus: normally closes first wk of life.
What TORCH infection is PDA associated with?
Rubella
In PDA, as a result of higher aortic pressure blood shunts ____ to _____ thru the ductus from _______ to _________ __________. In extreme cases what happens?
L;R; Aorta, PA; 70% of CO is shunted to pulm. circulation
True or False in PDA, PA pressures are greater than systemic pressures.
FALSE: Equal
What are some s/s of PDA?
FTT, bounding arterial pulses, widened pulse pressure, enlarged heart, classic continuous machinery systolic murmur.
What is tx for PDA?
surgery or catheter closure
What three heart disorders decrease pulmonary blood flow?
Pulmonary stenosis, TOF(Tetralogy of Fallot), Pulmonary Atresia(PA)
What is obstruction in the region of either the pul. valve or the subpulmonary ventricular outflow tract? can be present w. or w.o. an intact?
Pulmonary Stenosis; ventricular septum
What is the flow of the heart?
RA, RV, PA, lungs, P. vein, LA, LV, aorta, body
What syndrome is PS associated w?
Noonan’s syndrome, secondary to valve dysplasia
What does RV pressure hypertrophy in PS lead to?
RV failure
True or False cyanosis is indicative of critical PS
TRUE
What to tx of choice for PS?
Balloon valvuloplasty, surgical valvotomy
Tetralogy of Fallot (TOF) is a combination of what for defects?
PS, RVC hypertrophy, VSD, Overriding Aorta
TOF has what kind of shaped heart?
Boot
What are some s/s of TOF?
episodic loss of LOC, and squatting when fatigued to increase pul. flow and thus O2 saturations, RV hypertrophy
What is the absence of communication between the right ventricle and the pulmonary artery?
Pulmonary Atresia
What are some s/s of PA?
cyanosis present at birth, tachy, pul. edema, hepatomegaly
What defects cause obstructed systemic blood flow?
AS(Aortic Stenosis), Coarctation of the Aorta, HLHS(Hypoplastic Left Heart Syndrome), Mitral Stenosis, Interrupted Aortic Arch
What is an obstruction to the outflow from the left ventricle at or near the aortic valve that causes a systolic pressure gradient of more than 10 mm hg?
Aortic Stenosis
What are the three types of AS?
Valvular(most common), subvalvular(subaortic) involves the left outflow tract, Supravalvular involves the ascending aorta and is the least common.
What are some moderate S/S of AS?
chest pain, dyspnea, dizziness.
What are the systolic pressure gradients in mild AS? mod AS? Severe AS? Critical AS?
0-25 mm hg, 25-50 mm hg, 50-75 mm hg, greater than 75 mm hg.
What are some signs of Severe AS?
weak pulses, LS heart failure, sudden death
What type of patients is AS surgery reserved for?
pts w symptoms, and a resting gradient of 60-80 mm hg
True or false for supravalvular stenosis it is reserved for gradient of 40-50 mm hg bc of its progression.
FALSE: subaortic stenosis
True or False Balloon Valvoloplasty is standard tx for AS.
TRUE
What is a narrowing of the aorta at varying points anywhere from the transverse arch to the iliac bifurcation?
Coarctation
What other heart anomaly is coarctation associated with?
Bicuspid aortic valve
True or False Pts with Coarctation are PDA dependent.
TRUE
In coarctation of the aorta obstruction to ____ outflow leads to pressure hypertrophy of _____?
LV; LV
S/S of Coarctation?
diminution or absence of femoral pulses, high BP in upper extremities, 90% systolic htn of upper extremities, pulse discrepancy is rt vs lt arms, cardiomegaly, rib notching on xray
What is HLHS(Hypoplastic Left Heart Syndrome)?
mitral and aortic valves absent or stenosed along with an abnormally small LV and aorta.
S/S of HLHS?
tachypnea, dyspnea, decreased peripheral pulses, no murmur, cardiomegaly on chest Xray
What is the pulmonary artery is the outflow tract for the left ventricle and the aorta is the outflow tract for the right ventricle?
TGA or TGV (Transposition of the Great Vessels(arteries))
TGA results in?
cyanosis, hypoxia, acidosis, death
What is the pulmonary veins empty somewhere other then the left atrium?
Total Anomalous Pulmonary Venous Connection(TAPVC)
What are some s/s of TAPVC?
left - right shunt, pul. edema, pul. htn, cyanosis,
What is a single large vessel empties both ventricles and provides circulation for the pulmonary, systemic, and coronary circulation?
Truncus Arteriosus
In TA there is increased ______ _______ ______ resulting in dyspnea, tachypnea, CHF.
Pulmoary blood flow
What is Rastelli procedure used to tx?
Truncus
In VSD when do CHF symptoms begin to appear?
1-6 months
What is a common tx for PA?
Prostaglanin E1
True or False With severe coarctation maintain the ductus with prostaglandin E is essential.
TRUE
What defects cause increased pul. blood flow(too much blood to lungs)?
ASD, VSD, AVSD or AV canal, PDA
Which way does blood shunt in ASD?
L to R; normal saturations.
If there is pul. htn in ASD what do you see?
R to L shunt, decreased O2 sats, cyanosis, blood doesn’t get oxygenated.
In ASD when is closure generally recommended?
Qp: Qs ratio greater than 2:1
True or False if hole in heart got bigger the louder the murmur.
FALSE: if hole got smaller; good sign because means its closing.
PVR is high or low in babies?
high because never used lungs before birth
What are some indications of VSD?
FTT, ages 6-12 mo w. large VSD and pulm. htn, age greater than 24 mo w. Qp:Qs ratio greater than 2:1
What makes PDA close?
O2 and prostaglandins loss.
PDA is more common in what gender and is often associated with what?
Female 3:1, Coarctation and VSD
TOF always have what kind of shunt?
R to L; always cyanotic
In a PA what provides the only blood flow to the Pulm. arteries?
PDA
What is tx for PA?
Prostaglandin E1, Digoxin, Diuretics
True or False HLHS patients sats are 75-85% all the time.
TRUE
What is the tx for TGA?
Prostins, BAS, arterial switch
