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N 4300 > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

What is an opening in the atrial septum permitting free communication of blood between the atria?

A

ASD: Atrial Septal Defect

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2
Q

What are the three types of ASD?

A

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

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3
Q

True or False most ASD are asymptomatic but may tire easy and have mild growth failure.

A

TRUE

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4
Q

What are some s/s of ASD?

A

hyperactive precordium, RV heave, fixed widely split S2

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5
Q

What causes the systolic and diastolic murmurs of ASD?

A

s: caused by increased flow across the pulmonary valve
d: is caused by increased flow across the tricuspid valve

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6
Q

What is an abnormal opening in the ventricular septum, which allows free communication between the Rt and Lt ventricles?

A

VSD: Ventricular Septal Defect

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7
Q

What is the most common type of VSD? which usually closes up?

A

perimembranous; muscular

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8
Q

In VSD the left to right shunt occurs secondary to ______ being less than _________, not the higher pressure in the LV. Leads to what?

A

PVR; SVR

elevated RV and pul. pressures, vol. hypertrophy of LA and LV

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9
Q

True or False small- moderate VSD are asymptomatic and will close by 2 yrs of age.

A

TRUE

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10
Q

True or False harsh holosystolic murmur heard along the LSB, more prominent with Large VSD, may be absent with a small VSD

A

FALSE: prominent with a small VSD

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11
Q

True or False in VSD endocarditis prophylaxis is necessary.

A

TRUE

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12
Q

What results from incomplete fusion of the endocardial cushions?

A

AVSD: Atrioventricular Septal Defect

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13
Q

What genetic disease is AVSD more commonly seen in?

A

Down Syndrome

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14
Q

What is the most common incomplete form of AVSD?

A

Primum ASD, cleft in the MV & small VSD

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15
Q

What are some S/S of AVSD?

A

recurrent pul. infections, failure to thrive, tire easy, wide, fixed splitting S2, pul. systolic ejection murmur w. thrill, holosystolic murmur @ apex, cardiac enlargement

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16
Q

True or False AVSD may or may not require surgery.

A

FALSE: always does

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17
Q

What is persistence of the normal fetal vessel that joins the PA to the aorta?

A

PDA: Patent Ductus Arteriosus: normally closes first wk of life.

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18
Q

What TORCH infection is PDA associated with?

A

Rubella

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19
Q

In PDA, as a result of higher aortic pressure blood shunts ____ to _____ thru the ductus from _______ to _________ __________. In extreme cases what happens?

A

L;R; Aorta, PA; 70% of CO is shunted to pulm. circulation

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20
Q

True or False in PDA, PA pressures are greater than systemic pressures.

A

FALSE: Equal

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21
Q

What are some s/s of PDA?

A

FTT, bounding arterial pulses, widened pulse pressure, enlarged heart, classic continuous machinery systolic murmur.

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22
Q

What is tx for PDA?

A

surgery or catheter closure

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23
Q

What three heart disorders decrease pulmonary blood flow?

A

Pulmonary stenosis, TOF(Tetralogy of Fallot), Pulmonary Atresia(PA)

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24
Q

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?

A

Pulmonary Stenosis; ventricular septum

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25
Q

What is the flow of the heart?

A

RA, RV, PA, lungs, P. vein, LA, LV, aorta, body

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26
Q

What syndrome is PS associated w?

A

Noonan’s syndrome, secondary to valve dysplasia

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27
Q

What does RV pressure hypertrophy in PS lead to?

A

RV failure

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28
Q

True or False cyanosis is indicative of critical PS

A

TRUE

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29
Q

What to tx of choice for PS?

A

Balloon valvuloplasty, surgical valvotomy

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30
Q

Tetralogy of Fallot (TOF) is a combination of what for defects?

A

PS, RVC hypertrophy, VSD, Overriding Aorta

31
Q

TOF has what kind of shaped heart?

A

Boot

32
Q

What are some s/s of TOF?

A

episodic loss of LOC, and squatting when fatigued to increase pul. flow and thus O2 saturations, RV hypertrophy

33
Q

What is the absence of communication between the right ventricle and the pulmonary artery?

A

Pulmonary Atresia

34
Q

What are some s/s of PA?

A

cyanosis present at birth, tachy, pul. edema, hepatomegaly

35
Q

What defects cause obstructed systemic blood flow?

A

AS(Aortic Stenosis), Coarctation of the Aorta, HLHS(Hypoplastic Left Heart Syndrome), Mitral Stenosis, Interrupted Aortic Arch

36
Q

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?

A

Aortic Stenosis

37
Q

What are the three types of AS?

A

Valvular(most common), subvalvular(subaortic) involves the left outflow tract, Supravalvular involves the ascending aorta and is the least common.

38
Q

What are some moderate S/S of AS?

A

chest pain, dyspnea, dizziness.

39
Q

What are the systolic pressure gradients in mild AS? mod AS? Severe AS? Critical AS?

A

0-25 mm hg, 25-50 mm hg, 50-75 mm hg, greater than 75 mm hg.

40
Q

What are some signs of Severe AS?

A

weak pulses, LS heart failure, sudden death

41
Q

What type of patients is AS surgery reserved for?

A

pts w symptoms, and a resting gradient of 60-80 mm hg

42
Q

True or false for supravalvular stenosis it is reserved for gradient of 40-50 mm hg bc of its progression.

A

FALSE: subaortic stenosis

43
Q

True or False Balloon Valvoloplasty is standard tx for AS.

A

TRUE

44
Q

What is a narrowing of the aorta at varying points anywhere from the transverse arch to the iliac bifurcation?

A

Coarctation

45
Q

What other heart anomaly is coarctation associated with?

A

Bicuspid aortic valve

46
Q

True or False Pts with Coarctation are PDA dependent.

A

TRUE

47
Q

In coarctation of the aorta obstruction to ____ outflow leads to pressure hypertrophy of _____?

A

LV; LV

48
Q

S/S of Coarctation?

A

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

49
Q

What is HLHS(Hypoplastic Left Heart Syndrome)?

A

mitral and aortic valves absent or stenosed along with an abnormally small LV and aorta.

50
Q

S/S of HLHS?

A

tachypnea, dyspnea, decreased peripheral pulses, no murmur, cardiomegaly on chest Xray

51
Q

What is the pulmonary artery is the outflow tract for the left ventricle and the aorta is the outflow tract for the right ventricle?

A

TGA or TGV (Transposition of the Great Vessels(arteries))

52
Q

TGA results in?

A

cyanosis, hypoxia, acidosis, death

53
Q

What is the pulmonary veins empty somewhere other then the left atrium?

A

Total Anomalous Pulmonary Venous Connection(TAPVC)

54
Q

What are some s/s of TAPVC?

A

left - right shunt, pul. edema, pul. htn, cyanosis,

55
Q

What is a single large vessel empties both ventricles and provides circulation for the pulmonary, systemic, and coronary circulation?

A

Truncus Arteriosus

56
Q

In TA there is increased ______ _______ ______ resulting in dyspnea, tachypnea, CHF.

A

Pulmoary blood flow

57
Q

What is Rastelli procedure used to tx?

A

Truncus

58
Q

In VSD when do CHF symptoms begin to appear?

A

1-6 months

59
Q

What is a common tx for PA?

A

Prostaglanin E1

60
Q

True or False With severe coarctation maintain the ductus with prostaglandin E is essential.

A

TRUE

61
Q

What defects cause increased pul. blood flow(too much blood to lungs)?

A

ASD, VSD, AVSD or AV canal, PDA

62
Q

Which way does blood shunt in ASD?

A

L to R; normal saturations.

63
Q

If there is pul. htn in ASD what do you see?

A

R to L shunt, decreased O2 sats, cyanosis, blood doesn’t get oxygenated.

64
Q

In ASD when is closure generally recommended?

A

Qp: Qs ratio greater than 2:1

65
Q

True or False if hole in heart got bigger the louder the murmur.

A

FALSE: if hole got smaller; good sign because means its closing.

66
Q

PVR is high or low in babies?

A

high because never used lungs before birth

67
Q

What are some indications of VSD?

A

FTT, ages 6-12 mo w. large VSD and pulm. htn, age greater than 24 mo w. Qp:Qs ratio greater than 2:1

68
Q

What makes PDA close?

A

O2 and prostaglandins loss.

69
Q

PDA is more common in what gender and is often associated with what?

A

Female 3:1, Coarctation and VSD

70
Q

TOF always have what kind of shunt?

A

R to L; always cyanotic

71
Q

In a PA what provides the only blood flow to the Pulm. arteries?

A

PDA

72
Q

What is tx for PA?

A

Prostaglandin E1, Digoxin, Diuretics

73
Q

True or False HLHS patients sats are 75-85% all the time.

A

TRUE

74
Q

What is the tx for TGA?

A

Prostins, BAS, arterial switch

N 4300 (8 decks)

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