Congenital heart disease

Question 1

what are the 3 types of shunts that congenital heart disease cause?

Answer 1

1. left to righ
2. right to left
3. obstruction (like coarctation of the aorta)

Question 2

a left to right heart shunt is considered what?

what will a left to right shunt cause?

what complications can be seen with left to right shunt?

Answer 2

acyanotic

vauses volume overload in the rught side of the heart

pulmonary HTN, right ventricular hypertrophy, Eisenmenger’s complex (when right ventricular pressure overrides left ventricular pressure)

Question 3

in a left to right shunt with eisenmenger’s complex, the patient will develop what?

Answer 3

cyanosis tardive = pt will develop cyanosis because the shunt eventually reverses

Question 4

what are the 3 left to right shunts?

which is the most common congenital disease?

which is the most common diagnosed in adult life?

Answer 4

VSD, ASD, PDA

VSD is the most common congenital disease

ASD is the most common to be diagnosed in adult life

Question 5

VSD is associated with what other diseases?

most of the defect occurs where?

what are the small clinical findings for VSD?

what are the large clinical findings for VSD?

Answer 5

Cri Du Chat (ch. 4), trisomies 13 adn 18

in the membranous portion of the IVS

small = spontaneous closure

large = fulminant cardiac heart failure to late cyanosis

Question 6

ASD will most commonly be caused by: ostium primum or secundum?

ASD can also be associated with what syndrome?

Answer 6

secundum is most common

Fetal Alcohol syndrome

Question 7

PDA can be associated with what?

Answer 7

congenital rubella and Resp. Distress Syndrome,

Question 8

what is a PDA?

Answer 8

duct that remains open connecting the aorta to the pulmonary artery

Question 9

What are the clinical findings of PDA?

Answer 9

pink in upper extremities

cyanotic lower extremities

heart murmur- heard in diastole and systole

Question 10

how do you treat PDA?

Answer 10

use indomethacin

Question 11

What do you call right to left heart shunt?

Answer 11

cyanotic

Question 12

what happens in a right to left heart shunt?

Answer 12

blood from unoxygenated (right) part of heart goes into the left side of the heart

Question 13

what are the complications that can be developed from a right side to left side shunt?

Answer 13

2ry polycythemia

septicemia

increased incidence of infective endocarditis

fingers and toes clubbing

Question 14

wahtare the 5 T’s of right to left heart shunts?

Answer 14

1. Tetralogy of Fallot
2. Transposition fo the Great Vessels
3. Truncus Arteriosus
4. Tricuspid Atresia
5. Total anomalous Pulmonary Venous return

Question 15

what is the most common cyanotic congenital heart disease?

Answer 15

Tetralogy of Fallot

Question 16

what are the 4 (tetra) defects of Tetralogy of Fallot?

Answer 16

1. VSD
2. Pulmonary Stenosis with Right Ventricular outflow obstruction
3. Overriding the Aorta
4. Right Ventricular Hypertrophy

Question 17

Cyanosis caused by Tetralogy of Fallot depends on what?

Answer 17

the degree of pulmonary valve stenosis

Question 18

What is pink tetralogy?

how will newborns look?

Answer 18

the amount of pulmonary valve stenosis is minimal

newborns are acyanotic at birth

Question 19

What is classic tetralogy?

how will newborns look?

Answer 19

when the degree of pulmonary valve stenosis is severe

newborns will be cyanotic at birth (most of the unoxygenated blood is passing into the left ventricle)

Question 20

what are the clinical features found in tetralogy of fallot?

Answer 20

1. cyanosis in lips and mouth
2. cyanotic spells (usually after feeding, crying or straining)
3. patient squats to improve symptoms of cyanosis
   
   • compression of femoral artery will increase pressure while decreasing the right to left shunt

Question 21

what can allow this patients to live without needing an intervention?

Answer 21

presence of ASD or PDA - a left to right shunt

Question 22

what is a transposition of the great vessels?

what part of the heart remains normla?

Answer 22

aorta arises from right ventricule and the pulmonary artery arises from the left ventricle

the atria

Question 23

patients with transposition of the great vessels can live if there is presence of what?

Answer 23

a left to right shunt (ASD or VSD or PDA)

Question 24

What happens in truncus arteriosus?

Answer 24

aorta and pulmonary artery share a common trunk causing intermixture of blood

Question 25

what happens in tricuspid atresia?

Answer 25

patients have a atrial septal defect with right to left shunt

Question 26

what happens in anomalous pulmonary venous return?

Answer 26

the pulmonary vein empties into the right atrium

Question 27

What is coarctation of the aorta?

what are the 2 types of coarctation of the aorta?

whare are the differences?

Answer 27

a segemental narrowing or constriction of the aorta

1. pre-ductal coarctation

• happens in infants
• less common
• happens before the ductus arteriosus

2. post-ductal coarctation

• happens in adults
• more common
• happens after the ductus arteriosus

Question 28

what happnes in preductal coarctation of the aorta?

Answer 28

there is a constriction of the aorta between the subclavian artery and ductus arteriosus causing a decrese in blood supply of the lower part of the body

Question 29

pre-ductal coarcatation of the aorta is associated with what other disease?

Answer 29

Turner’s Syndrome

Question 30

Is post-ductal coarctation of the aorta symptomatic always?

Answer 30

no, it is asymptomatic in early life but symptoms appear in adolescence and adult life

Question 31

in post-ductal coarctation of the aorta, the constriction of the aorta will occur where?

Answer 31

distal to the ligamentum arteriosum (remnant of ductus arteriosus)

Question 32

in a post-ductal coarctation of the aorta, with a proximal aortic constriction, what is happening?

what symptoms will you

Answer 32

more blood flows into close branches so blood pressure increases in upper extremities while the proximal aorta dilates