Congenital heart issues

Question 1

etiology of coarctation of the aorta

congenital?

acquired?

Answer 1

congential -Turner’s syndrome

acquired -(Rare)- Takayasu arteritis

Question 2

Clinical features of coarctation of the aorta

Answer 2

Upper body- well developed and HTN with headaches and epistaxis. Hear a left interscapular systolic continuous murmur

Lower body - underdeveloped and claudication Brachial femoral pulse delay

Upper and lower body BP differs

Question 3

Diagnosis of coarctation of the aorta

Answer 3

ECG (LVH) CXR - inferior notching of hte 3rd to 8th ribs 3” sign due to aortic indentation TTE

Question 4

Treatment of coarctation of the aorta

Answer 4

balloon angioplasty and stent placement or surgery

Question 5

most common associated defect with Coarctation of aorta is:

Answer 5

bicuspid aortic valve (seen in 40% of cases)

Question 6

Large ASD can cause a left to right shunt and this can result in these findings on EKG

Answer 6

QRS can be prolonged wit ha rSr’ or rsR’ configuration which can cause a incomplete or complete RBBB on EKG. Can also see 1st degree AV block R axis deviation or P wave changes suggestive of RAH

Question 7

Ebstein’s anomaly can also have

Answer 7

WPW accessory pathway in 20% of the time.

Question 8

atrial septal defect (ASD) and moderate to large left to right shunt have increased flow through (which valve)

Answer 8

through the pulmonic valve and creates a mid systolic ejection murmur due to a large left to right shunting.

symptoms vary depending on severity of shunt and often occur by age 40.

Tx is surgical repair.

Initial symptoms are: fatigue, afib or flutter, stroke due to paradoxical embolism or pulmonary HTN. cyanosis only seen with theres’ another congenital malformation like pulmonary stenosis.

Question 9

what is characteristic of ASD murmur?

Answer 9

wide and fixed split second heart sound.

Question 10

continuous murmur in left infraclavicular region

Answer 10

patent ductus arteriosus

Question 11

moderate sized PDA can present with

Answer 11

dyspnea and exercise intolerance due to LV failure and wide pulse pressure

see bounding pulses and laterally displaced apical impulse

Question 12

large PDA can have

Answer 12

left to right shunting that leads to left ventricular LV volume overload and high output heart failure in infancy and early childhood.

If untreated, can progress to pulmonary HTN and Eisenmenger syndrome (Right to left shunting)

Question 13

pts who have unrepaired PDA are at greater risk for

Answer 13

infective endarteritis or PDA related endocarditis esp if there’s associated pulmonary HTN

see vegetations affecting the pulmonary end of PDA and leading to septic emboli

Question 14

indication for closure of PDA

Answer 14

history of infective endarteritis and infective endocarditis.

Question 15

congenital coarctation of aorta increases risk for

Answer 15

aortic dissection and intracranial aneurysm

see higher upper body HTN and decreased blood flow to extremities can have headaches and epistaxis

Question 16

PDA

Answer 16

Question 17

continuous cardiac murmur, HTN, and diminished femoral pulses are suggestive of

can also have severe HTN that causes headaches blurred vision or epistaxis or even can present as aortic dissection.

Answer 17

coarctation of aorta

Question 18

coarctation of aorta is seen with this other congenital syndrome

Answer 18

Turner’s syndrome = see phenotypic features of short stature, short webbed neck and broad shaped chest with widely spaced nipples and facies with micrognathia and high arched palate

see bicuspid aortic valve in 20-30% of these pts too.

can also see aortic root dilation and dissection.

Question 19

Down’s syndrome cardiac manifestatsion (trisomy 21)

Answer 19

see atrioventricular septal defects, VSD, atrial septal defects, tetraology of Fallot and PDA.

Question 20

Turner’s syndrome skeletal symptoms:

Answer 20

see short stature, short webbed neck, scoliosis and cubitus valgus and short metacarpals

Question 21

tetralogy of fallot anatomical features

Answer 21

Right ventricular hypertrophy

pulmonary stenosis

overriding aorta

VSD

most common form of congenital cyanotic heart disease

seen with Down’s syndrome