Exam 1 - Congenital Heart Defects Flashcards
What is the most common congenital disease?
Congenital Heart Dz
What is the most common Congenital Heart Dz?
Ventricular Septal Defect
Common risk factors for CHD?
Premarure, FHx, maternal infection in utero, rubella, genetic sundromes
Left to Right shunting of blood does what to the size/shape right side of the heart?
Dilates the right side of the heart
Right heart dilation causes what to the RV and pulmonary artery?
Decreased RV function and dilated pulmonary artery, then increased pulm vasculature
Is Left to Right shunting cyanotic?
No
Is Right to Left shunting cyanotic?
Yes
Why prenatal US so important?
To catch CHDs. New baby screenings only catch 50%
What is an Atrial Septal Defect? Shunt goes which way? Cyanotic?
Hole in atrial septum between RA and LA. Left to right shunting (noncyanotic).
Two main types of ASD?
- Ostium Secundum #1
2. Ostium Primum #2
Etiology of Ostium Secundum?
Second walls does not cover second hole d/t growth retardation. Spontaneous vs genetic.
Etiology of Ostium Primum?
First and Second Walls don’t fuse to endocardial tissue
Is an Ostium Primum isolated?
Usually not isolated. AV Canal defects, VSD, MR….
Symptoms of ASD?
Usually asymptomatic. Dyspnea, fatigue, exercise intolerant, recurrent rep infx.
Murmur and sounds in ASD?
Midsystolic pulmonary ejection murmur. Fixed-splie S2. Precordial thrill/lift
PE in ASD?
Failure to thrive. HF signs (tachycardia, hepatomegaly, ralls), irregular heart beat, IE, Eisnmenger Syndrome (Left to Right shunting, clubbed fingers).
EKG on ASD?
Tall P-waves=dilated right heart.
Complete or incomplete RBBB. Right axis deviation.
DX ASD gold standard?
Echo
Tx for ASD if no Sx and small defect?
Wait until 2
Tx for ASD if have Sx?
Surgery or percutaneous transcath repair
What percent of adults have a Patent Foramen Ovale?
30%
Is PFO an ASD?
Neyt
Sx of PFO?
Asymptomatic most ofren.
+/- stroke-like sx
+/- migraine HA
PE in PFO?
Cryptogenic stroke (stroke of unknown cause)
Dx in PFO?
2d Echo w/doppler
Tx in PFO?
Treat if have cryptogenic stroke/TIA. Anticoag, antiplatelet. Surgical closure of PFO.
What class of defect is the most common of all CHDs?
Ventricular Septal Defect
VSDs are what percent of all septal defects
50%
Two main types of VSD?
- Membranous/Pesudomembranous Type 2 (most common)
2. Muscular Defect Type 4 (5-20% of VSDs)
Etiology of Membranous/Pseudomembranous VSD?
Deficiency of membranous septum. Tricuspid regurg or aneurysm. Blood from LV goes to RV.
Sx of VSD?
Asymptomatic, SOB/DOE, fatigue.
Murmur and sounds in VSD?
Holosystolic Murmur. Palpable thrill.
PE on VSD
Holosystolic murmur, palbable thrill.
Peds=failure to thrive
HF signs: tachy, hepatomegaly, rales
Dx in VSD?
2D echo w/Doppler
CXR in VSD?
Cardiomegaly
EKG in VSD?
Often normal. Rght, left, of biventricular hypertrophy.
Tx in VSD depends on what?
Depends on size, location, and complications
Tx for small Type 2 and 4 VSD?
40% close spontaneously. If not, surgial repair.
VSD can cause what sort of hypertension? How to tx?
Pulmonary HTN. Meds for vasodilation.
Which gender develops a Patent Ductus Arteriosus most often
Women, 2:1.
Risk factors for PDA?
Premature birth, congenital rubella, FHx, congenital disorders
PDA shunts from where to where? Cyanotic?
Shunts blood from aorta to left pulmonary artery. Non-cyanotic.
Sx of PDA?
Usually Asx.
Murmur and sounds in PDA?
Continuous machine-like murmur. Thrill in upper right chest.
Pulse pressure with BP in PDA?
Widended pulse pressure with decreased DBP.
Dx in PDA?
2D Echo w/Doppler
CXR= normal or cardiomegaly
EKG= normal of LVH
Tx for PDA if premature babies?
Indomethacin or Ibuprofen. Prostaglandin-ihibitor can help close PDA.
Tx for PDA if meds don’t work?
Surgical ligation, transcath closure.
pick up at coart of aorta
pick up at coart of aorta
