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Cardiovascular > EXAM #2: ACYANOTIC HEART DISEASE > Flashcards

EXAM #2: ACYANOTIC HEART DISEASE Flashcards

1
Q

Why do holes in the heart create left-to-right shunts?

A

PVR is less than SVR*

Blood takes the path of less resistance

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2
Q

What is the most common type of ASD?

A

Secundum type

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3
Q

What is a Secundum Type ASD?

A

Patent foramen ovale that does NOT close gets called a “Secundum ASD”

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4
Q

What is a Primum ASD?

A

Low ASD

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5
Q

What is a Sinus Venosum ASD?

A

ASD up near the SVC

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6
Q

What are the complications of a left-to-right shunt in an ASD?

A

Volume overload of the:

1) RA
2) RV
3) Lungs

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7
Q

What determines the magnitude of the shunt?

A

1) Size

2) Relative compliance of the RV

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8
Q

What are the physical findings associated with an ASD?

A

1) Ejection murmur at pulmonary listening area
- Relative pulmonary stenosis b/c of increased volume, not actual decrease in valve size
2) S2 is widely split and fixed

No murmur from the flow across the defect itself

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9
Q

What are the ECG findings associated with an ASD?

A

1) RAE
2) RAD
3) RVH (tall R-waves on right precordium, which are actually a sign of dilation, not hypertrophy)

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10
Q

What are the signs of an ASD on CXR?

A

1) Increased pulmonary vasculature
2) Enlarged heart
3) Large pulmonary artery segment

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11
Q

What happens if a significant ASD is not identified or fixed? When do these symptoms present?

A
  • Pulmonary Hypertension
  • Atrial arrhythmias

BOTH in 3rd or 4th decade of life

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12
Q

What are the interventions for an ASD?

A

1) Open heart surgery
- Prosthetic patch
- Patient’s own pericardium
2) Device closure in cath. lab

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13
Q

What is an ASO?

A

Amplatzer Septal Occluder

*This is the device placed in the cath. lab to treat an ASD

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14
Q

What is the most common form of congenital heart disease?

A

VSD

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15
Q

What is the most common type of VSD?

A

Perimembranous

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16
Q

What is a Perimembranous VSD?

A

VSD in the membranous portion of the IV septum that can be:

1) Just below the aortic valve on the LEFT septum
2) Adjacent to the tricuspid valve on the RIGHT side of the septum

*Note that if on the right side of the septum, the shunt may be limited by the tricuspid valve

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17
Q

Where are muscular VSDs located? What is the unique clinical implication about these VSDs?

A

Located in the muscular portion of the IV septum

*EXCELLENT chance of spontaneous closure

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18
Q

What is an inlet VSD?

A

VSD associated with the AV valves i.e. the inlet of blood into the ventricles

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19
Q

What is an outlet or “supracritsal VSD?”

A

VSD associated with the pulmonary and aortic annuli

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20
Q

What is the impact of a small VSD?

A

No hemodynamic change

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21
Q

What direction is the shunt in VSD?

A

Left-to-right

*B/c PVR is less than SVR

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22
Q

Where will volume overload be in VSD?

A

1) Lungs (also pressure overloaded)
2) LA
3) LV

Blood basically goes from the LV directly into the pulmonary artery and does NOT fill the RV as one might think

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23
Q

What is the utility of the QP/QS ratio? Where is this measurement taken?

A

In the cath. lab, the following data is obtain:
QP= pulmonary a. flow
QS= systemic arterial flow

  • Normal= 1:1
  • Greater than 1.7:1 ratio= significant shunt
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24
Q

What are the implications of a large VSD?

A

1) Delayed growth and development
2) Decreased excercise tolerance
3) Frequent pulmonary infections
4) CHF

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25
Q

What is Eisenmeger Syndrome?

A

Reversal of left-to-right shunt b/c of increased PVR, greater than SVR

*Inoperable

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26
Q

What are the PE findings associated with a large VSD?

A

1) Poor weight gain
2) CHF
3) Systolic thrill
4) Systolic regurgitant murmur
5) Possible diastolic rumble with large shunt

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27
Q

What causes the murmur in a VSD?

A

Turbulent flow across VSD

V.s. an ASD where the murmur is not associated with flow across the hole itself

28
Q

Is it normal to not hear the murmur of a VSD in the first few day of life?

A

Yes–PVR and SVR are relatively equal at birth

29
Q

What ECG findings are associated with a large VSD?

A

1) LAE
2) LVH

IF pulmonary HTN, RVH

30
Q

What will a CXR show in a large VSD?

A

1) Cardiomegaly of varying severity

2) Increased pulmonary vascularity

31
Q

Which murmurs are most likely to close spontaneously?

A

1) Small membranous

2) Muscular

32
Q

How can VSDs be medically managed with drugs?

A

1) Digoxin
2) Diuretic
3) ACE inhibitor

*Also, high calorie intake

33
Q

What are the surgical indications for a VSD?

A

1) Growth failure

2) Large VSD at 6-12 months (i.e. no spontaneous closure)

34
Q

What are the contraindications for surgical intervention in a VSD?

A

1) Increased PVR

2) Cyanosis from Eisenmenger Syndrome

35
Q

What direction is the shunt in PDA?

A

Aorta to PA b/c PVR is less than SVR

36
Q

When is PDA a common problem?

A

Premature infants

37
Q

How does a PDA present on PE?

A

1) Tachycardia
2) Hyperactive precordium
3) Bounding peripheral pulses with a wide pulse pressure

*Wide pulse pressure b/c you have systole followed by run-off into the PDA, dropping the diastolic pressure

38
Q

How is the murmur of PDA described?

A

Continuious machine-like murmur

39
Q

What ECG changes associated with a PDA?

A

1) LAE
2) LVH
3) LAD

40
Q

What CXR finding is associated with a large PDA?

A

Cardiomegaly

41
Q

What is the deciding point about whether or not a PDA will close spontaneously?

A

1 week

42
Q

How can a PDA be medically managed, especially in a premature infant?

A

Indomethacin (prostaglandin synthetase inhibitor)

43
Q

How is a PDA managed surgically?

A

Ligation and division via left thoracotomy

44
Q

What is an Atrioventricluar Septal Defect (AVSD)?

A

Large communication at center of the heart

  • Lower atrial septum missing
  • Inlet portion of ventricular septum missing

*Note that this is also called an: endocardial cushion defect, complete ASD , or AVSD

45
Q

What is a complete atrioventricular septal defect associated with?

A

Down Syndrome

Definite test question

46
Q

How does a AVSD present?

A

1) Failure to thrive

2) CHF

47
Q

What should you do with a child that has Down’s Syndrome and left axis deviation at birth?

A

Highly suspicious for AVSD

48
Q

When are murmurs caused by ventricular outflow obstruction first heard?

A

At birth

49
Q

Outline the pathophysiology of pulmonary stenosis.

A

1) Elevated RV pressure to force blood across stenotic valve
2) RVH ensues
3) Causes RV heart failure

*Possible tricuspid regurgitation

50
Q

What is “critical” pulmonary stenosis?

A

PS with Cyanosis!

  • Possible hypoplasia of RV
  • Right-to-left shunt across patent foramen ovale
51
Q

How will the ECG appear in a child with pulmonary stenosis?

A

Relatively normal at first with:

  • RAD
  • RVH
52
Q

What is the preferred treatment for Pulmonary Stenosis?

A

Balloon valvuloplasty

53
Q

Outline the pathophysiology of aortic stenosis.

A

1) Elevated LV pressure to overcome stenotic aortic valve
2) LVH ensues
3) Left-sided failure

*Mitral valve regurgitation may occur

54
Q

How is aortic stenosis treated?

A

Balloon valvuloplasty in cath lab

*Note that results not as good as for PS AND need to be much more conservative

55
Q

What is the Ross Procedure?

A

1) Remove diseased aortic valve
2) Transplant patient’s pulmonic valve to aortic position–it will grow
3) Cadaver pulmonary valve

56
Q

What is the defect seen in Coarctation of the Aorta?

A
  • Abnormal tissue “shelf” is located in the “juxtaductal” region of the aorta itself
  • Left Subclavian a. is often near the site of the shelf/coarctation
57
Q

Outline the pathophysiology of Coarctation of the Aorta.

A
  • Abnormal tissue shelf obstructs blood flow from the LV
  • Obstruction is PAST the subclavian arteries
  • Consequently, BP in arms is HIGH and legs is LOW
58
Q

What is the classic sign of Coarctation of the Aorta?

A

Arm BP/pulses higher/stronger than leg

59
Q

What causes acute obstruction in Coarctation of the Aorta?

A

Closure of the ductus arteriosus

*This is like a pressure valve allowing some of the LV blood an “escape”–until it closes

60
Q

What are historical indications of Coartation of the Aorta?

A
  • Poor feeding
  • Dyspnea
  • Poor weight gain

*Or acute circulatory shock if ductus arteriosus closes

61
Q

What are the physical exam signs of Coarctation of the Aorta?

A
  • Pallor

- Dyspnea

62
Q

What are the ECG findings associated with Coarctation of the Aorta?

A
  • RVH in young children

- LVH in older children

63
Q

Describe the natural history of Coarctation of the Aorta.

A

1) CHF by 3 months of age

2) Renal impairment if late diagnosis

64
Q

How is Coarctation of the Aorta managed medically?

A

1) PGE1 to maintain ductal patency
2) Anti-congestive medications
3) Balloon angioplasty

65
Q

How is Coarctation of the Aorta managed surgically?

A

Resection via:

1) End-to-end anastomosis (small tissue shelf)
2) Conduit between “good” ends if defect is long

Cardiovascular (38 decks)

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