Exam 3, Congenital Heart Disease- Blonder

Question 1

What is patent foramen ovale

Answer 1

foramen covered by septum primum but is not sealed shut in 20% normal subjects

Question 2

how do you confirm Patent Foramen ovale

Answer 2

bubble study with IV and Echo!!

Question 3

what type of shunting occurs in patent foramen ovale

Answer 3

transient R to L shunting during onset of ventricular contraction explaining neurlogig events in non cyanotic patients

Question 4

what type of stroke can patent foramen ovale lead to

Answer 4

paradoxical so DVT emboli can cross and go to brain

Question 5

What type of overload occurs in herat with patent foramen ovale

Answer 5

R sided volume overload

Question 6

what determines severity of R heart damage in patent foramen ovale and ASD

Answer 6

how large the shunt is will determine if progress to R. HF

Question 7

What id most common adult heart defect

Answer 7

bicuspid aortic valve

Question 8

what is the second most common adult congenital defect after bicuspid aortic valve

Answer 8

ASD

Question 9

how do patients with ASD present

Answer 9

asymptomatic until adulthood

complications: atrial arrhythmias, paradoxical embolus, cerebral abscess, R HF, pulm HTN>eisenmenger syndrome

Question 10

What is eisenmenger syndrome

Answer 10

shunt reversal

Question 11

What are types of ASD

Answer 11

secundum- most common (foramen ovalis)
primum- large
sinus venosus
Scimitar syndrome

Question 12

primum ASD is associated with what other defects

Answer 12

AV valves or ventricular septum

AV canal, or endocardial cushion defect

Question 13

Sinus Venosus ASD is associated with what

Answer 13

anomalous pulmonary vein insertion

Question 14

what are 2 types of sinus venosus ASD

Answer 14

superior SVC defect

inferior IVC defect

Question 15

what is triad od scimitar syndrome

Answer 15

partial anomalous venous return
hypoplasia of a lobe of the R lung
thoracic aorta> pulmonary artery collaterals

Question 16

Most ASD have what type shunts

Answer 16

L to R

but large have R to L

Question 17

R heart volume overload in ASD defects can lead to what

Answer 17

pulmonary HTN and eisenmengers

Question 18

What size ASDs in heart are usually without symptoms

Answer 18

<8mm

Question 19

most patients with ASD become symptomatic when

Answer 19

by age 40

Question 20

What are the clinical manifestations of ASD

Answer 20

atrial arrhythmias
20% artrial fib or flutter, increases with advancing age
at risk for emoboli
migraine cephalgia
pulm HTN, eisenmenger syndrome
cyanosis (R to L)
pulmonic valve stenosis

Question 21

eisenmenger syndrome requires what pressure shunt

Answer 21

> 2.5:1

Question 22

Physical findings of ASD are related to what

Answer 22

size and location
size of shunt
pulmonary aretery pressure (R)

Question 23

What do you find on PE n precordium with ASD

Answer 23

RV heave, palpable PA at upper Left sternal border

Question 24

what additional heart sounds are heard with ASD

Answer 24

wide fixed split S2
Increased P2 with pulmonary HTN
S1 split with increase in tricuspid component

Question 25

What type of murmurs are heard in ASD

Answer 25

systolic ejection murmur Upper LSB from increased flow

early diastolic murmur in upper LSB from pulmonary insufficiency due to pulm HTN

Question 26

What is the most common congenital heart disease at birth

Answer 26

VSD

Question 27

how come VSD is not common adult congenital defect

Answer 27

spontaneous closure

Question 28

What are the types of VSD

Answer 28

Infundibular
Membranous
Inlet Defect
Muscular

Question 29

what is an infundibular VSD

Answer 29

below aortic and pulmonic valves, leading to progressive aortic regurg, the hallmark

Question 30

what is membranous VSD

Answer 30

conoventricular

deficiency of the membranous septum

Question 31

Where is an inlet defect VSD

Answer 31

AV canal, Down’s

Question 32

Where is a muscular VSD

Answer 32

in the trabecular system, 5-20%

Question 33

direction and severity of a VSD is determined how

Answer 33

functional size and ratio of pulmonary to systemic vascular Resistance

Question 34

What type of shunting occurs with small or restrictive VSD

Answer 34

L to R with no LV volume overload, no pulmonary HTN

Question 35

where is the mild volume overload seen with VSD

Answer 35

LA, LV

Question 36

what type of shunting occurs with a large VSD

Answer 36

moderate to large L to R shunts with LV volume overload

Question 37

if a large VSD is uncorrected what can occur

Answer 37

pulmonary arterial obsturctive disease with pulm HTN

Question 38

progressive pulmonary HTN can change heart how

Answer 38

Increase in RV pressure which can cause a shunt reversal of R to L (eisenmengers)

Question 39

what type of shunts cause cyanosis

Answer 39

R to L because unoxygenated blood is now systemic

Question 40

when eisenmenger syndrome is paired with a VSD what is it called

Answer 40

eisenmenger complex

Question 41

What VSD can lead to aortic regurg and why

Answer 41

membranous because right below aortic valve, can weaken the structure and cause prolapse and regurg

Question 42

On physical exam how does large VSD present

Answer 42

large holosystolic mrumur, LSB, 2nd or 3rd ICS thrill
EKG 66% normal
Echo!

Question 43

What are the 4 features of tetralogy of fallot

Answer 43

RVOT obstruction
VSD
aortic overrides IVS
concentric RVH

Question 44

Need for medical intervention in tetralogy of fallot is dependent on what

Answer 44

RVOT obstruction