Heart IV

Question 1

Most frequent heart defect in Trisomy 21 (Down’s Syndrome)

Answer 1

Atrioventricular Septal Defect (AVSD)

Question 2

Atrioventricular Septal Defect (AVSD) is composed of two types of septal defect which are …

Answer 2

Primum type ASD and membranous type VSD

Question 3

Atrioventricular Septal Defect is a ……

Answer 3

Severe endocardial cushion defect where there is an large defect in the atrioventricular wall.

Question 4

Murmurs, failure to thrive, Cyanosis, and Pulmonary Hypertension are clinical presentations of …..

Answer 4

Coronary Heart Disease

Question 5

The following are characteristics of which type of shunt:
• Venous blood from the right heart (pulmonary circuit) is mixed with the arterial blood in the left heart.
• There is decreased pulmonary blood flow which results in cyanosis (Early Cyanosis)
• The primary cause is an ASD or VSD associated with high pressure on the right side of the heart.

Answer 5

Right to Left Shunts

Question 6

The following are characteristics of which type of shunt:
• Excess volume through the right heart and pulmonary circuit causes pulmonary hypertension
• If untreated the workload of the right ventricle is increased lead to RVH and heart failure
• If pulmonary vascular pressures rise enough lead to pulmonary edema and cyanosis (Late Cyanosis)

Answer 6

Left to Right Shunts

Question 7

The following diseases are characteristic of which type of shunt:
– VSD – ASD – PDA

Answer 7

Left to Right Shunts

Question 8

The following diseases are characteristic of which type of shunt:
– Truncus arteriosus
– Transposition of the great vessels
– Tricuspid atresia
– Total anomalous pulmonary venous return

Answer 8

Right to Left Shunts

Question 9

Congenital heart disease associated with faulty migration of ……….. cells

Answer 9

Neural Crest Cells

Question 10

Faulty migration of neural crests results in….. and cause these main defects ……

Answer 10

Abnormal partitioning of the Truncus Arteriosus

• Main defects are:

1. Tetralogy of Fallot
2. Transposition of great vessels
3. Persistent truncus (mild cyanosis)
4. Aorticopulmonary septal defects

Question 11

Anterior superior displacement of the bulbar (infundibular) septum

Answer 11

Pulmonary Stenosis

Question 12

Pulmonary Stenosis results in ……

Answer 12

Results in unequal division of the truncus arteriosus into a small (stenotic) pulmonary trunk and a large aorta riding over the interventricular septum

Question 13

Misalignment of the truncal ridges, bulbar ridges and endocardial cushions results in failed fusion of these membranous septum components

Answer 13

Ventricular Septal Defect (VSD)

Question 14

Tetralogy of Fallot is an example of a ……. shunt that results in ………….. and ……….

Answer 14

• Right to Left Shunt
• Right ventricular hypertrophy – due to increased workload resulting from pulmonary stenosis
• Overriding aorta – aorta “rides over” the interventricular septum (there is a membranous VSD as described in 1. above), receiving blood pumped from both ventricles

Question 15

Symptoms of Tetralogy of Fallot are….

Answer 15

Cyanosis occuring with vigorous crying, feeding or agitation

Question 16

Switching of aorta and pulmonary trunk that is immediately lethal unless combined with another defect – PDA, ASD, VSD

Answer 16

Transposition of the Great Vessels

Question 17

Transposition of the Great Vessels is caused by …….

Answer 17

Faulty migration of neural crest cells leads to the absence of the spiral-twist in the aortico-pulmonary septum

Question 18

Failure of complete separation of the aorta and pulmonary artery caused by Failure of neural crest cells migration leads to failure in formation of aortico-pulmonary septum

Answer 18

Persistent Truncus Arteriosus

• Must be accompanied with a VSD or immediate death

Question 19

Persistent Truncus Arteriosus is associated with which diseases?

Answer 19

DiGeorge’s syndrome

Question 20

Abnormal drainage of the pulmonary veins into the systemic venous circulation resulting in severe cyanosis immediately after birth.

Answer 20

Total Anomalous Pulmonary Venous Return (TAPVR)

• Must be accompanied with a ASD or PDA to be compatible with life

Question 21

Disease: Pericardium and heart are exposed through a defect in the chest wall
– Failure of lateral walls to fuse in Week 4

Answer 21

Ectopia Cordis

Question 22

Disease: Inflammation of pericardium caused by
• Infectious 
• Renal failure 
• Post myocardial infarction 
• Post-surgical etc.

Answer 22

Pericarditis

Question 23

Pericarditis results in ……… a sound due to roughness of the parietal lining from inflammatory process.

Answer 23

Pericardial Friction Rub

Question 24

The accumulation of excess fluid within the pericardial space from results in arteries

Answer 24

Pericardial Effusion

– Causes:
• Pericarditis
• Connective tissue diseases
• Hypothyroidism

Question 25

Rapid Large fluid (usually blood) accumulation in the pericardial space leading to compression which prevents adequate filling of the chambers

Answer 25

Pericardial Tamponade

Question 26

Clinical Signs of Pericardial Tamponade:

Answer 26

Beck’s Triad:
• Hypotension-decreased ventricular filling
• Distant heart sounds-fluid in pericardial cavity
• Distended neck veins-decreased diastole filling

Question 27

Pericardial Tamponade Causes:

Answer 27

Potential causes:
Stab wound
Myocardial infarction
Rupture of heart muscle

Question 28

Pericardial Tamponade Treatment:

Answer 28

Pericardiocentesis:
• Paraxiphoid approach – tip of the xiphoid, or between xiphoid and left costal margin, angled towards left shoulder.
• Apical approach - left 5th or 6th intercostal space

Question 29

………. vein connects basilic and cephalic at cubital fossa

Answer 29

Median Cubital Vein

Question 30

Anterior penetrating wounds would more likely penetrate which part of the heart?

Answer 30

Right Ventricle

Question 31

Enlargement of the Left Ventricle can cause dysphagia because of its ….. position of the esophagus.

Answer 31

Anterior