L4: Acyanotic Heart Diseases - Obstructive Lesions

Question 1

Incidence of Aortic Stenosis

Answer 1

• 4 - 5 of CHD
• Males > Females

Question 2

Types of Aortic Stenosis

Answer 2

© Valvular stenosis.
© Supravalvular stenosis (Williams’ syndrome)
© Discrete subaortic stenosis
© Idiopathic hypertrophic subaortic stenosis (IHSS)

Question 3

Pathology of Aortic Stenosis

Answer 3

Question 4

Pathophysiology of Aortic Stenosis

Answer 4

Question 5

Symptoms of Aortic Stenosis

Answer 5

Question 6

Signs of Aortic Stenosis

Answer 6

Question 7

Signs of Aortic Stenosis

• General

Answer 7

Question 8

Signs of Aortic Stenosis

• Inspection & Palpation

Answer 8

Question 9

Signs of Aortic Stenosis

• Auscultation

Answer 9

Question 10

Murmur in Aortic Stenosis

• Site
• Character
• Grade
• Radiation
• Timing
• Other Murmur

Answer 10

Question 11

Investigations for Aortic Stenosis

Answer 11

Question 12

Investigations for Aortic Stenosis

• Chest X-Ray

Answer 12

Question 13

Investigations for Aortic Stenosis

• ECG

Answer 13

Question 14

Investigations for Aortic Stenosis

• ECHO

Answer 14

Question 15

Complications of Aortic Stenosis

Answer 15

• Infective endocarditis.
• Arrhythmias.
• Sudden death.
• HF in critical AS or very late

Question 16

TTT of Aortic Stenosis

Answer 16

Question 17

TTT of Aortic Stenosis

• Indications of balloon valvuloplasty

Answer 17

• Asymptomatic patient with MPG > 50 with T wave changes.
• Symptomatic patient with MPG > 50 mmHg

Question 18

Incidence of Pulmonary Stenosis

Answer 18

8 - 12 % of CHD

Question 19

Types of Pulmonary Stenosis

Answer 19

• Valvular stenosis.
• Infravalvular stenosis
• Supravalvular PS (or stenosis of the MPA)

Question 20

Pathophsyiology of Pulmonary Stenosis

Answer 20

Question 21

Symptoms of Pulmonary Stenosis

Answer 21

Question 22

Signs of Pulmonary Stenosis

Answer 22

Question 23

Signs of Pulmonary Stenosis

• General

Answer 23

Question 24

Signs of Pulmonary Stenosis

• Inspection & Palpation

Answer 24

Question 25

Signs of Pulmonary Stenosis

• Auscultation

Answer 25

Question 26

Signs of Pulmonary Stenosis

• Heart Sounds

Answer 26

Question 27

Signs of Pulmonary Stenosis

• Murmur

Answer 27

Question 28

Murmur in Pulmonary Stenosis

• Site
• Grade
• Radiation
• Timing
• Notes

Answer 28

Question 29

INVx for Pulmonary Stenosis

Answer 29

Question 30

INVx for Pulmonary Stenosis

• Chest X-Ray

Answer 30

Question 31

INVx for Pulmonary Stenosis

• ECG

Answer 31

• Right axis deviation
• RVH in moderate PS (the degree of RVH depends on the severity of PS)

Question 32

INVx for Pulmonary Stenosis

• ECHO

Answer 32

To assess the degree of the valve stenosis

Question 33

Complications of Pulmonary Stenosis

Answer 33

• CHF may develop in patients with severe stenosis.
• Sudden death is possible in patients with severe stenosis during heavy physical activities.

Question 34

TTT of Pulmonary Stenosis

Answer 34

Question 35

Natural History & Prognosis of Pulmonary Stenosis

Answer 35

Question 36

Prevelance of Coartication of Aorta

Answer 36

Question 37

Etiology of Coartication of Aorta

Answer 37

Question 38

Pathology of Coartication of Aorta

Answer 38

Question 39

Pathology of Coartication of Aorta

• Post-Ductal

Answer 39

Question 40

Pathology of Coartication of Aorta

• Pre-Ductal

Answer 40

Question 41

Pathogenesis of Coartication of Aorta

Answer 41

Question 42

Pathogenesis of Coartication of Aorta

• In Utero

Answer 42

Question 43

Pathogenesis of Coartication of Aorta

• Neonatal Period

Answer 43

Question 44

Pathogenesis of Coartication of Aorta

• At Birth

Answer 44

Question 45

Pathogenesis of Coartication of Aorta

• Compensatory Mechanisms

Answer 45

Question 45

CP of Coartication of Aorta

Answer 45

• Symptoms & Signs

Question 46

Symptoms of Coartication of Aorta

Answer 46

Question 47

Symptoms of Coartication of Aorta

• Newborn with severe COA

Answer 47

• Poor perfusion
• CHF
• Acidemia
• Deferential cyanosis.
• Shock

Question 48

Symptoms of Coartication of Aorta

• Deferntial Cyanosis

Answer 48

• O2 saturation measured in the right arm (preductal) is > in the leg (post-ductal) due to right-to-left shunting across the PDA into the descending thoracic aorta.

Question 49

Signs of Coartication of Aorta

Answer 49

Question 50

Signs of Coartication of Aorta

• General

Answer 50

Question 51

Signs of Coartication of Aorta

• Auscultation

Answer 51

Question 52

Signs of Coartication of Aorta

• Heart Sounds

Answer 52

S2 —> single & accentuated

Question 53

Signs of Coartication of Aorta

• Murmur

Answer 53

• 50% —–> No murmur
• 50% —-> Non-specific ejection systolic murmur over the precordium
• The heart murmur may become louder after treatment

Question 54

Investigations for Coartication of Aorta

Answer 54

Question 55

Investigations for Coartication of Aorta

• Chest X-Ray

Answer 55

Question 56

Investigations for Coartication of Aorta

• ECG

Answer 56

• A normal or right axis deviation
• RVH or right bundle branch block (RBBB) are present rather than LVH.
• LVH is seen in older children

Question 57

Investigations for Coartication of Aorta

• ECHO

Answer 57

2D echo and color flow Doppler studies usually show:
- Site of the coarctation
- Extent of the coarctation.

Question 58

Investigations for Coartication of Aorta

• MSCT

Answer 58

…

Question 59

Natural History of Coartication of Aorta

Answer 59

Question 60

TTT of Coartication of Aorta

Answer 60

Question 61

TTT of Coartication of Aorta

• Medical

Answer 61

Question 62

TTT of Coartication of Aorta

• Surgical

Answer 62

Question 63

TTT of Coartication of Aorta

• Balloon Angioplasty

Answer 63

Question 64

In asymptomatic patients, medical management may be ……

Answer 64