Lec 13 : Grown-up Congenital Heart Diseases (Adult)

Question 1

The following murmurs have female predominance EXCEPT

a. patent ductus arteriosus
b. Ebstein anomaly
c. aortic valve stenosis
d. atrial septal defect

Answer 1

c. aortic valve stenosis

F: PDA, EA, ASD, VSD w/ PDA
M: AS, CoA, TGA, TA, PA, hypoplastic LV

Male lesions are more severe.

Question 2

This is the most common diagnosed CHD in adults.

Answer 2

ASD

ASDs are generally asymptomatic at birth and up until older age. Symptoms appear after Eisenmengerization.

Question 3

Cyanosis is a manifestation of what kind of shunts?

Answer 3

right to left shunts

Question 4

Differentiate hypertrophy from enlargement.

Answer 4

hypertrophy - pressure overload

enlargement - volume overload

Question 5

True of potential hematologic complications of CHDs EXCEPT.

a. low hematocrit
b. bleeding diathesis
c. artifactual thrombocytopenia
d. abnormal von Willebrand factor
e. NOTA

Answer 5

a. low hematocrit

Patients with CHDs tend to have high hematocrit and symptomatic hyperviscosity due to compensatory erythropoiesis.

Question 6

Give 3 potential respiratory complications of CHDs.

Answer 6

decreased compliance
compression of airways
scoliosis
hemoptysis
phrenic nerve injury
recurrent laryngeal nerve injury
pulmonary thromboembolism

Question 7

This type of embolism happens when an embolus from the venous system crosses a septal defect and goes into the systemic circulation causing end-organ block of blood flow.

Answer 7

paradoxic embolism

Question 8

Which of the following is the worst sequelae of CHD repair?

a. thromboembolism
b. myocardial dysfunction
c. sudden death
d. persistent shunts
e. NOTA

Answer 8

c. sudden death

There may be a chance of survival in other events.

Question 9

Which of the following CHDs is associated with the greatest risk for sudden death?

a. univentricular hearts
b. TGA
c. CoA
d. TOF
e. AS

Answer 9

a. univentricular hearts (first in the list)

b. TGA (most severe since cyanotic just right after birth)

Question 10

The following are causes of volume overload in left-sided heart failure EXCEPT

a. R-L shunts
b. pregnancy
c. increased sodium intake
d. iatrogenic
e. NOTA

Answer 10

e. NOTA

All conditions lead to volume overload. Pregnancy is a physiologic state of hypervolemia.

Question 11

Which of the following is/are symptom/s of right-sided heart failure?

a. exertional dyspnea
b. distended neck veins
c. bipedal edema
d. B & C
e. AOTA

Answer 11

d. B & C

Exertional dyspnea is s symptom of left-sided heart failure.

Question 12

This complication is predisposed by flooding of lungs and is common in patients with L-R shunts.

Answer 12

Infections

Question 13

There is an increased risk (>88%) of fetal loss when maternal arterial O2 saturation reaches what level?

Answer 13

<85% O2 saturation

Question 14

This is the worst type of ASD.

Answer 14

ostium primum / primum type

This is commonly associated with valvular and ventriculad septal defects and usually may be a part of CAVSD / ECD.

Question 15

The degree of atrial shunting in ASD is determined by what two factors?

Answer 15

size of the defect

diastolic filling properties of the ventricles