Nov21 M3-Congenital Heart Disease

Question 1

acyanotic vs cyanotic heart disease

Answer 1

cyanotic = O2 saturation is affected

Question 2

acyanotic CHD

Answer 2

ASD, VSD, coarctation of the aorta

Question 3

cause of PDA (patent ductus arteriosus)

Answer 3

deficient levels of PG E1 at birth so no closure of ductus arteriosus

Question 4

cyanotic CHD

Answer 4

Tetralogy of Fallot

Eisenmenger syndrome

Question 5

what causes foramen ovale closure at birth

Answer 5

increase in LA pressure and drop in RA pressure

Question 6

PFO (patent foramen ovale) clinical significance

Answer 6

common (25%) and no significance unless stroke or DVT

Question 7

PFO is one of many _______

Answer 7

ASDs

Question 8

types of ASDs

Answer 8

secundum, primum, sinus venosus defect (superior or inferior)

Question 9

secundum ASD (most common) def

Answer 9

inadequate formation of septum secundum or too much resorption of septum primum

Question 10

secundum ASD main causes

Answer 10

• sporadic cases

- inheritable 2e ASD where radial bone missing (familial septal defect or Hold-Oram syndrome)

Question 11

primum ASD assoc with what

Answer 11

endocardial cushion defect (AVCD = AV canal defect or AVSD)

Question 12

1 ASD problem where

Answer 12

inferior portion of atrial septum

Question 13

sinus venosus defect assoc with what

Answer 13

partial anomalous pulm venous return (one pulm vein connected to SVC)

Question 14

ASD prob with time

Answer 14

shunt lesions are all volume loaded. blood moves from high P to low P. Overload RA and lungs with time

Question 15

ASD treatment

Answer 15

closure if symptomatic arrhythmia and enlarged RV + treat arrhythmia

Question 16

why ASD takes much more time than VSD to develop

Answer 16

atrium very compliant

Question 17

ventricular septum components

Answer 17

• Infudibular septum
• membranous septum
• AV or inlet or subarterial septum
• trabecular or muscular septum

Question 18

most common VSD

Answer 18

membranous septum defect

Question 19

what determines degree of shunting and hemodynamci effect in VSD

Answer 19

size of shunt + PVR and TPR (systemic and vascular R)

Question 20

murmur rule in VSD

Answer 20

smaller hole, louder murmur, small significance

Question 21

which VSDs cause RV enlargement

Answer 21

muscular VSDs (trabecular)

Question 22

which VSDs cause LV enlargement

Answer 22

membranous and subarterial (inlet or AV) septum defects

Question 23

VSD best to worst

Answer 23

asymptomatic-small, dyspnea-large, Eisenmenger (dyspnea + cyanosis)-large

Question 24

jet velocity def

Answer 24

speed of jet across shunt. created by LV pressure - RV pressure gradient (VSD jet pressure)

Question 25

Eisenmenger syndrome def

Answer 25

large L to R shunt led to pulm pressure and resistance higher than systemic ones, eventually reversal of shunt and cyanosis

Question 26

coarctation of the aorta def + 2 types

Answer 26

narrowing of aorta near ligamentum arteriosum. post-ductal and preductal

Question 27

coarctation of the aorta main problems

Answer 27

LV hypertrophy, less blood flow to lower body (head is ok), high BP in both arms or right arm if is b4 left subclavian

Question 28

coarctation of the aorta treatment (neonate vs child vs adult)

Answer 28

neonate: PG to make a PDA child: surgery adult: balloon or surgery

Question 29

4 anomalies in ToF

Answer 29

VSD, RV hypertrophy, subvalv or valv PS, overriding aorta

Question 30

condition where ToF seen

Answer 30

DiGeorge Syndrome (22q11 deletion)

Question 31

cause of ToF

Answer 31

anterior and cephalad displacement of the infundibular septum

Question 32

why cyanosis in ToF

Answer 32

pulm stenosis creates resistance + R to L shunt

Question 33

importance of PS in ToF

Answer 33

protects from pulm htn (phtn)

Question 34

tet spells def

Answer 34

ToF in children causes dyspnea on exertion. after exercise, have cyanosis, hypervent, syncope, irritability, convulsions

Question 35

tet spells what children do

Answer 35

squat (increases systemic resistance. less R to L shunting

Question 36

ToF treatment

Answer 36

surgery: close VSD. relieve PS

Question 37

2 important exam signs in ToF

Answer 37

clubbing, low O2 sat