Nov21 M3-Congenital Heart Disease Flashcards
acyanotic vs cyanotic heart disease
cyanotic = O2 saturation is affected
acyanotic CHD
ASD, VSD, coarctation of the aorta
cause of PDA (patent ductus arteriosus)
deficient levels of PG E1 at birth so no closure of ductus arteriosus
cyanotic CHD
Tetralogy of Fallot
Eisenmenger syndrome
what causes foramen ovale closure at birth
increase in LA pressure and drop in RA pressure
PFO (patent foramen ovale) clinical significance
common (25%) and no significance unless stroke or DVT
PFO is one of many _______
ASDs
types of ASDs
secundum, primum, sinus venosus defect (superior or inferior)
secundum ASD (most common) def
inadequate formation of septum secundum or too much resorption of septum primum
secundum ASD main causes
- sporadic cases
- inheritable 2e ASD where radial bone missing (familial septal defect or Hold-Oram syndrome)
primum ASD assoc with what
endocardial cushion defect (AVCD = AV canal defect or AVSD)
1 ASD problem where
inferior portion of atrial septum
sinus venosus defect assoc with what
partial anomalous pulm venous return (one pulm vein connected to SVC)
ASD prob with time
shunt lesions are all volume loaded. blood moves from high P to low P. Overload RA and lungs with time
ASD treatment
closure if symptomatic arrhythmia and enlarged RV + treat arrhythmia
why ASD takes much more time than VSD to develop
atrium very compliant
ventricular septum components
- Infudibular septum
- membranous septum
- AV or inlet or subarterial septum
- trabecular or muscular septum
most common VSD
membranous septum defect
what determines degree of shunting and hemodynamci effect in VSD
size of shunt + PVR and TPR (systemic and vascular R)
murmur rule in VSD
smaller hole, louder murmur, small significance
which VSDs cause RV enlargement
muscular VSDs (trabecular)
which VSDs cause LV enlargement
membranous and subarterial (inlet or AV) septum defects
VSD best to worst
asymptomatic-small, dyspnea-large, Eisenmenger (dyspnea + cyanosis)-large
jet velocity def
speed of jet across shunt. created by LV pressure - RV pressure gradient (VSD jet pressure)
Eisenmenger syndrome def
large L to R shunt led to pulm pressure and resistance higher than systemic ones, eventually reversal of shunt and cyanosis
coarctation of the aorta def + 2 types
narrowing of aorta near ligamentum arteriosum. post-ductal and preductal
coarctation of the aorta main problems
LV hypertrophy, less blood flow to lower body (head is ok), high BP in both arms or right arm if is b4 left subclavian
coarctation of the aorta treatment (neonate vs child vs adult)
neonate: PG to make a PDA
child: surgery
adult: balloon or surgery
4 anomalies in ToF
VSD, RV hypertrophy, subvalv or valv PS, overriding aorta
condition where ToF seen
DiGeorge Syndrome (22q11 deletion)
cause of ToF
anterior and cephalad displacement of the infundibular septum
why cyanosis in ToF
pulm stenosis creates resistance + R to L shunt
importance of PS in ToF
protects from pulm htn (phtn)
tet spells def
ToF in children causes dyspnea on exertion. after exercise, have cyanosis, hypervent, syncope, irritability, convulsions
tet spells what children do
squat (increases systemic resistance. less R to L shunting
ToF treatment
surgery: close VSD. relieve PS
2 important exam signs in ToF
clubbing, low O2 sat
