S2 L6.2: Congenital Heart Disease Part 2 Flashcards
One of the most common anomalies of the great vessels 8/10,000 births
Patent Ductus Arteriosus
From the bifurcation of PA to aorta just distal to the left subclavian artery
Ductus Arteriosus
Statement 1: Patent Ductus Arteriosus has a maternal history of rubella
Statement 2: If no CHF by age 10, most likely symptomatic in adulthood
a. TF
b. FT
c. TT
d. FF
a. TF
2: Asymptomatic
Membranous type is most common congenital cardiac defect
12/10,000 births
F:M = 1:1
Ventricular Septal Defect
In ventricular septal defect it may occur in isolation.
May occur in isolation
Small defects may undergo ___ (do not
need intervention)
Spontaneous Closure
Clinical Features of Ventricular Defect
Exertional dyspnea, chest pain, syncope, hemoptysis (coughing out of blood)
VS is divided into three major components:
Inlet, Trabecular, Outlet
○ Found in the muscular septum
○ Bordered entirely by myocardium
○ Can be trabecular, inlet, or outlet in location
Muscular VSDs
○ Often have inlet, outlet, or trabecular extension
○ Bordered in part by fibrous continuity between the leaflets of an AV valve and an arterial valve
Membranous VSDs
○ More common in Asian patients
○ Situated in the outlet septum
○ Bordered by fibrous continuity of the aortic and pulmonary valves
Doubly committed subarterial VSDs
● Most common cyanotic congenital heart disease
● Due to unequal division of the conus resulting from anterior displacement of the conotruncal system
Tetralogy of Fallot
Reversal of the shunting from usual L→R to R→L and develop a R sided heart failure
Eisenmenger Syndrome
Statement 1: Eisenmengerization could either be an equalization of pressure or flow reversal
Statement 2: Final consequence is flooding or inundating of the lungs d/t increased blood flow
a. TF
b. FT
c. TT
d. FF
c. TT
Development of pulmonary HTN in the presence of increased pulmonary blood flow
Eisenmenger Reaction
Association of VSD with pulmonary HTN and shunt
reversal
Eisenmenger Complex
D/t lack of O2, there will be an increase in production of vehicles that carry O2
Compensatory erythrocytosis
Failure of the conotruncal septum to follow its normal spiral course and runs straight down
Transposition of the Great Arteries
T/F: In the transposition of the Great Arteries displays cyanosis at birth which worsens shortly therafter when ductus closes
True
Failure of conotruncal ridges to fuse and to descend toward the ventricles
Persistent Truncus Arteriosus
In Persistent Truncus Arteriosus:
Statement 1: Pulmonary artery arises some distance above the origin of the divided truncus
Statement 2: Always with a VSD to redirect the blood flow
a. TF
b. FT
c. TT
d. FF
b. FT
Undivided Truncus
Symptoms of heart failure and poor physical development usually appear in the __
First weeks or months of life
Facial dysmorphism, a high incidence of extracardiac malformations, atrophy or absence of the thymus gland, Tlymphocyte deficiency, and a predilection to infection
DiGeorge syndrome
Prevalence of truncal valve regurgitation increases with age, causing __ and increasing susceptibility to __
- biventricular heart failure
- endocarditis
Involves obliteration of the right AV orifice
Absence or fusion of tricuspid valve
Severe cyanosis due to obligatory admixture of systemic and pulmonary venous blood in the left ventricle
Tricuspid Artresia
If there is no tricuspid valve, how will the blood in the right atrium reach the lungs?
Have to open the PFO and then blood will flow into the left atrium
If there is no tricuspid valve, how will blood in the left atrium reach the pulmonary bed?
There must be an opening, VSD, so that it can flow into the lungs via the pulmonary artery
Can pts with CHD exercise or do sports?
Yes and No, if pt is then corrected and the pt stamina or physical status/functional capacity is poor, then definitely you can’t allow them to do sports
Why do heart defects predispose an individual to infection?
● Bacteria loves to thrive in abnormal places
● Like in valvular heart diseases and mitral stenosis, pathogens love to live in these abnormal areas
6-STEP APPROACH TO EXERCISE IN CHD
- Know your patient
- Assess functional parameters
- Decide statis component of exercise
- Do CP stress testing
- Execute exercise program
- Followup
Pathway of Circulation in the Blood
a. Right Ventricle
b. Bicuspid Valve
c. Lungs
d. Tricuspid Valve
e. Left Ventricle
f. IVC & SVC
g. Pulmonary Semilunar Valve
h. Left Atrium
i. Pulmonary arteries
j. Aortic Semilunar Valve
k. Right Atrium
l. Pulmonary veins
m. Aorta
F
K
D
A
G
C
L
H
B
E
J
M
