VI. Cardiology

Question 1

Functional closure of the ductus arteriosus

Answer 1

10-15 hours

Question 2

Anatomic closure of the ductus arteriosus

Answer 2

2-3 weeks of age

Question 3

Types of ASD

Answer 3

1. Ostium secundum (most common, 50-70%) 2. Ostium primum (15%) 3. Sinus venosus (10%)

Question 4

Enlargement of the right side of the heart (RA, RV, PA), may be asymptomatic in children due to high rate of spontaneous closure, may cause CHF and pulmonary hypertension in adults

Answer 4

ASD

Question 5

Most common CHD, enlargement of the LA, LV, MPA, may present as delayed growth and development, decreased exercise tolerance, repeated pulmo infections, precordial bulge and CHF

Answer 5

VSD (Tx: Digoxin and diuretics for CHF; surgery)

Question 6

Common in premature infants; due to the persistent patency of a normal fetal strcuture between the left PA and the descending aorta; enlarged LA,LV, MPA, and aorta; tachycardia; exertional dyspnea; hyperactive precordium, bounding peripheral pulses with wide pulse pressure

Answer 6

PDA (Tx: nonsurgical closure with stainless coils, surgival closure)

Question 7

The aorta arises from the RV carrying desaturated blood to the body while the PA arises posteriorly from the LV carrying oxygenated blood to the lungs; defects that permit mixing of the 2 circulations like ASD, VSD, or PDA permits survival

Answer 7

TGA (Tx: 1. Palliative: Rashkind-balloon atrial septostomy; Blalock Hanlon-atrial septostomy 2. Definitive: switch R and L sided blood at 3 levels: Senning or Mustard-atrial, Rastellie-ventricular, Jatene-great artery)

Question 8

Most common cause of cyanotic disease in the NEWBORN; sever arterial hypoxemia unresponsive to O2 inhalation; signs of CHF with dyspnes and feeding difficulties

Answer 8

TGA

Question 9

CXR: egg shaped cardiac silhoutte

Answer 9

TGA

Question 10

CXR: boot shaped heart (small heart size, decreased pulmonary markings, concave MPA with an upturned apex)

Answer 10

TOF (Tx: Blalock Taussig (above 3 y/o); Gore-Tex shunt (under 3 months); total repair of the defect (patch closure of VSD and widening of the RVOT by resection)

Question 11

Paroxysm of hyperpnea, irritability, prolonged crying, increasing cyanosis, decreasing intensity of murmur seen in TOF

Answer 11

Hypoxic/Tet spells (Tx: put child in knee-chest position to trap the systemic venous blood in the legs, decreasing systemic venous blood return and helps calm the baby)

Question 12

Components of TOF

Answer 12

P-R-O-Ve: pulmonary stenosis, RVH, overriding of the aorta, VSD

Question 13

Results in a hypoplastic right ventricle with VSD, ASD, and pulmonary stenosis

Answer 13

Tricuspid atresia (Tx: 1. Blalock-Taussig - severely cyanotic 2. Pulmonary arterial banding 3. Bdrectional Glenn shunt - anastomosis bet the SVC and PA (4-8mos) 4. Modified Fontan operation - 1.5-3y/o)

Question 14

Results from a failure of development of the spiral septum which separates the embryologic precursor of the aorta and the PA; PA arise from the aorta; a large VSD is always present

Answer 14

Truncus Arteriosus (Tx: Rastelli repair)

Question 15

All 4 pulmonary veins drain to the RA leading to RV overload; CXR: SNOWMAN’S SIGN

Answer 15

TAPVR