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Congenital Heart Dz
Cardiology
| Question | Answer |
|---|---|
| Percentage of babies born with heart defect | 1% |
| Most common congenital heart malformation | VSD. 30-60% of all CHDs. 2-6/1000 live births. More common in males. |
| Second most common congenital heart malformation | atrial septal defect (30-40% of all CHDs) |
| name the two anatomic right-to-left intracardiac / great vessel shunts in utero | foramen ovale, ductus arteriosus |
| Location of the ductus arteriosus | small projection connecting the pulmonary artery to the aorta, bypassing the pulmonary circulation |
| Location of the ductus venosus | shunt from the umbilical vein to the inferior vena cava, bypassing the liver |
| Major signs and symptoms of congenital heart disease | cyanosis, dyspnea/tachypnea, syncope, failure to thrive, edema/ascites |
| lab finding consistent with cyanosis | low oxygen sat, elevated hem |
| Initial imaging modality of choice in suspected congenital heart disease | echo |
| Eisenmenger's syndrome | phenomenon occurring with long standing L to R shunts in which increasing pulmonary arterial pressures and flow rate result in shunt reversal to R to L |
| Location of ASD | hole between the right and left atria |
| 3 types of ASD | sinus venosus, ostium secundum (most common type: 6-10% of all CHDs), ostium primum |
| Most commonly diagnosed congenital cardiac defect | VSD |
| Location of VSD | hole between the right and left ventricles |
| Most common of the mixed shunts | transposition of the great arteries |
| Anatomical outcome in transposition of the great arteries | two separate closed systems |
| The two anatomical abnormalities that must be present in order for a patient to survive transposition of the great arteries: | ASD, PDA |
| Components of truncus arteriosus | single trunk from the heart, VSD |
| Tetralogy of Fallot consists of: | pulmonic stenosis, VSD, overriding aorta, RV stenosis & obstruction, RV hypertrophy |
| Anatomical abnormality that must be present for survival in tetralogy of Fallot | patent ductus arteriosus |
| Anatomical abnormality in tricuspid atresia | hypoplasia of the R ventricle |
| What keeps a PDA open? | prostaglandin E2 (inhibitors will close it) |
| Post common congenital obstructing lesion | pulmonary stenosis |
| Prominent physical findings in coarctation of the aorta | Differential BP (lower in legs), delayed femoral pulse compared with brachial; FTT; bilateral claudication; HTN; HA; S4; AS & AR murmurs |
| Anatomical cause of coarctation of the aorta | complication due to closure of the ductus arteriosus; usually located distal to left subclavian artery |
| Most rare congenital heart disease | mitral valve disease |
| Most common cyanotic heart defect (R to L shunt) | Tetralogy of Fallot |
| Shunting in ASD & VSD is typically: | left to right (TEE is TOC to determine) |
| ASD clinical features | often asx until adult; possible failure to thrive; DOE & fatigue (possible pHTN); RV lift; murmur; clubbing; cyanosis |
| VSD clinical features | FTT in infancy, dyspnea, JVD, LLSB thrill, S3, clubbing, cyanosis |
| Coarctation of aorta on CXR: | rib notching |
| PDA may result from: | maternal rubella |
| PDA clinical features | FTT; recurrent resp infxns; fatigue; DOE; angina & syncope in adults. Bounding pulse; wide pulse pressure and loud S2 |
| Small boot-shaped heart in pediatric patient = | tetralogy of Fallot |
| tetralogy of Fallot: CBC finding = | polycythemia |
| Types of acyanotic CHD (6) | ASD, VSD, PDA, coarctation of aorta, aortic stenosis (bicuspid valve), pulmonic stenosis |
| Cyanotic ductal-independent CHD | truncus, transposition, TAPVR |
| Cyanotic ductal-dependent pulmonary-flow CHD | Tricuspid atresia, tetralogy, Ebstein |
| Cyanotic ductal-dependent systemic-flow CHD | HLHS |
| How many patients with ASD develop symptoms? | 70% have sxs by their 40s (DOE, fatigue, palps, syncope) |
| In a teen/young adult with HTN, need to rule out: | coarctation of aorta |
| In 50% of cases of coarctation of aorta, one also finds: | bicuspid valve (also increased incidence of cerebral berry aneurysm) |
| Coarctation of aorta mgmt: | Prostaglandin E1; usually surgery (balloon dilation of segment) |
| What closes a PDA? | Prostaglandin inhibitors (eg, indomethacin; thus, NSAIDs are contraindicated in PG) |
| Imaging test for PDA: | MRI, CT, or CTA >> TTE |
| Tet spells = | sudden, marked increase in cyanosis followed by syncope (may result in hypoxic brain injury & death); older kids often squat during spell to improve cerebral blood flow |
| PDA prevalence | F:M 2:1. More common in preterm infants <1500gm. May be seen with VSD & coarctation of aorta. |
| Which CHD is associated with increased renin levels that may lead to HTN? | Coarctation of aorta |
| Cyanotic CHDs (5) | Tetralogy of Fallot. Transposition of the great arteries (TOGA). TAPVR. Truncus arteriosus. Tricuspid atresia. |
Created by:
Abarnard
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