04.28 - Valve Disease 2 (Nichols)

Question 1

4 Components of Tetrology of Fallot

Answer 1

PROVe: Pulmonic Stenosis, RV Hypertorphy, Overriding Aorta, Ventricular Septal Defect

Question 2

6 Cyanotic Congenital Heart Defects

Answer 2

TOF, Transposition, Truncus Arteriosus, Total Anomalous Pulmonary Venous Return, Tricuspid Atresia, Hypoplastic Left Heart

Question 3

90% of ASD’s are

Answer 3

Ostium Secundum Defects

Question 4

ASD vs VSD: in which does Pulmonary HTN occur more quickly

Answer 4

VSD

Question 5

ASD vs VSD: which has increased risk for infective endocarditis

Answer 5

VSD due to jet lesions

Question 6

Clinical severity of TOF depends largely on

Answer 6

Degree Pulmonary Outflow Obstruction (if mild –> Condition is more benign)

Question 7

Clubbing of the tips of fingers and toes, Polycythemia, Paradoxical Embolization

Answer 7

Severe systemic cyanosis (Right-to-Left Shunts)

Question 8

Common congenital heart defect in females with Turner

Answer 8

Coarction of Aorta

Question 9

Defect in lowest part of atrial septum

Answer 9

Ostium Primum ASD

Question 10

Does Libman-Sacks Endocarditis often embolize?

Answer 10

No

Question 11

Eisenmenger Syndrome

Answer 11

When a Left-to-Right shunt reverses do to increased Pulmonary hypertension

Question 12

Harsh, “machinery-like” murmurs

Answer 12

PDA

Question 13

In Calcific Aortic Stenosis, onset of symptoms =

Answer 13

Time for valve replacement

Question 14

In more than half of cases, Coarction of Aorta is accompanied by

Answer 14

Bicuspid Aortic Valve

Question 15

In whom is Libman-Sack Endocarditis most common

Answer 15

Young Black Females (same as SLE?)

Question 16

Large, boot-shaped heart

Answer 16

Tetrology of Fallot

Question 17

Location of Ostium Secundum vs Ostium Primum

Answer 17

Ostium Secundum is Fossa Ovalis, Primum is near AV valve

Question 18

Marantic Endocarditis: common or rare

Answer 18

Common

Question 19

Markedly enlarged intercostal and internal mammary arteries

Answer 19

Postductal Coarction without PDA

Question 20

Midsystolic Click =

Answer 20

Mitral Valve Prolapse

Question 21

Morphologic changes in Ostium Secundum ASD

Answer 21

RA and RV dilation, RV hypertrophy, Dilation of Pulmonary Artery (increased volume load)

Question 22

Most common cause of cyanotic congenital heart disease

Answer 22

Tet of Fallot

Question 23

Most common congenital cardiac anomaly at birth

Answer 23

VSD

Question 24

Most common defects to be first diagnosed in adults

Answer 24

ASD’s (VSD’s more common at birth, but many close spontaneously)

Question 25

Murmur in PDA

Answer 25

Harsh, "machinery-like" murmur

Question 26

Once significant pulmonary HTN develops, the structural defects of congenital HD

Answer 26

are considered irreversible

Question 27

Ostium Primum ASD's can be related to

Answer 27

Mitral and Tricuspid valve abnormalities

Question 28

Paradoxical embolus

Answer 28

Venous embolus that enters systemic circulation (thru patent septum or foramen ovale)

Question 29

Percent of VSDs that occur in isolation

Answer 29

20-30 (Most are associated with other malformations)

Question 30

Prevalence of Probe-patent Foramen Ovale

Answer 30

20%

Question 31

Pulmonary HTN in TOF

Answer 31

No, because Pulmonic Outflow Stenosis protects pulmonary vasculature

Question 32

Result of Left-to-Right Shunts

Answer 32

Increase pulmonary resistance --> RV Hypertrophy and eventually failure or shunt reversal

Question 33

Right-to-Left shunting in TOF also increases risk of

Answer 33

Infective Endocarditis and Systemic Embolization

Question 34

RV Failure in TOF

Answer 34

Rare, no Pulmonary HTN

Question 35

Sinus Venosus ASD's are often accompanied by

Answer 35

Anomalous drainage of pulmonary veins into RA or SVC

Question 36

Site of approx 90% of VSD's

Answer 36

Basal (membranous) region (last part of septum to develop)

Question 37

Size of chambers of TOF

Answer 37

Left side normal, RV hypertrophy

Question 38

Tiny (1-2mm) verrucous (wartlike) vegetations lined up on line of valve closure

Answer 38

Acute Rheumatic Valvulitis

Question 39

Top 3 Congenital Hart Malformations

Answer 39

VSD, ASD, Pulmonary Stenosis

Question 40

Typical sequelae of Cyanotic Heart Disease

Answer 40

Polycythemia; Hypertrophic Osteoarthropathy

Question 41

What is nuclear dust

Answer 41

Basophilic debris

Question 42

What leads to radiographically visible "notchin" of the ribs

Answer 42

Postductal Coarction without PDA

Question 43

What size are vegetations of Libman-Sacks Endocarditis

Answer 43

Intermediate (bigger than Acute Rheumatic, smaller than Infective Endocarditis)

Question 44

What type of defect is Ostium Secundum

Answer 44

ASD

Question 45

When are you most likely to Eisenmenger Syndrome

Answer 45

Children with congenital heart disease with septal defects, and chronic left-to-right sunts

Question 46

When do ASD's become symptomatic

Answer 46

Adulthood

Question 47

When does Postductal Coarction without PDA present

Answer 47

Usually asymptomatic, and may remain unrecognized until adult

Question 48

When does Preductal Coarction with PDA usually present

Answer 48

Early in life, most infants don't survive neonatal period

Question 49

When is survival possible in Transposition

Answer 49

Shunt such as VSD

Question 50

When will Paraxodical embolism occur

Answer 50

If right sided pressures increase: Pulmonary HTN or Valsalva