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Cardiology Boards > Congenital > Flashcards

Congenital Flashcards

1
Q

BAV screening

A

First degree relatives

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2
Q

Secundum ASD anatomy

A

Absence of tissue in region of fossa ovalis (center of septum)

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3
Q

Secundum ASD shunt

A

Left to right shunt

RA and RV enlargement

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4
Q

Holt Oram Syndrome

A

Heart-hand syndrome
TBX5 mutation, AD
Associated with secundum ASD

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5
Q

Secundum ASD EKG

A

RAD, RBBB from RV overload

R wave notches in inferior limb leads

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6
Q

Secundum ASD closure indications

A 
Symptoms class I
No symptoms class IIa
No PVD - PASP < 50% systemic, PVR < 1/3 SVR, no R to L shunt on pulse ox
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7
Q

Sinus venous defect

A

Superior portion of septum, posterior to fossa ovalis
A/w anomalous RUPV
L-> R -> RV overload

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8
Q

Sinus venous defect treatment

A

Surgical closure if
impaired functional capacity
R enlargement
No cyanosis or PVD

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9
Q

Primum ASD

A

Partial A-V canal defect, inferior portion of septum
A/w Downs
AV valves abnormal, on same level, MV usually cleft
R enlargement
RBBB and LAD

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10
Q

Primum ASD treatment

A

Surgical closure if
impaired functional capacity
R enlargement
No cyanosis or PVD

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11
Q

Primum ASD associated lesions

A
  • Secundum ASD
  • VSD
  • PS
  • Subaortic stenosis - abnormal MV insertion in LVOT
  • Left SVC
  • Coarctation
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12
Q

Complete AV canal defect

A

Atrial defect above valve, ventricular below
One big AV valve
L->R shunt -> PVD
Huge R sided enlargement
Must be repaired in infancy or Eisenmenger’s develops

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13
Q

Look for anomalous PVs

A

RV volume overload, no ASD

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14
Q

Anomalous PV repair if

A

Qp:Qs > 1.5
Symptoms
RV enlargement

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15
Q

Indication to close VSD

A

LV enlargement

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16
Q

Muscular VSD

A

bordered by myocardium

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17
Q

Perimembranous VSD

A

Beneath commissure between R and posteirior cusps and remote from L cusp

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18
Q

Infundibuluar, outlet supracristal VSD

A
  • Lies beneath commissure between R and L cusps
  • Aortic prolapse
  • Earlier closure to prevent AR
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19
Q

Sub-aortic and sub-pulmonary VSD

A

Should be closed to prevent AR

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20
Q

PDA closure

A
  • LA or LV enlargement with net L to R shunt

- PASP < 50% systemic & PVR < 1/3 systemic

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21
Q

Pulmonary stenosis associated with

A

Noonan’s syndrome

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22
Q

PS severe

A

PG > 65
Peak vel > 4
MG > 35

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23
Q

PS treatment

A

Balloon if mod-severe and HF, cyanosis or exercise intolerance without other reasons
Surgical if ineligible or failed balloon

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24
Q

20 years after Pulm balloon valvotomy complications

A

Arrhythmias
RV enlargement
TR
PR

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25
Q

Indications for coarctation repair

A

HTN + significant coarctation
Arm/leg peak-peak grad >20 or mean doppler systolic > 20
Arm/leg >10 or mean doppler systolic > 10 with collateral flow
Arm/leg or doppler > 10 + decreased LV function or AF

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26
Q

Ebstein’s indications for repair

A 
Decreased exercise capacity
Cyanosis (risk for stroke)
Severe TR
Bypass tract
Severe RV enlargement with onset of dysfunction
27
Q

Holt Oram a/w

A

Secundum ASD

28
Q

Down syndrome a/w

A

AV septal defects (partial or complete AV canal)

29
Q

Noonan syndrome a/w

A

Pulmonary stenosis

30
Q

Turner syndrome a/w

A

coarctation

31
Q

Phlebotomy for complex CHD indications

A

Symptomatic hyper viscosity with Hb > 20, Hct > 0.65
Fluids
If symptoms and Hit <0.65, suspect iron deficiency

32
Q

Treatment of complex CHD iron deficiency

A

Ferrous sulfate once daily

Discontinue when Hct rises rapidly

33
Q

Therapy for Eisenmenger’s

A

PH meds
ERAs
PDE5i
Prostacyclin agonists

34
Q

Tetralogy of Fallot

A

Large sub aortic VSD
RVOT obstruction +/- PS
Overriding aorta
RVH

35
Q

ToF associations

A

DiGeorge syndrome (low nasal bridge and ears, wide eyes)
Right aortic arch
Anomalous coronary arteries
Secundum ASD

36
Q

ToF simple repair

A

Close VSD
Resect RVOT muscle
+/- Pulm valvotomy

37
Q

ToF complex repair

A

RVOT patch
Excision of Pulm valve
RV to PA conduit

38
Q

Issues after ToF repair

A 
RV dysfunction if late
Residual RVOT gradient, VSD
Severe PR most common
Post-op RBBB
Arrhythmias
39
Q

Replace PV in ToF

A

Before irreversible RV dysfunction

40
Q

Shunts for ToF

A

Cynatoic heart disease with low pulmonary blood flow
Improves oxygenation, makes small PAs grow
Problems: distortion of PAs, pHTN and LV overload, no heart-lung transplant if lateral thoracotomy

41
Q

Classic Glenn ToF

A

SVC -> R PA

42
Q

Bidirectional Glenn ToF

A

SVC -> both PAs

43
Q

Blalock-Taussig ToF

A

Subclavian -> PA

44
Q

Waterston ToF

A

Ascending Ao -> R PA

45
Q

Potts ToF

A

Descending Ao -> L PA

46
Q

dTGA

A

Morphologic RV on right

Aorta anterior and to the right, from RV

47
Q

L TGA

A

RV on left
Aorta anterior and to left
Congenitally corrected transposition, blood going to right places

48
Q

dTGA surgery

A

Arterial switch

Atrial switch

49
Q

Arterial switch dTGA

A

Great arteries switched, coronaries reimplanted

50
Q

Mustard dTGA

A

Baffle from IVC -> SVC -> LV

RV becomes systemic ventricle

51
Q

Mustard dTGA complications

A
  • Eventual RV failure, TR
  • Atrial arrhythmias
  • Baffle obstruction, leak (ASD) - beware PPM
52
Q

lTGA associated with

A
  • VSD
  • PS
  • Tricuspid / left systemic AV valve regurgitation
  • Systemic ventricular dysfunction (may be from leaky AV valve)
  • Conduction abnormalities >75%
    • Inversion of bundles, absence of septal Q waves, have inferior Q waves
    • CHB
53
Q

Doublet inlet ventricle

A

Two AV valves into single ventricle

54
Q

Single inlet ventricle

A

One AV valve entering ventricle

TV atresia, ASD

55
Q

Common inlet ventricle

A

One big AV valve entering ventricle

56
Q

Fontan

A

For single ventricle

Diverts blood from vena cave, RA -> PA

57
Q

BAV surveillance with ascending aortic aneurysm >4.5 cm

A

Annual

58
Q

BAV surveillance with mild AS, no aneurysm

A

Every 3-5 years

59
Q

Coarctation surveillance after intervention without symptoms

A

MRA or CTA every 3-5 years

60
Q

Takayasu arteritis criteria (look for 3+)

A 
Age < 40
Claudication
Dec brachial artery pulse
Subclavian artery or aortic bruit
SBP variation > 10 mm Hg between arms
Angiographic (CT, MR) evidence of aorta or branch vessel stenosis
61
Q

Platypnea Orthodeoxia Syndrome

A

Dyspnea and hypoxemia when upright
Resolves when supine
Intracardiac shunt, pulmonary conditions
agitated bubble study in supine and upright positions

62
Q

Causes of Playpnea-orthodeoxia

A

PFO
ASD
Atrial septal aneurysm with fenestration
Pulm - interstitial lung disease, HPS, Pulm AVMs

63
Q

PFO and platpnea orthodeoxia syndrome occur if

A 
Distortion of intertribal septum in upright position
Post-pneumonectomy, lung transplant
Right hemidiaphragm paralysis
Kyphoscoliosis
Ascending aortic dilatation

Cardiology Boards (11 decks)

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