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CARD 1101 > Mod13 CHD > Flashcards

Mod13 CHD Flashcards

1
Q

Congenital Heart Disease (CHD)

A

defect in embryogenesis of the heart that may be severe enough to alter cardiac function

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2
Q

Anatomical defect usually results from:

A

altered embryonic development of normal structure

failure of such a structure to progress beyond early stage of embryonic or fetal development

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3
Q

Exposure of these during critical period are RFs for CDH

A

anticoagulant Warfarin
Anticonvulsive trimethadione
chronic alcohol abuse
infection with rubella

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4
Q

Congenital defects allow survival into adult life if:

A

lesion is mild
multiple lesions counterbalance each other
compensatory mechs take place
lesions have had intervetions (surgery/catherterization)

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5
Q

Cyanotic CDH

A

defect that allows blood low in O2 to be shunted from R-L side of heart, bypassing lungs for re-oxygenation; results in baby’s skin having blue tint

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6
Q

Common Cyanotic Lesions

A

tetralogy of Fallot
transposition of the great arteries
Ebstein’s anomaly (intermittent cyanosis)
Eisenmenger’s syndrome

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7
Q

Common Acyanotic lesions

A 
atrial septal defect (ASD)
ventricular septal defect (VSD)
Atrioventricular septal defect 
Patent Ductus arteriosus 
congential aortic stenosis 
pulmonic stenosis 
coarctation of aorta (dissection)
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8
Q

Atrial Septal Defect (ASD)

A

opening in the interatrial septum that remains after birth; causing predominantly L-R shunting

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9
Q

3 main types of ASD

A 
Ostium Secundum (70%) 
Ostium Primum (20%)
Sinus Venosus (10%)
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10
Q

Ostium Secundum (type of ASD)

A

occurs where there is inadequate dev of septum primum and/or septum secundum

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11
Q

Ostium Primum (type of ASD)

A

occurs when the septum primum in unable to fuse with endocardial cushions

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12
Q

Sinus Venosus (type of ASD)

A

occurs when sinus venosus is not completely absorbed in RA; usually found along with anomalous drainage of pulmonary veins

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13
Q

Patent Foramen Ovale (PFO)

A

when fusion of atrial septa fails; extremely common type of ASD (25%); 40% of patients with ischemic stroke also have PFO

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14
Q

Signs and Symptoms of ASD

A 
heart murmur
exertional dyspnea 
fatigue 
atrial arrhythmias 
lower respiratory tract infections 
***may spontaneously close in first 5 years of life
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15
Q

Diagnosis of ASD

A

Colour doppler interrogation with Echo or TEE; can see saline bubbles crossing interatrial septum

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16
Q

Treatment of ASD

A

Surgical treatment with pericardial or Dacron patch; transcatheter closure

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17
Q

Ventricular Septal Defect (VSD)

A

common opening in interventricular septal wall (divides LV and RV) which results in L-R shunting of blood

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18
Q

5 types of ventricular septal defects

A

Perimembranous (most common)
Trabecular (2nd most common)
Inlet: associated with atrioventricular septal defects
Outlet: associated with aortic regurgitation
Malalignment- tetralogy of Fallot

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19
Q

Formation of VSD

A

deficiency of growth/failure of alignment or fusion of the ventricular muscle septum

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20
Q

signs/symptoms of VSD

A

large VSD show early signs of HF, tachypnea, poor feeding, frequent respiratory tract infections and cyanotic

21
Q

Diagnosis of VSD

A

harsh holosytolic murmur; colour doppler interrogation with TEE or TTE

22
Q

Treatment of VSD

A

surgical treatment with pericardial or Dacron patch or transcatheter closure

23
Q

Atrioventricular septal defect

A

spectrum of defects that occur in the embryonic endocardial cushions which can affect the atrial and ventricular septa and parts of atrioventricular valves

24
Q

3 types of atrioventricular septal defects

A

partial, complete and incomplete

25
Q

partial atrioventricular septal defect

A

ostium primum ASD and cleft mitral valve

26
Q

Complete atrioventricular septal defect

A

ostium primum, inlet type VSD, common AV valve

27
Q

Incomplete atrioventricular septal defect

A

two AV valve orifices, LV and RA shunt, trileaflet cleft mitral valve

28
Q

Signs and Symptoms of Atrioventricular septal defect

A

associated with HF, cyanosis, and Eisenmenger’s syndrome

29
Q

Treatment of Atrioventricular septal defect

A

closure of ASD or VSD

Repair of AV valve

30
Q

Patent Ductus Arteriosus (PDA)

A

persistence of fetal connection of the aorta to the pulmonary artery which is supposed to begin to close within few hours after birth; common in infants whose mothers contacted rubella, who are premature and who are born at high altitudes; will see blood shunting from aorta into pulmonary vascular beds

31
Q

Formation of Patent ductus arteriosus

A

normally, due to sudden increase in O2 tension and decrease in protaglandins at birth the ductus will close; when it fails it results in abnormal L-R shunting of blood btw systemic and pulmonary vascular beds

32
Q

Role of Ductus arteriosus

A

diverts blood flow away from high resistance pulmonary circuit and into descending aorta

33
Q

Amount of O2 blood shunted from aorta into pulmonary artery determined by:

A

cross-sectional area and length of ductus

relative resistance of pulmonary and systemic vasculatures

34
Q

signs and symptoms of patent ductus arteriosus (PDAs)

A

HF, Tachycardia, poor feeding, slow growth; may be cyanotic in presence of pulmonary vascular disease
will feel fatigue, dyspnea, respiratory tract infections and palpitations

35
Q

Diagnosis of PDA

A

continous murmur; doppler colour interrogation with echo

36
Q

Treatment of PDA

A

ligration division or placement of clip on ductus

transcatheter closure with an occlude, coil or plug

37
Q

Congenital Aortic Stenosis

A

narrowing of aortic valve orifice from abnormal development of valve

38
Q

Signs and symptoms of Congenital aortic stenosis

A

dependant on severity; HF can cause tachycardia/pnea, and poor feeding
as it worsens: exertional dyspnea, angina, syncope, soft A2, systolic ejection murmur

39
Q

Diagnosis of congenital aortic stenosis

A

harsh crescendo-decresendo systolic ejection murmur; but echo is always the best tool

40
Q

Treatment of congenital aortic stenosis

A

valvuloplasty

valve replacement

41
Q

Congenital pulmonic stenosis

A

obstruction of blood flow from RV to main pulmonary artery during systole; at level of valve, surpravalvular or subvalvular

42
Q

Diagnosis of congenital pulmonic stenosis

A

pulmonic ejection click; echo is most useful tool to determine severity, morphology of valve and extent of compensatory mechs

43
Q

Treatment of congenital pulmonic stenosis

A

valvuloplasty
valve replacement
***same as aortic stenosis

44
Q

Coarctation of Aorta

A

constricted segment in aortic lumen; associated with Turner’s Syndrome; majority of patients also have Bicuspid Aortic valve (50-80%)

45
Q

Three types of Coarctations (based on location of narrowing in relation to ductus arteriosus)

A

Preductal: proximal of ductus
Postductal: distal to ductus
Juxtaductal: adjacent to ductus

46
Q

Preductal Coarctation formation:

A

occurs when there is decrease in blood flow through left side of heart during fetal development (causing underdeveloped aorta); will see cyanosis if they have preexisitng PDA

47
Q

Postductal coarctation formation:

A

caused my muscular tissue extending into aorta during fetal development which later constricts

48
Q

Diagnosis of Coarctation

A

diagnosed by difference in 15-20mmHg or greater in systolic BP in right arm vs right leg; echo is still best tool

49
Q

treatment of aortic coarctation

A

bypass tube graft
dacron graft/patch repair
surgical resection

CARD 1101 (14 decks)

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