11.22 C

Question 1

What are the six types of cardiac pathophysiology?

Answer 1

• pump failure
• flow obstruction
• regurgitant flow
• shunted flow
• disorders of cardiac conduction
• rupture of the heart or major vessel

Question 2

What are the three major categories of cardiac pathophysiology related to congenital heart disease?

Answer 2

• left to right shunt
• right to left shunt
• obstruction

Question 3

What are some common causes of congenital left to right shunts?

Answer 3

• atrial septal defects (ASD)
• ventricular septal defects (VSD)
• patent ductus arteriosus (PDA)

Question 4

What syndromes are most commonly linked to congenital heart disease?

Answer 4

Down syndrome and diGeorge syndrome

Question 5

The most common genetic cause of congenital heart disease is what?

Answer 5

trisomy 21

Question 6

The greatest risk factor for a child being born with a congenital heart disease is what?

Answer 6

a parent or sibling having one

Question 7

Why is Tetralogy of Fallot emphasized so much if it is so rare?

Answer 7

it is the most common congenital heart disease that presents with cyanosis

Question 8

The most common congential heart disease is what?

Answer 8

a ventricular septal defect

Question 9

Ventricular septal defects are most commonly the result of a defect in which part of the interventricular septum?

Answer 9

the membranous portion, especially if it is a large defect

Question 10

How are ventricular septal defects treated?

Answer 10

• most are tolerated well into adulthood and don’t need treatment
• many spontaneously close
• larger ones must be plugged to prevent obstructive pulmonary vascular disease

Question 11

The biggest problem with large left to right shunts is that they eventually lead to what?

Answer 11

pulmonary hypertension

Question 12

Babies with large ventricular septal defects often present with what major sign of heart failure?

Answer 12

pulmonary edema

Question 13

The most important sign that a baby has a ventricular septal defect is what?

Answer 13

that he or she fails to thrive

Question 14

What is Eisenmenger syndrome?

Answer 14

a complication of a ventricular septal defect in which the left to right shunt becomes a right to left one as the pulmonary vessels constrict to reduce blood flow leading to hypertrophy and increased pressure in the pulmonary system

Question 15

Eisenmenger syndrome is a complication of what congenital heart disease?

Answer 15

ventricular septal defect

Question 16

Those with ventricular septal defects show cyanosis when in the course of their disease?

Answer 16

after shunt reversal

Question 17

What are the three types of atrial septal defects?

Answer 17

• secundum (most common)
• primum
• sinus venosus type

Question 18

A secundum atrial septal defect results from a deficient what?

Answer 18

septum secundum formation near the center of the atrial septum by the fossa ovalis

Question 19

Where is a primum atrial septal defect located?

Answer 19

adjacent to the AV valves

Question 20

Atrial septal defects of the sinus venosus type are located where?

Answer 20

near the entrance of the superior vena cava

Question 21

What is the age of onset for ASDs?

Answer 21

typically they are asymptomatic until adulthood

Question 22

Murmurs associated with atrial septal defects are due to what?

Answer 22

excessive flow through the pulmonary valve

Question 23

Is pulmonary hypertension a sign of ventricular or atrial septal defects?

Answer 23

typically ventricular, not atrial

Question 24

A boot-shaped cardiac shadow is indicative of what?

Answer 24

Tetralogy of Fallot

Question 25

Why does Tetralogy of Fallot generate a boot-shaped cardiac shadow?

Answer 25

because of the hypertrophy of the right ventricle

Question 26

Why is severe cyanosis rare just after birth in those with Tetralogy of Fallot?

Answer 26

because of patent ductus arteriosus

Question 27

Cyanosis worsens in Tetralogy of Fallot when what happens?

Answer 27

the ductus arteriosus closes up around day 1

Question 28

What is the diagnostic test for Tetralogy of Fallot?

Answer 28

• put on supplemental oxygen

- won’t have much effect on oxygen levels of a child with ToF

Question 29

What are the common right to left shunts regarding congenital heart disease?

Answer 29

• tetralogy of fallot

- transposition of the great vessels

Question 30

How can transposition of the great vessels be treated?

Answer 30

• prostaglandin to keep ductus arteriosus open
• balloon atrial septostomy to enlarge foramen ovale
• surgical correction always necessary

Question 31

What congential heart disease has a continuous machinery-like murmur?

Answer 31

patent ductus arteriosus

Question 32

How does a left to right shunt get reversed?

Answer 32

the additional volume and pressure overloads produce obstructive changes in small pulmonary arteries, leading to reversal of flow

Question 33

If you want to keep the ductus arteriosus open, administer what?

Answer 33

prostaglandin E

Question 34

What is indomethacin?

Answer 34

a prostaglandin inhibitor given to help closure of the ductus arteriosus

Question 35

Aortic stenosis is due to what?

Answer 35

a bicuspid aortic valve which causes turbulent flow and microtrauma to the valve leaflets, eventually resulting in calcification and stenosis