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acyanotic lesions Flashcards

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1
Q

VSD and ASD: pressure vs volume

A

VSD is pressure overload

ASD is volume overload (not as bad)

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2
Q

types of ASD - which is most common

A

1) secundum (60%) - anomalous pul return in 10%
2) primum (30%)
3) sinus venosus (10%) - anomalous drainage in SVC/IVC
4) coronary sinus - rare

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3
Q

ASD vs PFO shunts

A

PFO doesnt usually cause intra-cardiac shunts

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4
Q

T21 a/w which ASD

A

primum

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5
Q

which is closer to the AV node - primum or secundum ASD

A

primum

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6
Q

ASD vs VSD shunt magnitude determined by what two factors

A

ASD A) size of defect and B) compliance of ventricle

VSD A) size of defect and B) PVR (lower then PVR, more shunt)

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7
Q

why does CHD/pulmonary HTN develop so late in ASDs?

A

not pressure issue - there’s no direct transmission of systemic pressures
pulmonary arteries can handle the increased volume for quite some time, with normal PA pressures

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8
Q

classic murmur findings in ASD (3) vs VSD (4)

A

ASD:

  1. fixed split of S2 (more pulmonary flow)
  2. grade 2-3 ejection systolic at LUSE - get a RELATIVE pulmonary stenosis due to inc flow
  3. mid diastolic rumble sometimes - can be a/w tricuspid stenosis

VSD:

  1. holosystolic murmur LLSE +/- thrill (due to flow)
  2. Apical mid-diastolic rumble: relative mitral stenosis
  3. Early diastolic decrescendo murmur of AR (infundibular VSD)
  4. loud P2 (PHTN/Eisenmengers)
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9
Q

ecg findings of ASD

A

RBBB from RV dilation - not from actual block!

mild RVH

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10
Q

cxr findings of ASD vs VSD

A

ASD: RA enlargement, inc pulmonary vascular markings
VSD: LAH bc of inc volume return and RAH
- remember in Eisenmenger’s the LAH will improve bc now pul pressure > systemic

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11
Q

natural hx of ASD

A

<3mm - 100% spontaneously close
3-8mm - 80% by 1-2yo
>8mm - rare spont close

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12
Q

preferred way to close an ASD

A

non-surgical via catheter into IVC and expanding device!

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13
Q

conditions a/w VSD (3)

A

Turner
T21
DiGeorge

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14
Q

most common type of VSD

A

peri-membranous

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15
Q

why do we care about a outlet (infundibular or conal) VSD

A

aortic leaflet can prolapse through the VSD and cause aortic insufficiency or RVOT

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16
Q

which type of VSDs do not close spontaneously? which do?

A

Inlet and outlet (infundibular) VSDs do NOT

muscular > perimembranous DO close

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17
Q

ecg findings of VSD

A 
dependent on size of VSD 
small = normal 
Moderate VSD = LVH and occasional LAH 
Large VSD = BVH with or without LAH
If pulmonary obstructive disease = only RVH
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18
Q

indications for surgical repair of VSD

A

PHTN, shunt >2:1

impact on growth <6mo

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19
Q

frequent complication of surgical VSD repair

A

RBBB

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20
Q

when does Eisenmengers tend to happen in a VSD

A

teenage years

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21
Q

complete vs partial AVSD

A 
complete = VSD + primum ASD + clefts in the mitral and tricuspid valve (single valve orifice, usually 5 leaftlets)
partial = ostium primum type of ASD +  cleft in the mitral valve
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22
Q

AVSD basically means what condition?

A

T21 (70% AVSD are T21)

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23
Q

partial AVSD vs just a primum ASD

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A

partial AVSD - MR often trivial, but can have LA / LV enlargement if MR is significant, and CHF can therefore develop earlier

24
Q

when to repair a partial AVSD

Study These Flashcards
A

elective + asymptomatic -> 2-4yo

earlier in FTT, MR, or common atrium

25
how is the shunt of a complete AVSD different from a VSD?
it's an obligatory shunt, determined by size of defect not PVR: from LV > RA
26
heart sounds of complete AVSD (3)
1. S1 is accentuated – due to abnormal AV valve 2. S2 narrowly splits 3. P2 increased in intensity – due to pulmonary HTN
27
classic exam findings for PDA (4)
bounding peripheral pulses, wide pulse pressure hyperactive praecordium continuous machinery murmur left infraclavicular/LUSE apical diastolic rumble (mitral flow)
28
Eisenmenger's in PDA - what is different about the cyanosis
LOWER half body cyanosis only
29
natural Hx of PDA in prem vs term
prem - PDA can spontaneously close | term - rare
30
what sided hypertrophy with PDA, and why?
Increased flow returning to the left heart results in increased left atrial and left ventricular end-diastolic pressures. The left ventricle compensates by increasing stroke volume and eventually may hypertrophy to normalize wall stress.
31
standard approach to fixing a PDA surgically
posterolateral thoracotomy
32
peripheral pulmonary stenosis - 3 major causes
a. Congenital rubella b. Alagille syndrome c. Williams syndrome
33
Peripheral or valvular peripheral stenosis: - congenital rubella - alagille - williams - noonan
Congenital rubella = BOTH Alagille = peripheral Williams = peripheral Noonan = valvular with dysplastic pulmonary valves
34
murmur: - PS - peripheral PS - AS - MS - MR - AR
- PS: ejection systolic LUSE, click - peripheral PS: mid systolic LUSE, axilla and back - AS: ejection systolic RUSE, click - MS: mid diastolic rumble, apex - MR: regurgitant systolic, apex. S3 often present - AR: High pitched diastolic decrescendo murmur with water hammer pulse
35
what happens to the vessel post a stenosis
dilation
36
ways to treat a PS vs AS
PS - PGE infusion - keep PDA open balloon valvuloplasty - treatment choice for all ages surgery - valve replacement AS - keep PDA open, no competitive sport in severe AS balloon valvuloplasty not as effective surgical more common, less time to re-intervention
37
what does an ejection click mean on auscultation? | mid systolic click?
ejection: valvular stenosis of some kind! | mid systolic: MVP!!
38
types of AS
1) valvular (70%) - bicuspid v common 2) subvalvular (25%) - 2/3 have associated cardiac lesions 3) supravalvular (5%) - annular constriction at valsalva sinus
39
two conditions associated with supravalvular AS
1. William syndrome | 2. Familial hypercholesterolaemia
40
classic triad of AS presentation
1. dyspnoea 2. chest pain 3. exertional syncope
41
signs of critical AS in a neonate
reduced peripheral perfusion (weak and thread pulse, pale cool skin, slow cap refill - from ductus closing
42
what other aortic conditions can result from AS?
post stenotic aortic dilatation | AR
43
what is the main surgery we use for AS?
Ross operation: patient's own pulmonary valve replaces their shitty aortic one then a homograft replaces the pulmonary valve- lasts longer as lower pressures, but will eventually need replacement
44
coarct - think what syndromic condition
Turners
45
coarct - think what associated defects
bicuspid aortic in 50-80% | berry aneurysm
46
CXR findings of coarct
1) rib notching between 4th-8th ribs in >8yo with large collateratls 2) post stenotic dilatation of aorta
47
ways a coarct can present
1) well neonate - differential cyanosis, absent femoral pulses 2) unwell neonate - shock in first 6 weeks, absent femoral pulses 3) older child - HTN (UL>LL), murmur
48
complications post coarct repair
coarct repair either - end to end anastamosis, subclavian flap, balloon re-stenosis aneurysm HTN
49
what syndrome must always be thought of with interrupted aortic arch
DiGeorge - need to do workup e.g. Ca
50
what arrhythmia can result from MS
AF
51
most common valvular involvement in children with rheumatic heart disease
MR
52
causes of MR in children
1. rheumatic fever | 2. associated with AVSDs
53
MVP - a/w what syndromes
CT diseases: Marfan, EDS, osteogenesis imperfecta, Stickler syndrome, PCKD (adults)
54
MVP most commonly associated with what other cardiac defect
secundum ASD
55
what can cause an AR?
bicuspid aortic valve | dilated aortic root e.g. marfans, EDS
56
what is cor triatrium
Atrium divided into 3 parts by fibromuscular septum (usually two on left) --> like MS

cardiology (6 decks)

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