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Flashcards in Cardiology Deck (102)
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To measure blood pressure, one must have a mercury sphygmomanometer with a cuff that covers

approximately two thirds of the upper part of the arm or leg.


The intensity of systolic murmurs is graded from I to VI:

I, barely audible;
II, medium intensity;
III, loud but no thrill;
IV, loud with a thrill;
V, very loud but still requiring positioning of the stethoscope at least partly on the chest;
VI, so loud that the murmur can be heard with the stethoscope off the chest


The heart is usually enlarged when the maximal cardiac width is

more than half the maximal chest width (cardiothoracic ratio >50%),


In the posteroanterior view, the left border of the cardiac shadow consists of three convex shadows produced, from above downward, by the

aortic knob, the main and left pulmonary arteries, and the left ventricle


Three structures contribute to the right border of the cardiac silhouette.

from above:
superior vena cava
ascending aorta
right atrium.


Lesions Resulting in Increased Volume Load

those that cause left-to-right shunting: atrial septal defect, ventricular septal defect (VSD), AV septal defects (AV canal), and patent ductus arteriosus


Heart Failure in left to right CHD

-tachypnea, chest retractions, nasal flaring, and wheezing.
-Sympathetic activation leads to sweating and irritability
-the imbalance between oxygen supply and demand lead to failure to thrive.


Lesions Resulting in Increased Pressure Load

due to obstruction to normal blood flow:
-valvular pulmonic stenosis, valvular aortic stenosis, and coarctation of the aorta
- tricuspid or mitral stenosis, cor triatriatum and obstruction of the pulmonary veins.


Characteristic of right-sided heart failure

-peripheral edema


Characteristic of left-sided heart failure

-pulmonary edema
-poor perfusion


Cyanotic Lesions with Decreased Pulmonary Blood Flow

-tricuspid atresia
-tetralogy of Fallot
-various forms of single ventricle with pulmonary stenosis

These lesions must include both an obstruction to pulmonary blood flow (at the tricuspid valve or right ventricular or pulmonary valve level) and a pathway by which systemic venous blood can shunt from right to left and enter the systemic circulation (via a patent foramen ovale, atrial septal defect, or VSD)


Cyanotic Lesions with Increased Pulmonary Blood Flow

Cyanosis is caused by either
1) abnormal ventricular-arterial connections
-Transposition of the great vessels (TGA)
2) total mixing of systemic venous and pulmonary venous blood within the heart
-total anomalous pulmonary venous return (TAPVR)
-truncus arteriosus


Syndrome associated with ASD which includes a hypoplastic or absent radii and a 1st-degree heart block

Holt-Oram syndrome


most common form of ASD

Ostium Secundum Defect


Ostium Secundum Defect

-most often asymptomatic
-subtle failure to thrive
-mild left precordial valve
-enlargement of the RA and RV and dilatation of the PA
-2nd heart sound is widely split and fixed in its splitting
-ECG: NA or RAD, rsR' pattern in the precordial leads


In patients with Ostium Secundum ASD, surgical or transcatheter device closure is advised for

-all symptomatic patients
-for asymptomatic patients with a Qp : Qs ratio of at least 2 : 1 or those with right ventricular enlargement


Procedure of choice for ASD

percutaneous catheter device closure


In patients with ASD, closure is not required in

-patients with small secundum ASDs and minimal left-to-right shunts without right ventricular enlargement


True or False:
Small- to moderate-sized ASDs detected in term infants may close spontaneously.



True or False:
antibiotic prophylaxis for isolated secundum ASDs is recommended.

Infective endocarditis is extremely rare, and antibiotic prophylaxis for isolated secundum ASDs is NOT recommended.


AV septal defect, also known as an AV canal defect or an endocardial cushion defect, consists of

contiguous atrial and ventricular septal defects with markedly abnormal AV valves


Atrioventricular Septal Defects is commonly associated with what syndrome?

Down Syndrome


most common cardiac malformation and accounts for 25% of congenital heart disease



Most common type of VSD

membranous type


characteristic murmur of a small VSD

-loud, harsh, or blowing holosystolic murmur over the lower left sternal border
-frequently accompanied by a thrill


characteristic of large VSD

-pulmonary blood flow and pulmonary hypertension result to dyspnea, feeding difficulties, poor growth, profuse perspiration, recurrent pulmonary infections, and cardiac failure in early infancy.
-duskiness during infections or crying
-Prominent left precordium
-palpable parasternal lift, a laterally displaced apical impulse and apical thrust, and a systolic thrill.


Typical CXR of VSD

small VSD: normal
large VSD: cardiomegaly with prominence of both ventricles, the left atrium, and the pulmonary artery, increased pulmonary markings, pulmonary effusion, and pulmonary edema


Natural course of VSD:

-30-50% of small defects close spontaneously during the 1st 2 yr of life
- Small muscular VSDs are more likely to close (up to 80%) than membranous VSDs (up to 35%)
-majority close before 4yo
- infective endocarditis is a long-term risk


True or False
All VSD should be surgically repaired.

Surgical repair is currently not recommended for patients with small VSD.


what should you advise in patients with small VSD?

-should be encouraged to live a normal life, with no restrictions on physical activity
-integrity of primary and permanent teeth should be carefully maintained