Is ASD a R –> L shunt or a L –> R shunt?
It is a Left to Right shunt
What is the most common congenital anomaly in adults?
ASD
T or F: Most ASDs will close in childhood
True
Which of the following is least true about ASDs:
- It is a cyanotic shunt
- The most common location for an ASD is the osmium secundum
- Pulmonary pressures are modestly elevated in ASD
- Only about 15% of ASDs go into Eisenmenger Syndrome
- Is it an Acyanotic Left to Right shunt unless VERY huge causing Eisenmenger Syndrome
A 13 y/o male is complaining he cannot run as much as he used to during track practice. He also complains thatHIS chest feels like it thumping a lot lately. On PE, you hear a fixed split of S2 and a systolic murmur at the ULSB. You also hear a diastolic murmur at the LLSB. You order a CXR, EKG, an Echo and refer to pediatric cardiology. While awaiting for the test results–what is your leading diagnosis of this patient?
ASD
What is the proper treatment for a patient with ASD?
- Surgical closure
2. Percutaneous closure
What is the triad of sxs older children and adolescents often present with when they have ASD?
- Decreased stamina
- Palpitations
- Blood clots
Which of the following is most true about Coarctation of the aorta?
- It is a Cyanotic lesion of the heart
- 2% are Preductal
- 50% are Postductal
- Very common finding in Trisomy 21 patients
- It is an Acyanotic lesion of the heart.
- YES; 2% are Preductal lesions
- 98% are Postductal lesions
- Very common finding in Turners patients
Explain the “collateral” damage in Coarctation of the Aorta.
- Due to the narrowing of the aorta, the pressure increases in the LV
- Collateral vessels (intercostal arteries) that bypass coarctation, enlarge as well
What should you always include in your differential diagnosis of HTN in a 20-30 year old?
Coarctation of the aorta
If left unprepared, what is the sequelae of Coarctation of the aorta?
Development of CAD
On PE of an 18 y/o male, you notice a discrepancy in BP from LUE being greater than the RUE. Where is your suspected lesion of coarctation?
Pre ductal–lesion is proximal to the Left subclavian
On PE, you hear a mid-late systolic ejection murmur, heart best between the scapula and to the left of the spine with an ejection click. Based on this finding, what is the more likely diagnosis?
Coarctation of the aorta with an associated bicuspid valve
ejection click = associated bicuspid valve
On PE, you hear a mid-late systolic ejection murmur, heart best between the scapula and to the left of the spine with an ejection click. Based on this finding, what would you expect to see on a CXR of this patient?
Notching or scalloping of posterior surface of inferior ribs “3” sign
With a neonate recently diagnosed with severe Coarctation of the aorta, what is the best management?
- Give prostaglandin infusion to keep the PDA open to bypass coarctation
- Surgical correction
Which cardiac lesion carries a significant morbidity/mortality with a mean age of death at 38?
Coarctation of the aorta
Is PDA cyanotic or acyanotic?
Acyanotic
What are risk factors to developing PDA?
- First trimester Rubella infection
- Prematurity
- Birth at high altitude–due to a low oxygen concentration
When will PDA become cyanotic?
If pulmonary vascular disease occurs, then the patient can have Eisenmenger syndrome and become cyanotic
Explain the process of the ductus arteriosus closure.
Usually the ductus constricts after birth (10-15hrs) due to a sudden rise in the blood oxygen tension and reduction in the level of circulating prostaglandins
What sxs would you expect a patient with PDA to exhibit?
- Small PDA: asxs
- Moderate PDA: dyspnea, fatigue, and palpitations
- Large PDA with a L to R shunt develop early HF usually within the first year of life
- Afib can also occur
What is the most common cyanotic heart defect?
Tetralogy of Fallot
What is the congenital defect occurs in Tetrology of Fallot?
Abnormal anterior and cephalad displacement of the infundibular (outflow tract) `portion of the inter ventricular septum
- VSD
- Subvalvular pulmonic stenosis
- Overriding aorta
- RVH
A 2 month old infant comes into the clinic for a well check. His mother says she notices her child “getting tired” during feeds. He is often irritable and seems to have a hard time breathing all the time. Mom says he often raises his legs to his chest and notices that this often soothes him. On PE, you see clubbing of fingers and toes. You also hear a systolic ejection murmur at the ULSB with a single S2. There is also a palpable RV heave. What would you expect this infants CXR to look like?
A boot
