Cardiology

Question 1

MC birth defect

Answer 1

congenital heart disease

Question 2

Left to Right shunts → acyanotic

Answer 2

the “D”s → ASD, VSD, PDA, AVSD

Question 3

Right to Left shunts → cyanotic

Answer 3

the “T”s → ToF, TGA, TA, TA, TAPVC

Question 4

obstructive lesions that cause congenital heart defects

Answer 4

coarctation of aorta 
pulmonary stensosis 
pulmonary atresia 
aortic stenosis 
aortic atresis (HLHS)

Question 5

when there is a defect or communication between the left and right heart blood usually shunts _____

Answer 5

from left to right

Question 6

why is cyanosis not typical in left to right shunts?

Answer 6

Pulmonary vascular resistance is less than systemic → increase in pulmonary blood flow occrs

Question 7

Pulmonary vascular bed (after being exposed to excessive flow and pressure) undergoes vasoconstriction that becomes irreversible → increased pulmonary vascular resistance and shunt reversal

Answer 7

Eisenmenger Syndrome

Question 8

MC type of atrial septal defect

Answer 8

secundum ASD → at fossa ovalis

Question 9

endocardial cushion defect just above the AV valves associated with cleft mitral valve

Answer 9

Primum ASD

Question 10

located near the SVC and often associated with anomalous pulmonary vein

Answer 10

Sinus venosus ASD

Question 11

Atrial septal defect is often seen in

Answer 11

Holt-Oram Syndrome

Question 12

How may large ASD present?

Answer 12

murmur

Question 13

Treatment for Secundum ASD

Answer 13

heart cath to close the defect with plug like device

Question 14

when in the cardiac cycle will shunting occur in ASD?

Answer 14

diastole

Question 15

MC common congenital heart defect

Answer 15

Ventricular Septal Defect

Question 16

Three types of VSD

Answer 16

membranous MC (below aortic valve)
muscular (often small and self limited)
infundibular

Question 17

How will small VSD present?

Answer 17

loud blowing systolic murmur

Question 18

How will moderate VSD present?

Answer 18

murmur and HF due to excessive pulmonary blood flow

Question 19

Large VSD can cause ___ if not surgically closed during infancy

Answer 19

pulmonary hypertension

Question 20

when is blood shunted with a VSD?

Answer 20

systole → excess blood goes directly to the lungs since RV in contracting

Question 21

how are VSD surgically repaired?

Answer 21

patched

Question 22

persistence of a normal fetal structure → commonly seen in premature infants and produces machine like murmur

Answer 22

Patent Ductus Arteriosus [PDA]

Question 23

If an infant with PDA is cyanotic or has obstructive heart disease, what can you use to maintain the patency of PDA?

Answer 23

prostaglandin E

Question 24

Treatment for PDA

Answer 24

close with coil or occluder in cath lab

Question 25

Infants with PDA have continous left to right shunt but when does it increase?

Answer 25

systole

Question 26

what patient population is atrioventricular septal defect commonly seen in?

Answer 26

Down Syndrome

Question 27

due to failure of superior and inferior endocardial cushions to fuse and related to primum ASD

Answer 27

atrioventricular septal defect

Question 28

when do you routinely repair AVSD?

Answer 28

6 months of age

Question 29

deoxygenated blood gets into systemic circulation

Answer 29

right to left shunt

Question 30

Three ways that Right to Left Shunt occurs

Answer 30

``` septal defect and obstruction to pulmonary blood flow (ToF) obligate right to left shunt (transposition of great arteries) obligate mixing (TAPVC) ```

Question 31

cyanosis + complications (sterile or septic embolization) + hypertrophic osteoarthropathy (clubbing) and polycythemia

Answer 31

right to left shunt

Question 32

5 "T"s of Right to Left shunts

Answer 32

``` Tetralogy of Fallot Transposition of Great Arteries Truncus Arteriosus Tricuspid Atresia Total Anomalous Pulmonary Venous Connection ```

Question 33

Four classic features of Tetralogy of Fallot

Answer 33

1. VSD 2. obstruction right ventricular outflow (pulmonary valve and/or subpulmonic stenosis) 3. Right ventricular hypertrophy on EKG 4. Overriding aorta

Question 34

MC cyanotic lesion → 3 or 4 year old who is squating

Answer 34

Tetralogy of Fallot

Question 35

Severity of Tetralogy of Fallot is based on…

Answer 35

severity of subpulmonic stenosis

Question 36

CXR reveals "boot shaped" heart

Answer 36

Tetralogy of Fallot

Question 37

results from abnormal septation of truncal and aortopulmonary septa → atrioventricular concordance and ventriculoarterial discordance

Answer 37

d-TGA (transposition of great arteries)

Question 38

If your patient has D-TGA, what do you hope they also have? Having this allows the blood to mix so you aren't circulating deoxygenated blood in the body and oxygenated blood stays circulating in the lungs

Answer 38

VSD

Question 39

For TGA, what do you look for on fetal ultrasound?

Answer 39

pulmonary artery and aorta are running parallel | [normal → pulmonary artery crosses over aorta]

Question 40

How do you manage newborn with TGA without VSD presenting with profound cyanosis?

Answer 40

palliation with prostaglandin and possibly balloon atrial septostomy

Question 41

failure of separation of embryologic pulmonary artery and aorta

Answer 41

truncus arteriosus

Question 42

100% of truncus arteriosus also have

Answer 42

VSD

Question 43

result from unequal division of AV canal

Answer 43

tricuspid atresia

Question 44

three things also seen with Tricuspid Atresia

Answer 44

ASD VSD small right ventricle

Question 45

Name of procedure used for Tricuspid Atresia and patients with only one ventricle

Answer 45

Fontan Procedure

Question 46

common pulmonary vein fails to connect to left atrium + ASD

Answer 46

total anomalous pulmonary venous connection (TAPVC)

Question 47

3 types of total anomalous pulmonary venous connection

Answer 47

infracardiac cardiac supracardiac

Question 48

location of coarctation of aorta that presents in infant

Answer 48

proximal to PDA

Question 49

location of coarctation of aorta that presents in adult

Answer 49

paraductal or postductal

Question 50

increased incidence of coarctation of aorta in patients with

Answer 50

Turner Syndrome

Question 51

Treatment for pulmonary valve stenosis

Answer 51

balloon dilation → may leak and get SOB → replace valve with bovine jugular vein valve

Question 52

intact ventricular septum + RV is hypoplastic + ASD is present + flow to lungs occurs through PDA or multiple aorta to pulmonary collateral vessels

Answer 52

pulmonary atresia

Question 53

Three types of aortic stenosis

Answer 53

valvular subvalvular supravalvular

Question 54

supra AS often seen in

Answer 54

Williams Syndrome

Question 55

MC seen in hypoplastic left heart syndrome (HLHS)

Answer 55

Aortic atresia

Question 56

benign, vibratory and low pitched murmur "groaning sound" LLSB and radiates to aortic outflow tract loudest at 5 months - 5/6 years

Answer 56

Still's murmur

Question 57

high pitch murmue that radiates all over the chest | common in babies

Answer 57

branch pulmonary stenosis

Question 58

high frequency and blowing murmur

Answer 58

VSD

Question 59

crunchy and medium pitched murmur

Answer 59

pulmonary and aortic stenosis