Congenital Heart Disease 1 (Mayo) Flashcards Preview

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Flashcards in Congenital Heart Disease 1 (Mayo) Deck (47):
0

Missing tissue in fossa ovalis

Secundum ASD

1

Physical exam findings in Secundum ASD

RV heave
PA SEM +/- TV diastolic murmur
FIXED SPLIT S2

2

ECG w/ RBBB and RAD. CXR with enlarged PA (c/w Ao). Dx?

Secundum ASD

3

If you are thinking of Secundum ASD and see enlarged LA, what is Dx?

Primum ASD

4

Main complications of Secundum ASD

Afib (from enlarged RA)

5

What class indication is cath for Secundum ASD?

III

6

When do you close Secundum ASD?

If any RV enlargement (shunt calc doesn't matter!)

7

If echo shows RV volume overload and no ASD, what do you think of?

Anomalous Pulm veins

8

Diagnosis of defect in superior atrial septum, posterior to fossa ovalis and anomalous pulmonary veins

Sinus venosus ASD

9

If RV overload, what do you do?

Find the shunt

10

Defect of inferior septum, MV cleft and Down's syndrome

Primum ASD

11

What is the relation of AV valves in Primum ASD?

On same level

12

Normally, which valve is apically displaced?

TV

13

**What type of ASD has RBBB with LAD?

Primum ASD

14

Name 3 associations with Primum ASD

Sub aortic stenosis
L-SVC
Coarctation

15

A Primum ASD is synonymous with?

Partial A-V canal

16

What type of VSD large, or small makes a loud murmur?

Small

17

With a large defect, what type of murmur might you get?

MV diastolic (like MS)

18

What type of murmur do you hear with eisenmenger's?

None

19

Which VSDs usually close spontaneously?

Muscular and membranous

20

Which VSDs, even if small, need to be closed to prevent AR?

Supracristal (sub aortic or sub pulmonary)

21

Which congenital lesion is associated with maternal rubella?

PDA

22

Physical exam in PDA

Wide pulse pressure
Brisk upstroke
Dynamic LV
machinery murmur

23

F:M incidence of PDA

3:1

24

Class I indications to close PDA

If LV enlarged
PAH if net shunt is L-->R
Endocarditis

25

What syndrome is associated with PS?

Noonan's

26

Physical exam in PS

Soft and late P2
A wave on JVP
RV heave

27

If RV dilated with PS, what to do?

Look for an associated lesion

28

In what part of systole will click be if PS is severe?

Early (b/c of RVH)

29

Which R-sided sound decreases with inspiration?

PS click (not murmur)

30

If CXR shows PA sticking out into lung, Dx?

PS (post stenotic dilatation of PA)

31

Class I indications for balloon valvotomy in PS

asymptomatic: domed PV/peak grad > 60/mean grad> 40
Sxs: domed PV/peak grad> 50/ mean grad> 30

32

How and when will complications of ballon valvotomy for PS present?

20y later with arrhythmias, TR, RV enlargement from PR

33

where in Ao does coarctation usually occur?

just distal to subclavian artery

34

what dz is commonly associated with Turner's and bicuspid AV?

Coarctation

35

CXR findings of coarctation

Figure 3 sign, rib notching

36

Histopathology of Ao in coarctation

cystic medial necrosis

37

Class I indications for coarctation repair

P2P gradient >20
if <20, need imaging showing sig coarct with collaterals

38

why is echo doppler potentially misleading in coarctation?

because the gradient could be lower if good collaterals

39

How do you decrease mortality in coarctation?

surgery early in life

40

what f/u is needed after Dacron patch repair of coarctation?

-mandatory yearly imaging (e.g. MR) to r/o aneurysm at repair site
- head imaging to r/o intracranial aneurysm
- tight control of BP, CAD risk

41

Inferiorly displaced TV and atrialized RV, Dx?

Ebstein's Anomaly

42

two lesions associated with Ebstein's

ASD/PFO, bypass tract

43

ECG shows RBBB, tall (Himalayan) P waves, prolonged PR, pre-excitation and AF/Afl. Dx?

Ebstein's

44

cyanosis, cool periphery, V wave on JVP, subtle RV lift, Loud T1, holosystolic TR murmur that increases with inspiration. Dx?

Ebstein's

45

CXR showing globular heart (xmas tree ornament) with small Ao and PA. Dx?

Ebstein's

46

5 indications to repair Ebstein's (valve repair, ASD closure, reduce atrialized component of RV)

decreased exercise capacity/RV dysfunction
Progressive cyanosis or paradoxical embolism
severe TR
bypass tract or arrhythmias nope amenable to catheter-based therapy
cardiothoracic ratio > 60%