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` > Congenital Heart Disease 1 (Mayo) > Flashcards

Congenital Heart Disease 1 (Mayo) Flashcards

1
Q

Physical exam findings in Secundum ASD

A

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

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2
Q

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

A

Secundum ASD

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3
Q

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

A

Primum ASD

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4
Q

Main complications of Secundum ASD

A

Afib (from enlarged RA)

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5
Q

What class indication is cath for Secundum ASD?

A

III

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6
Q

When do you close Secundum ASD?

A

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

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7
Q

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

A

Anomalous Pulm veins

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8
Q

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

A

Sinus venosus ASD

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9
Q

If RV overload, what do you do?

A

Find the shunt

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10
Q

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

A

Primum ASD

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11
Q

What is the relation of AV valves in Primum ASD?

A

On same level

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12
Q

Normally, which valve is apically displaced?

A

TV

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13
Q

**What type of ASD has RBBB with LAD?

A

Primum ASD

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14
Q

Name 3 associations with Primum ASD

A

Sub aortic stenosis
L-SVC
Coarctation

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15
Q

A Primum ASD is synonymous with?

A

Partial A-V canal

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16
Q

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

A

Small

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17
Q

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

A

MV diastolic (like MS)

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18
Q

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

A

None

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19
Q

Which VSDs usually close spontaneously?

A

Muscular and membranous

20
Q

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

A

Supracristal (sub aortic or sub pulmonary)

21
Q

Which congenital lesion is associated with maternal rubella?

A

PDA

22
Q

Physical exam in PDA

A

Wide pulse pressure
Brisk upstroke
Dynamic LV
machinery murmur

23
Q

F:M incidence of PDA

A

3:1

24
Q

Class I indications to close PDA

A

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

25
Q

What syndrome is associated with PS?

A

Noonan’s

26
Q

Physical exam in PS

A

Soft and late P2
A wave on JVP
RV heave

27
Q

If RV dilated with PS, what to do?

A

Look for an associated lesion

28
Q

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

A

Early (b/c of RVH)

29
Q

Which R-sided sound decreases with inspiration?

A

PS click (not murmur)

30
Q

If CXR shows PA sticking out into lung, Dx?

A

PS (post stenotic dilatation of PA)

31
Q

Class I indications for balloon valvotomy in PS

A

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

32
Q

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

A

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

33
Q

where in Ao does coarctation usually occur?

A

just distal to subclavian artery

34
Q

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

A

Coarctation

35
Q

CXR findings of coarctation

A

Figure 3 sign, rib notching

36
Q

Histopathology of Ao in coarctation

A

cystic medial necrosis

37
Q

Class I indications for coarctation repair

A

P2P gradient >20

if <20, need imaging showing sig coarct with collaterals

38
Q

why is echo doppler potentially misleading in coarctation?

A

because the gradient could be lower if good collaterals

39
Q

How do you decrease mortality in coarctation?

A

surgery early in life

40
Q

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

A
  • 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
Q

Inferiorly displaced TV and atrialized RV, Dx?

A

Ebstein’s Anomaly

42
Q

two lesions associated with Ebstein’s

A

ASD/PFO, bypass tract

43
Q

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

A

Ebstein’s

44
Q

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

A

Ebstein’s

45
Q

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

A

Ebstein’s

46
Q

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

A

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%

47
Q

Missing tissue in fossa ovalis

A

Secundum ASD

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