Congenital Heart Disease 2 (Mayo) Flashcards Preview

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Flashcards in Congenital Heart Disease 2 (Mayo) Deck (52):
0

Large shunt (usu VSD)--> VSD--> reverse to R to L shunt w/ cyanosis. Sxs = SOB, Syncope, hemoptysis, stroke
Dx?

Eisenmenger's

1

Pink hands and blue feet. Dx?

Eisenmenger's with PDA

2

Cyanosis/clubbing, a-wave JVP, RV heave, click, diastolic murmur of PR from PA dilation, loud P2. Dx?

Eisenmenger's

3

Eisenmenger's CXR

Big "mogul #2" from big PA, calcified PA

4

Drug class to avoid in eisenmenger's

Vasodilators (no NTG)

5

Rx for eisenmenger's

PAH Rx: Bosentan, sildenafil, prostacyclin

6

Tet of fallot

- large sub aortic VSD
- RVOT obstruction (+/-PS)
- overriding Ao
- RVH

7

DDR of overriding Ao

TOF, Pulm atresia, truncus

8

Which lesion in TOF determines security of TOF?

RVOT obstruction (b/c blue blood sneaks over from RV to LV and causes cyanosis)

9

Difference between RV and LV pressures in TOF

RVp = LVp

10

Name 3 associated lesions with TOF

- R- Ao arch on CXR
- anomalous coronary artery
- Secundum ASD

11

TOF PE

Cyanosis
RV lift
Thrill if PS severe
Systolic murmur over pulmonic area
ABSENT P2

12

Most common problem after TOF repair

PR--> RV inc--> inc QRS--> VT--> SCD

13

EKG findings in TOF

RBBB
Wide QRS

14

What is the repair for TOF?

RVOT patch
Close VSD
Excise PV

15

What is next step if pt with TOF repair comes in with arrhythmia ?

Look for Hemodynamic abnormality (most likely PR which should be promptly corrected with PVR)

16

What is the purpose of creating a shunt for congenital heart diseases?

Increase blood flow through pulmonary vasculature

17

Glenn

SVC--> RPA

18

Bidirectional Glenn

SVC to RPA and LPA

19

Blalock-Tausigg

Subclavian Artery--> PA

20

Waterston shunt

Asc Ao-->RPA

21

Potts Shunt

Desc Ao--> LPA

22

Complications of creating shunts for congenital heart disease

Distortion of PA
Large shunt= Pulm HTN and LV overload
No heart/lung Tx if Lateral thoracotomy

23

When do you consider phlebotomy for a patient with cyanosis HD?

Hgb> 20 , Hct > 65

24

If pt has iron deficiency and cyanotic CHD, what are they at risk for?

Stroke

25

What do you do if pt has sxs of hyperviscosity and Hct> 65? <65?

Hydrate
Suspect iron def, give gentle iron suppl.

26

How much should you phlebotomize a pt with cyanotic CHD?

Max 1 u

27

Are cyanotic CHD pt's at risk for thromboemboli or bleeding?

Bleeding

28

What should be done for all IV lines attached to cyanotic CHD pt's?

Place air filters to avoid air emboli

29

Name a spinal problem that cyanotic CHD pt's get and can you do Sx?

Scoliosis
No- unacceptable bleed risk

30

Name a rheumatologic dz that cyanotic CHD patients get

Gout

31

Mortality rate for patients with cyanotic CHD who get pregnant

50%

32

D-loop

RV on R
Ao- anterior and to R

33

L-loop

RV on Left
Ao- anterior and to left

34

What is an arterial switch and what dz do you use it for?

TGA
just switch arteries back to correct ventricles

35

Main step in Mustard procedure for TGA

Take blue blood from SVC/IVC into LA

36

Long term complication of Mustard procedure for TGA

RV Failure needing OHT

37

Name the lesion in L-TGA

RV and LV switched

38

Echo for L-TGA

TV is on Left. And as always apically displaced

39

What is L-TGA associated with?

VSD, PS, TR, CHB, RV Dysfxn

40

L-TGA ECG

Q waves in II, III, aVF
AVB

41

3 types of single ventricle, atrioventricular connections

- double inlet
- single inlet (tricuspid atresia)
- common inlet (one AV valve)

42

What lesion must a single inlet ventricle have to survive?

ASD

43

Rx for single ventricle?

Fontan

44

What is goal of very contain procedure?

To separate blue and red blood

45

What arrhythmias are our tan patients prone to? Why?

Atrial
Inc RA size

46

What is the major complication of increased RA size in fontan?

RA Thrombus--> PE

47

What to remember about treating atrial arrhythmias in fontan patients?

Always r/o clot with TEE first

48

Fontan pt comes in with pleural effusion, ascites, diarrhea, JVD. Suspected Dx and next tests?

Protein Losing Enteropathy
Serum albumin, Upr, *STOOL alpha1 AT*

49

Rx for protein losing Enteropathy after fontan

Repair fontan obstruction

50

Pathophysiology of protein losing Enteropathy in fontan. Mortality rate?

Inc'd systemic venous P--> inc'd thoracic duct P
50% at 5yrs

51

Another name for congenitally corrected transposition

L-TGA