Congenital Heart Dz

Question 1

Atrial Septal Defect (ASD)

Answer 1

Opening in the atrial septum permitting free communication of blood btw the atria. Seen in 10% of all CHD.

Question 2

Most common type of ASD

Answer 2

Secondum, at the fossa ovalis.
Followed by primum (lower) and
Sinus Venus (high in septum, rare)

Question 3

ASD S/S

Answer 3

Most are asymptomatic
Rarely presents with CHF and CV S/S
Easy fatiguability, mild growth failure

Question 4

ASD clinical findings

Answer 4

Hyperactive precordium, RV heave
Widely split S2
Systolic ejection murmor at LSB
Mid diastolic murmor over LLSB

Question 5

Why are murmors heart with ASD?

Answer 5

Increased flow across the pulmonary valve (or tricuspid)

Question 6

ASD Tx

Answer 6

Closure electively between ages of 2 and 5

Closure before age 25 shows best prognosis

Question 7

Is endocarditis prophylaxis required for ASD?

Answer 7

No

Question 8

Ventricular Septal Defect (VSD)

Answer 8

Abnormal opening in the ventricular septum

Accounts for 25% of congenital abnormalities

Question 9

Most common type of VSD?

Answer 9

Perimembranous

Question 10

Small VSD S/S

Answer 10

Small VSD usually asymptomatic
50% will close spontaneously by 2 yrs
Harsh holistic murmor on LSB

Question 11

Severe VSD S/S

Answer 11

Harsh holosystolic murmor heard along LSB
Prominent PE, diastolic murmor
CHF, FTT, Resp infections, exercise intoleranceHyperactive precordium

Question 12

Symptomatic VSD Tx

Answer 12

Medical tx with afterload reducers and diuretics

Surgical closure

Question 13

Atrioventricular Septal Defect (AVSD)

Answer 13

Incomplete fusion of the endorcardial cushions

4% of all Congenital defects

Question 14

What dz is AVSD more commonly seen in?

Answer 14

Downs syndrome

Seen in 25% of cases

Question 15

Fixed split second sound =?

Answer 15

ASD

Question 16

AVSD S/S

Answer 16

CHF in infancy
Recurrent pulm infxns
Failure to thrive
Exercise intolerance
Late cyanosis from R to L shunt
Cardiac enlargement

Question 17

AVSD Tx

Answer 17

Surgery is always required

Treat congestion

Question 18

Patent Ductus Arteriosis (PDA)

Answer 18

Persistence of the normal fetal vessel that joins the PA to the Aorta
Normally closes in 1st week of life
Accounts for 10% of CHD
More females than males
Associated with coarctation and VSD

Question 19

PDA S/S

Answer 19

Asymptomatic for small ones
CHF
Bounding arterial pulses
Widened pulse pressure
Enlarges heart
CLassic continuous machinary systolic murmor

Question 20

PDA Tx

Answer 20

Indomethican
Surgical closure
Need to prevent pulmonary vascular dz

Question 21

Which chambers are enlarged in VSD?

Answer 21

L and R ventricles and L atrium

Question 22

Pulmonary Stenosis

Answer 22

Obstruction in the region of the pulmonary valve or the subpulmonary ventricular outflow tract.
Accounts for 7-10% of CHD
Can present w/ or w/o intact ventricular septum

Question 23

What dz is pulmonary stenosis associated with?

Answer 23

Noonan’s Syndrome, secondary to valve dysplasia

Question 24

Pulmonary Stenosis S/S

Answer 24

Depends on severity
Split 2nd sound with delay
Heart failure and cyanosis in severe cases

Question 25

Pulmonary stenosis Tx

Answer 25

Stenosis relief Balloon valvuloplasty Surgical valvotomy is an option

Question 26

Aortic Stenosis

Answer 26

An obstruction of LV outflow at or near the aortic valve. 7% of CHD Valvular is most common

Question 27

Which syndrome is Aortic stenosis found in?

Answer 27

WIlliams Syndrome

Question 28

Which chambers are enlarged in aortic stenosis?

Answer 28

LV and LA

Question 29

Aortic Stenosis S/S

Answer 29

``` Exercise intolerance CP, dyspnea, dizziness, syncope Weak pulses, L sided heart failure Sudden Death Systolic thrill ```

Question 30

Aortic Stenosis Tx

Answer 30

Balloon Valvuloplasty is standard of tx

Question 31

Coarctation of the Aorta

Answer 31

Narrowing of the aorta. 98% are juxtaductal 3:1 males 7% of all CHD

Question 32

What other congenital abnormality is coarctation of the aorta seen in?

Answer 32

Bicuspid aortic valve (70% of cases)

Question 33

What genetic syndrome is coarctation of the aorta seen in?

Answer 33

Turner's syndrome

Question 34

Coarctation S/S

Answer 34

Diminution or absent femoral pulses Higher BP in arms than legs 90% of systolic HTN in upper extremities Pulse discrepancy in rt and lt arms

Question 35

What will be seen on Xray with coarctation

Answer 35

rib notching and cardiomegaly

Question 36

Coarctation Tx

Answer 36

Prostaglandin E Surgical intervention Angioplasty

Question 37

Tetralogy of Fallot

Answer 37

Malignant VSD Overriding Aorta Pulmonic Stenosis RVH

Question 38

Tetralogy Tx

Answer 38

Surgery...

Question 39

Transposition D-type

Answer 39

PA arises from LV Aorta from RV Cyanosis occurs Prostaglandin given to keep ductus open

Question 40

L-Type Transposition

Answer 40

Heart is completely flip flopped Works until late childhood Many complications

Question 41

Ebsteins Anomoly

Answer 41

Atrialization of RV | Massive R atrium

Question 42

Ebsteins presentation

Answer 42

``` Pediatric Murmur Atrial arrhythmias cyanosis R to L shunt ```