Exam 3, Congenital Heart Disease- Blonder Flashcards Preview

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Flashcards in Exam 3, Congenital Heart Disease- Blonder Deck (44):
1

What is patent foramen ovale

foramen covered by septum primum but is not sealed shut in 20% normal subjects

2

how do you confirm Patent Foramen ovale

bubble study with IV and Echo!!

3

what type of shunting occurs in patent foramen ovale

transient R to L shunting during onset of ventricular contraction explaining neurlogig events in non cyanotic patients

4

what type of stroke can patent foramen ovale lead to

paradoxical so DVT emboli can cross and go to brain

5

What type of overload occurs in herat with patent foramen ovale

R sided volume overload

6

what determines severity of R heart damage in patent foramen ovale and ASD

how large the shunt is will determine if progress to R. HF

7

What id most common adult heart defect

bicuspid aortic valve

8

what is the second most common adult congenital defect after bicuspid aortic valve

ASD

9

how do patients with ASD present

asymptomatic until adulthood
complications: atrial arrhythmias, paradoxical embolus, cerebral abscess, R HF, pulm HTN>eisenmenger syndrome

10

What is eisenmenger syndrome

shunt reversal

11

What are types of ASD

secundum- most common (foramen ovalis)
primum- large
sinus venosus
Scimitar syndrome

12

primum ASD is associated with what other defects

AV valves or ventricular septum
AV canal, or endocardial cushion defect

13

Sinus Venosus ASD is associated with what

anomalous pulmonary vein insertion

14

what are 2 types of sinus venosus ASD

superior SVC defect
inferior IVC defect

15

what is triad od scimitar syndrome

partial anomalous venous return
hypoplasia of a lobe of the R lung
thoracic aorta> pulmonary artery collaterals

16

Most ASD have what type shunts

L to R
but large have R to L

17

R heart volume overload in ASD defects can lead to what

pulmonary HTN and eisenmengers

18

What size ASDs in heart are usually without symptoms

<8mm

19

most patients with ASD become symptomatic when

by age 40

20

What are the clinical manifestations of ASD

atrial arrhythmias
20% artrial fib or flutter, increases with advancing age
at risk for emoboli
migraine cephalgia
pulm HTN, eisenmenger syndrome
cyanosis (R to L)
pulmonic valve stenosis

21

eisenmenger syndrome requires what pressure shunt

>2.5:1

22

Physical findings of ASD are related to what

size and location
size of shunt
pulmonary aretery pressure (R)

23

What do you find on PE n precordium with ASD

RV heave, palpable PA at upper Left sternal border

24

what additional heart sounds are heard with ASD

wide fixed split S2
Increased P2 with pulmonary HTN
S1 split with increase in tricuspid component

25

What type of murmurs are heard in ASD

systolic ejection murmur Upper LSB from increased flow
early diastolic murmur in upper LSB from pulmonary insufficiency due to pulm HTN

26

What is the most common congenital heart disease at birth

VSD

27

how come VSD is not common adult congenital defect

spontaneous closure

28

What are the types of VSD

Infundibular
Membranous
Inlet Defect
Muscular

29

what is an infundibular VSD

below aortic and pulmonic valves, leading to progressive aortic regurg, the hallmark

30

what is membranous VSD

conoventricular
deficiency of the membranous septum

31

Where is an inlet defect VSD

AV canal, Down's

32

Where is a muscular VSD

in the trabecular system, 5-20%

33

direction and severity of a VSD is determined how

functional size and ratio of pulmonary to systemic vascular Resistance

34

What type of shunting occurs with small or restrictive VSD

L to R with no LV volume overload, no pulmonary HTN

35

where is the mild volume overload seen with VSD

LA, LV

36

what type of shunting occurs with a large VSD

moderate to large L to R shunts with LV volume overload

37

if a large VSD is uncorrected what can occur

pulmonary arterial obsturctive disease with pulm HTN

38

progressive pulmonary HTN can change heart how

Increase in RV pressure which can cause a shunt reversal of R to L (eisenmengers)

39

what type of shunts cause cyanosis

R to L because unoxygenated blood is now systemic

40

when eisenmenger syndrome is paired with a VSD what is it called

eisenmenger complex

41

What VSD can lead to aortic regurg and why

membranous because right below aortic valve, can weaken the structure and cause prolapse and regurg

42

On physical exam how does large VSD present

large holosystolic mrumur, LSB, 2nd or 3rd ICS thrill
EKG 66% normal
Echo!

43

What are the 4 features of tetralogy of fallot

RVOT obstruction
VSD
aortic overrides IVS
concentric RVH

44

Need for medical intervention in tetralogy of fallot is dependent on what

RVOT obstruction