Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

97 Cards in this Set

  • Front
  • Back
Passage of oxygenated blood back to the lungs bypassing systemic circulation and causing excess blood to flow to lungs - name shunt
Left to Right
How do you quantify left to right shunt
Ratio of pulmonary blood flow to systemic blood flow --> Qp:Qs ratio
Qp:Qs ratio in individuals without a shunt
Most common defects resulting in L to R shunt
With the exception of bicuspid aortic valve what it the most common congenital heart lesion
Equation of pressure gradient
P = Q*R
For the systemic circulation what is the pressure gradient
Pressure gradient is between aorta and RA - mean aortic pressure - mean RA pressure
For pulmonary circulation what is the pressure gradient
Between pulmonary artery and pulmonary veins (LA) - mean PA pressure - mean PV pressure
What is higher systemic or pulmonary vascular resistance
Systemic (15-20)

(Pulmonary (1-2))
Which VSD is evident right after birth - small or large? Why?
Small - there is no interference with normal fall in pulmonary vascular resistance at birth, there will be rapid fall in PA and RV pressure and VSD is evident right after birth if its small because of significant pressure gradient that develops, can hear murmur right away as blood goes through the hole
Why is large VSD not evident right after birth
When defect is large, pressure gradient never develops between L and R ventricles, there will be no rapid fall in resistance that is present normally at birth, resistance will be falling slowly so you will be able to detect it only 2-4 weeks after the birth.
6 weeks old male presents with symptoms of CHF -tachypnea, poor growth and easy fatigue manifested by breathlessness with feeding - diagnosis
Large ventricular septal defect
What are the signs and symptoms of CHF in infancy are due?
Left to right shunting secondary to excessive pulmonary blood flow
4 weeks old female presents with tachypnea, excessive sweating, hyperdynamic precordial pulsations, hepatomegaly and low weight for age. Loud holosystolic grade 3-4 murmur is heard at L sternal border 4th-5th intercostal space - diagnosis
Intensity and splitting of S2 in VSD depends on _
pulmonary artery pressure
Rumbling diastolic murmur is heard at the apex - what is the diagnosis
Large left to right shunt
Chest x ray of a newborn shows cardiomegaly and increased vascular pulmonary markings and pulmonary edema - diagnosis
Fick equation for pulmonary blood flow
CO = Q = O2 consumption (mL/min) / O2 content pulmonar vein - O2 content pulmonary artery
Fick equation for systemic blood flow
CO = Qs = O2 consumption/ O2 content aorta - O2 content vein
How do you determine oxygen content
By measuring hemoglobin concentration and percent of hemoglobin which is saturated with oxygen - can be measured by pulsimetry or blood sample
What happens in VSD with L atrium and L ventricle
Distended because of increased pulmonary blood flow
Large ventral septal defects should be closed by what age
6 months
How do you treat VSD prior to surgical closure
Treat CHF symptoms with diuretic to alleviate pulmonary congestion and digoxin which alleviates symptoms
If VSD is near aortic valve leaflets there is a danger of _
Aortic regurgitation
Failure to surgically repair large VSD will result in increased pulmonary vascular resistance - the shunt will reverse across the VSD going right to left leading to cyanosis - what is this called
Eisenmenger syndrome
In ASD there is a shunt between _
left atrium to right atrium
Oxygenated blood from lungs returns to the right side of the heart and makes a return trip to lungs- what defect
Defects in atrial septum are most common in what region
Fossa ovalis - secundum atrial septal defects
Why is there left to right shunting in ASD
Left ventricle after birth rapidly becomes more muscular and less compliant than right ventricle - causing progressive left to right shunting
Which ventricle is volume overloaded in ASD
Which ventricle is volume overloaded in VSD
Left ventricle
In VSD there is step up in saturation in _
In ASD there is step up in saturation in _
Step up in saturation in RA is diagnostic of _
Is there an effect of ASD on pulmonary resistance after birth
NO - unlike VSD there is very little or no effect on fall in pulmonary vascular resistance after birth
Is there evidence of ASD right after birth
NO - develops within few weeks or months
4 month old male is evaluated for congenital heart disease - you can hear systolic ejection murmur over the pulmonic area at the left upper sternal border. Widely split S2 is heard and the split is fixed, there is a hyperdynamic R ventricular impulse, there is also a diastolic rumbling murmur at the left lower sternal border
Diastolic rumbling murmur is heard in patients with both VSD and ASD - how do you differentiate them
Diastolic rumbling murmur in ASD is due to increased flow through tricuspid valve so its better heard at L lower sternal border. Diastolic rumbling murmur in VSD is due to increased blood flow through mitral valve so its better heard at the apex of the heart
Normal fetal passageway that provides outlet for flow from R ventricle in fetus
Ductus arteriosus
Blood normally flows from pulmonary artery to aorta through _
Ductus arteriosus
On catheterization saturation is normal in all chambers of the heart and no step up in oxygen saturation is seen until sample is withdrawn from pulmonary arteries - which defect?
Patent ductus arteriosus
Chest x ray shows large heart shadow due to L ventricular volume overload, pulmonary vascularity is increased and there are signs of pulmonary edema - which defect
Examination of a child reveals a continuous murmur maximal over the left chest and heard well in the back, murmur is very characteristic and machinery like, peripheral pulses are bounding (wide pulse pressure) - which defect
Name conditions that can result in wide pulse pressure
Aortic regurgitation


Surgically placed shunt between systemic artery and pulmonary artery
Patient presents with endocardial cushion defect - which disease is it strongly associated with?
In PDA there is shunt between _
Aorta and pulmonary artery
in VSD there is shunt between _
LV and PA
AV valves, inferior portion of atrial septum and posterior portion of ventricular septum originate from _
Endocardial cushions
Primum atrial septal defect with or without VSD originates from _
Endocardial cushion defect
Patients with this defect have left to right shunting at the atrial and ventricular level and CHF by 6-8 weeks of age
AV canal (AV septal defect)
Catheterization reveals step up from SVC to RA and further step up in RV - which defect?
AV canal
Passage of unoxygenated blood back into systemic circulation bypassing the lungs
R to L shunt
Which shunt results in cyanosis
R to L shunt
In patients with _ cyanosis is less easily observed while in patients with _ its more easily observed
Less easily in anemic patients

More easily in patients with erythrocytosis
Two most common cyanotic heart defects
Tetralogy of Fallot and transposition of great vessels
4 defects of tetralogy of Fallot
Pulmonary stenosis


Overriding aorta

Child presents in infancy with murmur due to subpulmonary obstruction and cyanosis - name defect
Tetralogy of Fallot
Oxygen saturation is same in SVC, RA, RV and pulmonary arteries, pressure in R and L ventricles are equal but pressure in PA is low - name problem
Tetralogy of Fallot
Why is pressure in pulmonary artery low in tetralogy of Fallot
Obstruction between pulmonary arteries and R ventricle
In tetralogy of Fallot pulmonary flow decreased or increased
Chest x ray in child shows normal heart size, lung fields appear dark (decreased pulmonary vascularity), cardiac silhoette has boot shaped contour
Tetralogy of Fallot
Subpulmonic obstruction in tetralogy of Fallot is caused by _
Cardiac muscle
7 year old boy experiences episodes of extreme cyanosis and hypoxemia, hypoxemia sometimes is so severe that it leads to loss of consciousness and seizures
Tetralogy of Fallot
Older children with hypercyanotic spells - diagnosis? How can they abort attacks?
Tetralogy of Fallot

Why does squatting helps children with hypercyanotic spells
Squatting increases systemic arterial resistance which effectively decreases R to L shunt into aorta and causes more blood to go into pulmonary circuit
In the hospital setting severe hypercyanotic spell can be treated with _
IV beta blockers which decreases contracility and relieves subpulmonary obstruction, systemic vasoconstrictors can also be used such as phenylephrine, oxygen and morphine are also useful
Which drugs are contraindicated in child with hypercyanotic spell
Any agent that increases myocardial contractility such as sympathomimetics - epinephrine, NE, isoproterenol - will increase dynamic obstruction
Blalock Taussig shunt is surgical procedure done to correct _
Tetralogy of Fallot
Subclavian artery is transected and anastomosed directly to pulmonary artery - name procedure
Blalock Taussig
Complete repair of tetralogy of Fallot ivolves _
Relieving pulmonary outflow obstruction and closing VSD
Aorta comes from right ventricle and and pulmonary artery from left ventricle - name defect
Transposition of great arteries
Systemic venous blood deoxygenated returns to the R atrium and Right ventricle and returns directly to aorta. Pulmonary venous blood fully saturated returns to L ventricle and L atrium and then returned to lungs without going to the body - name defect
Transposition of great arteries
Which shunt is usually present in kids with transposition of great vessels
Patent foramen ovale
Medication lifesaving in babies with severe tetralogy of Fallot or any other defect in which blood could not be delivered to pulmonary arteries
Prostaglandin E
Newborn presents with cyanosis and decreased systemic saturation is not reversed by giving oxygen
Transposition of great vessels
Single second heart sound is the sign of what defect
Transposition of great vessels
Diagnosis of transposition is made by _
Name defect that results in complete mixing - pulmonary and systemic venous return completely mixes in either heart or great vessels
Truncus arteriosus
Failure of separation of pulmonary artery and aorta
Truncus arteriosus
No step up from superior vena cava to R atrium and large increase in R ventricle and common trunk, oxygen saturation in aorta and pulmonary arteries is equal, R and L ventricular pressures are also equal, systolic pressures in aorta and pulmonary arteries are equal
Truncus arteriosus
Examination of an infant shows tachypnea, poor feeding and failure to thrive, precordium is very dynamic, there is an ejection murmur, murmur is continuous and heard well in the back, peripheral pulses are bounding because of wide pulse pressure
Truncus arteriosus
Chest x ray shows large heart with increased pulmonary vascular marking and pulmonary edema - defect
Truncus arteriosus
In this defect there is no access from RA to RV and RV is hypoplastic
Tricuspid atresia
EKG shows abnormally superior vector force indistinguishable from left anterior hemiblock except that it occur congenitally
Tricuspid atresia
Fontan operation is used in patients with what condition
Tricuspid atresia
Rise in right ventricular pressure in proportion to the degree of obstruction resulting in RVH gives you a diagnosis of _
Pulmonary valve stenosis
Physical examination reveals a harsh systolic ejection murmur which becomes higher pitched the greater the pressure gradient, murmur is associated with ejection click, palpable precordial thrill is generally felt
Pulmonary valve stenosis
EKG shows RVH - diagnosis
Pulmonary valve stenosis
Treatment of choice for pulmonic stenosis
Balloon valvuloplasty
Balloon valvuloplasty for treatment of pulmonic stenosis is not effective in kids with _
Noonan syndrome
Child presents with mild mental retardation, infantile hypercalcemia elfin facial features and outgoing personality - which heart defect most likely presents
Williams syndrome - supravalvular aortic stenosis
Lower oxygen saturation in lower body than in upper body is a sign of_
Aortic stenosis
Child presents with cool, clammy and pale skin, urine output diminished, femoral pulses are absent and metabolic acidosis is evident - diagnosed with aortic stenosis and shock due to closure of PDA - treatment?
Prostaglandin E
There is high incidence of coarctation of aorta in patients with _
Turners syndrome
Clinical findings in patient include decreased pulse pressure in lower extremities with weak and sometimes absent pulses, hypertension in upper extremities and ejection murmur which is heard best in the back on L side, chest x ray shows rib notching
Coarctation of aorta
What does EKG show in patient with coarctation of aorta
Any infant presenting with shock like picture especially if they were previously thought to be well should be suspected to have _
Left sided heart obstruction