Cardio Final

Front 1

Passage of oxygenated blood back to the lungs bypassing systemic circulation and causing excess blood to flow to lungs - name shunt

Back 1

Left to Right

Front 2

How do you quantify left to right shunt

Back 2

Ratio of pulmonary blood flow to systemic blood flow --> Qp:Qs ratio

Front 3

Qp:Qs ratio in individuals without a shunt

Back 3

1

Front 4

Most common defects resulting in L to R shunt

Back 4

ASD, VSD, PDA

Front 5

With the exception of bicuspid aortic valve what it the most common congenital heart lesion

Back 5

VSD

Front 6

Equation of pressure gradient

Back 6

P = Q*R

Front 7

For the systemic circulation what is the pressure gradient

Back 7

Pressure gradient is between aorta and RA - mean aortic pressure - mean RA pressure

Front 8

For pulmonary circulation what is the pressure gradient

Back 8

Between pulmonary artery and pulmonary veins (LA) - mean PA pressure - mean PV pressure

Front 9

What is higher systemic or pulmonary vascular resistance

Back 9

Systemic (15-20)

(Pulmonary (1-2))

Front 10

Which VSD is evident right after birth - small or large? Why?

Back 10

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

Front 11

Why is large VSD not evident right after birth

Back 11

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.

Front 12

6 weeks old male presents with symptoms of CHF -tachypnea, poor growth and easy fatigue manifested by breathlessness with feeding - diagnosis

Back 12

Large ventricular septal defect

Front 13

What are the signs and symptoms of CHF in infancy are due?

Back 13

Left to right shunting secondary to excessive pulmonary blood flow

Front 14

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

Back 14

VSD

Front 15

Intensity and splitting of S2 in VSD depends on _

Back 15

pulmonary artery pressure

Front 16

Rumbling diastolic murmur is heard at the apex - what is the diagnosis

Back 16

Large left to right shunt

Front 17

Chest x ray of a newborn shows cardiomegaly and increased vascular pulmonary markings and pulmonary edema - diagnosis

Back 17

VSD

Front 18

Fick equation for pulmonary blood flow

Back 18

CO = Q = O2 consumption (mL/min) / O2 content pulmonar vein - O2 content pulmonary artery

Front 19

Fick equation for systemic blood flow

Back 19

CO = Qs = O2 consumption/ O2 content aorta - O2 content vein

Front 20

How do you determine oxygen content

Back 20

By measuring hemoglobin concentration and percent of hemoglobin which is saturated with oxygen - can be measured by pulsimetry or blood sample

Front 21

What happens in VSD with L atrium and L ventricle

Back 21

Distended because of increased pulmonary blood flow

Front 22

Large ventral septal defects should be closed by what age

Back 22

6 months

Front 23

How do you treat VSD prior to surgical closure

Back 23

Treat CHF symptoms with diuretic to alleviate pulmonary congestion and digoxin which alleviates symptoms

Front 24

If VSD is near aortic valve leaflets there is a danger of _

Back 24

Aortic regurgitation

Front 25

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

Back 25

Eisenmenger syndrome

Front 26

In ASD there is a shunt between _

Back 26

left atrium to right atrium

Front 27

Oxygenated blood from lungs returns to the right side of the heart and makes a return trip to lungs- what defect

Back 27

ASD

Front 28

Defects in atrial septum are most common in what region

Back 28

Fossa ovalis - secundum atrial septal defects

Front 29

Why is there left to right shunting in ASD

Back 29

Left ventricle after birth rapidly becomes more muscular and less compliant than right ventricle - causing progressive left to right shunting

Front 30

Which ventricle is volume overloaded in ASD

Back 30

RV

Front 31

Which ventricle is volume overloaded in VSD

Back 31

Left ventricle

Front 32

In VSD there is step up in saturation in _

Back 32

RV, PA

Front 33

In ASD there is step up in saturation in _

Back 33

RA, RV, PA

Front 34

Step up in saturation in RA is diagnostic of _

Back 34

ASD

Front 35

Is there an effect of ASD on pulmonary resistance after birth

Back 35

NO - unlike VSD there is very little or no effect on fall in pulmonary vascular resistance after birth

Front 36

Is there evidence of ASD right after birth

Back 36

NO - develops within few weeks or months

Front 37

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

Back 37

ASD

Front 38

Diastolic rumbling murmur is heard in patients with both VSD and ASD - how do you differentiate them

Back 38

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

Front 39

Normal fetal passageway that provides outlet for flow from R ventricle in fetus

Back 39

Ductus arteriosus

Front 40

Blood normally flows from pulmonary artery to aorta through _

Back 40

Ductus arteriosus

Front 41

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?

Back 41

Patent ductus arteriosus

Front 42

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

Back 42

PDA

Front 43

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

Back 43

PDA

Front 44

Name conditions that can result in wide pulse pressure

Back 44

Aortic regurgitation

PDA

Surgically placed shunt between systemic artery and pulmonary artery

Front 45

Patient presents with endocardial cushion defect - which disease is it strongly associated with?

Back 45

Downs

Front 46

In PDA there is shunt between _

Back 46

Aorta and pulmonary artery

Front 47

in VSD there is shunt between _

Back 47

LV and PA

Front 48

AV valves, inferior portion of atrial septum and posterior portion of ventricular septum originate from _

Back 48

Endocardial cushions

Front 49

Primum atrial septal defect with or without VSD originates from _

Back 49

Endocardial cushion defect

Front 50

Patients with this defect have left to right shunting at the atrial and ventricular level and CHF by 6-8 weeks of age

Back 50

AV canal (AV septal defect)

Front 51

Catheterization reveals step up from SVC to RA and further step up in RV - which defect?

Back 51

AV canal

Front 52

Passage of unoxygenated blood back into systemic circulation bypassing the lungs

Back 52

R to L shunt

Front 53

Which shunt results in cyanosis

Back 53

R to L shunt

Front 54

In patients with _ cyanosis is less easily observed while in patients with _ its more easily observed

Back 54

Less easily in anemic patients

More easily in patients with erythrocytosis

Front 55

Two most common cyanotic heart defects

Back 55

Tetralogy of Fallot and transposition of great vessels

Front 56

4 defects of tetralogy of Fallot

Back 56

Pulmonary stenosis

RVH

Overriding aorta

VSD

Front 57

Child presents in infancy with murmur due to subpulmonary obstruction and cyanosis - name defect

Back 57

Tetralogy of Fallot

Front 58

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

Back 58

Tetralogy of Fallot

Front 59

Why is pressure in pulmonary artery low in tetralogy of Fallot

Back 59

Obstruction between pulmonary arteries and R ventricle

Front 60

In tetralogy of Fallot pulmonary flow decreased or increased

Back 60

Decreased

Front 61

Chest x ray in child shows normal heart size, lung fields appear dark (decreased pulmonary vascularity), cardiac silhoette has boot shaped contour

Back 61

Tetralogy of Fallot

Front 62

Subpulmonic obstruction in tetralogy of Fallot is caused by _

Back 62

Cardiac muscle

Front 63

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

Back 63

Tetralogy of Fallot

Front 64

Older children with hypercyanotic spells - diagnosis? How can they abort attacks?

Back 64

Tetralogy of Fallot

Squatting

Front 65

Why does squatting helps children with hypercyanotic spells

Back 65

Squatting increases systemic arterial resistance which effectively decreases R to L shunt into aorta and causes more blood to go into pulmonary circuit

Front 66

In the hospital setting severe hypercyanotic spell can be treated with _

Back 66

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

Front 67

Which drugs are contraindicated in child with hypercyanotic spell

Back 67

Any agent that increases myocardial contractility such as sympathomimetics - epinephrine, NE, isoproterenol - will increase dynamic obstruction

Front 68

Blalock Taussig shunt is surgical procedure done to correct _

Back 68

Tetralogy of Fallot

Front 69

Subclavian artery is transected and anastomosed directly to pulmonary artery - name procedure

Back 69

Blalock Taussig

Front 70

Complete repair of tetralogy of Fallot ivolves _

Back 70

Relieving pulmonary outflow obstruction and closing VSD

Front 71

Aorta comes from right ventricle and and pulmonary artery from left ventricle - name defect

Back 71

Transposition of great arteries

Front 72

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

Back 72

Transposition of great arteries

Front 73

Which shunt is usually present in kids with transposition of great vessels

Back 73

Patent foramen ovale

Front 74

Medication lifesaving in babies with severe tetralogy of Fallot or any other defect in which blood could not be delivered to pulmonary arteries

Back 74

Prostaglandin E

Front 75

Newborn presents with cyanosis and decreased systemic saturation is not reversed by giving oxygen

Back 75

Transposition of great vessels

Front 76

Single second heart sound is the sign of what defect

Back 76

Transposition of great vessels

Front 77

Diagnosis of transposition is made by _

Back 77

Echo

Front 78

Name defect that results in complete mixing - pulmonary and systemic venous return completely mixes in either heart or great vessels

Back 78

Truncus arteriosus

Front 79

Failure of separation of pulmonary artery and aorta

Back 79

Truncus arteriosus

Front 80

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

Back 80

Truncus arteriosus

Front 81

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

Back 81

Truncus arteriosus

Front 82

Chest x ray shows large heart with increased pulmonary vascular marking and pulmonary edema - defect

Back 82

Truncus arteriosus

Front 83

In this defect there is no access from RA to RV and RV is hypoplastic

Back 83

Tricuspid atresia

Front 84

EKG shows abnormally superior vector force indistinguishable from left anterior hemiblock except that it occur congenitally

Back 84

Tricuspid atresia

Front 85

Fontan operation is used in patients with what condition

Back 85

Tricuspid atresia

Front 86

Rise in right ventricular pressure in proportion to the degree of obstruction resulting in RVH gives you a diagnosis of _

Back 86

Pulmonary valve stenosis

Front 87

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

Back 87

Pulmonary valve stenosis

Front 88

EKG shows RVH - diagnosis

Back 88

Pulmonary valve stenosis

Front 89

Treatment of choice for pulmonic stenosis

Back 89

Balloon valvuloplasty

Front 90

Balloon valvuloplasty for treatment of pulmonic stenosis is not effective in kids with _

Back 90

Noonan syndrome

Front 91

Child presents with mild mental retardation, infantile hypercalcemia elfin facial features and outgoing personality - which heart defect most likely presents

Back 91

Williams syndrome - supravalvular aortic stenosis

Front 92

Lower oxygen saturation in lower body than in upper body is a sign of_

Back 92

Aortic stenosis

Front 93

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?

Back 93

Prostaglandin E

Front 94

There is high incidence of coarctation of aorta in patients with _

Back 94

Turners syndrome

Front 95

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

Back 95

Coarctation of aorta

Front 96

What does EKG show in patient with coarctation of aorta

Back 96

LVH

Front 97

Any infant presenting with shock like picture especially if they were previously thought to be well should be suspected to have _

Back 97

Left sided heart obstruction