Clinical Assessment Of Congenital Heart Disease

Front 1

Life-threatening cardiac disease in newborn infants occur in about ___ in 1,000 live births.

Back 1

3

Front 2

Risk and Risk Factors

Maternal Diabetes ______________

Back 2

HCM, VSD, TGA, COA

Front 3

SLE could mean _________

Back 3

congenital heart block

Front 4

Congenital Rubella could mean _________-

Back 4

PDA & PPS

Front 5

___ risk in the general population

Back 5

1%

Front 6

____ risk for second pregnancy if first resulted in CHD

Back 6

2-6%

Front 7

______ for 3rd child if 1 & 2 = CHD

Back 7

20-30%

Front 8

Stenotic Lesions could be ________ or _______

Back 8

Aortic stenosis
Pulmonary stenosis

Front 9

Shunting Lesions could be ______ or _______

Back 9

Right to Left
Left to Right

Front 10

Mixing lesions could be ______,______, or_______

Back 10

Truncus
TAPVR
HLHS

Front 11

Acyanotic Congenital Heart lesions can be _________ or ________

Back 11

volume lesions or obstructive lesions

Front 12

Volume lesions involve left to right shunts or shunting of _________ blood back to the lungs. Increasing shunting leads to increased pulmonary blood flow, decreased pulmonary compliance, increase work of breathing and finally increase left ventricular output and failure.

Back 12

fully oxygenated

Front 13

Volume lesions include ______, ______,______, & ______

Back 13

VSD, ASD, AV canal, and PDA

Front 14

__________ hinder cardiac/pulmonary output leading to increased ventricular muscle mass (hypertrophy) to pump against the obstruction to maintain cardiac/pulmonary output

Back 14

Obstructive lesions

Front 15

Obstructive lesions include ________, __________, & _______

Back 15

Valvular pulmonic stenosis, aortic stenosis, and coarctation of the aorta

Front 16

______ is the most common cardiac anomaly with an incidence of 1.5 to 2.5 per 1,000 live births

Back 16

VSD

Front 17

VSD Seldom cause significant problems and are detected because of associated ________ usually not present at birth

Back 17

heart murmur

Front 18

4 types of VSD are

Back 18

Perimembranous
Muscular
Subarterial defects
Malalignment defects

Front 19

30-40% of VSD close spontaneously by age ____ months

Back 19

6

Front 20

______ has a murmur that is:
loud
harsh
blowing
pansystolic
LLSB +/- thrill

Back 20

VSD

Front 21

_____ of all Congenital Heart Disease is an Atrial Septal Defect

Back 21

5-10%

Front 22

______ has a murmur that is:
Ejection
Medium pitched
LMSB
2nd heart sound widely split
secondary to increase RV diastolic volume and prolonged ejection time

Back 22

Atrial Septal Defect

Front 23

Symptoms of ASD develop in the ____ decade of life

Back 23

3rd

Front 24

Late manifestations of ASD include:
________ Hypertension
Tricuspid and Mitral ________
______ arrhythmias
__________, paradoxical embolization through an ASD

Back 24

Pulmonary

regurgitation

Atrial

Cerebrovascular accident

Front 25

_____________ involves a normal part of fetal anatomy which allows 80-92% of right ventricular outflow to bypass the lungs and enter the descending aorta.

Back 25

Patent Ductus Arteriosus PDA

Front 26

PDA remains open in fetal life because of low ____.

Back 26

PaO2

Front 27

PDA usually closes in a term infant within __ day

Back 27

1

Front 28

Persistence of the PDA may lead to ______ and _________

Back 28

pulmonary vascular disease
infective endocarditis

Front 29

The __________ in PDA is a continuous musical/machinery like murmur heard best at the ULSB and subclavicular areas

Back 29

Murmur

Front 30

PDA also involves:
- ______ pulses
- Hyperdynamic precordium
- ______ EKG or mild LVH
- CXR
- _____ LA and LV

Back 30

Bounding
Normal
Large

Front 31

Coarctation of the Aorta (COA) is _____ of all CHD

Back 31

8-10%

Front 32

98% of COA occur _____the origin of the left subclavian artery

Back 32

below

Front 33

COA is _____ more likely in males

Back 33

2X

Front 34

30 % of those with ________ have COA

Back 34

Turners Syndrome

Front 35

those with COA often have ________ aortic valve in (70%)

Back 35

Bicuspid

Front 36

There is _______ BP proximal to COA & ________ BP distal to COA

Back 36

Increased
Decreased

Front 37

In COA, infants often present with signs and symptoms of _________ including:
-Weak peripheral pulses with poor perfusion
-Poor urine output
-Lethargy
-Poor feeding
-Metabolic acidosis
-No history of illness symptoms

Back 37

cardiovascular collapse

Front 38

What is this murmur?

S2 single and loud
No murmur in 50 %
Systolic ejection murmur
Gallop rhythm
Blood pressure differential upper vs lower extremity

Back 38

Coarctation in Infant

Front 39

What is this murmur?

Short systolic
LSB 3-4th space
Transmitted to back and neck
Interscapular murmur

Back 39

Coarctation - Older Child

Front 40

___% of patients w/ coarction have upper extremity hypertension

Back 40

90

Front 41

___% of patients w/ coarction have weak/absent femoral/pedal pulse

Back 41

40

Front 42

Some people with coarctation die between 20-40 yrs. of age secondary to ________
-Premature coronary artery disease
-Congestive heart failure
- Hypertensive encephalopathy
-Intracranial hemorrhage
Infective Endocarditis

Back 42

hypertension

Front 43

Cyanotic - 5 T’s and 1H

Back 43

Tetralogy of Fallot
Transposition of the Great Arteries
Total Anomalous Pulmonary Venous Return
Tricuspid Atresia
Truncus Arteriosus
Hypoplastic Left Heart Syndrome

Front 44

TOF occurs in _____% of CDH. Pulmonary Atresia in __%

Back 44

10%
1%

Front 45

Transposition of the Great Arteries occurs in _____ of those w/ CHD

Back 45

5%

Front 46

Total Anomalous Pulmonary Venous Return occurs in ____ of those w/ CHD

Back 46

1%

Front 47

Tricuspid Atresia occurs in _____% of those w/ CHD

Back 47

1-3%

Front 48

Truncus Arteriosus occurs in _____% of those w/ CHD

Back 48

<1%

Front 49

Hypoplastic Left Heart Syndrome occurs in _____% of those w/ CHD

Back 49

1%

Front 50

_______ is the most common cyanotic heart defect in children beyond infancy

Back 50

Tetralogy of Fallot--TOF

Front 51

Tetralogy of Fallot includes ____________, _________, _____________, ___________, _________

Back 51

Pulmonary stenosis
Ventricular septal defect
Right ventricular hypertrophy
Overriding Aorta
25 % have a right sided aortic arch

Front 52

With TOF _____ develops at birth or later depending on size of VSD (pink Tets)

Back 52

Cyanosis

Front 53

Your listening to a pts heart and you hear:
-S2 single in aortic component only
-A heart murmur with:
-Systolic ejection murmur
- long murmur
-Grade 3-5/6
-LUSB - LMSB

Back 53

TOF

Front 54

Occurring in am following crying, feeding, defecation, a pt w/ a CHD experiences:
-Severe hypoxia
-Hypernea
-Irritability/crying
** DECREASED HEART MURMUR**

Back 54

TOF - Tet Spell

Front 55

A severe spell can lead to:
-Limpness
-Seizure
-Cerebrovascular accident
-_________

Back 55

Death

Front 56

Tet Spell - Treatment
-Knee chest position
-Morphine
-Treat acidosis
-Vasoconstrictors (i.e., phenylephrine, Ketamine)
-Propranolol
note: ________ - doesn’t help

Back 56

Oxygen

Front 57

A 2 day old infant is noted to be feeding poorly with labored breathing. You note that the tongue appears blue tinged. Pulse Ox shows sats at 85 percent. 100% oxygen hood is given over 20 minutes. Blood gas reveals a PaO2 of only 78%.
CXR shows the “egg on a string” appearance of the cardiac silhouette

Back 57

Transposition of the Great Arteries

Front 58

Transposition of the Great Arteries is ____% of all Congenital Heart Disease

Back 58

5%

Front 59

In TOTGV the _____arises from the right ventricle and carries desaturated blood to the body.
The __________ arises from the left ventricle and carries saturated blood to the lungs.

Back 59

aorta
pulmonary artery

Front 60

Transposition of the Great Arteries ______ involve atrial or septal defects

Back 60

may

Front 61

Transposition of the Great Arteries involves Male: female ratio of _____

Back 61

3:1

Front 62

A child has cyanosis at birth
CHF with tachypnea, no respiratory distress.
S2 is single and loud with
amurmur (diagnosis does not depend on murmer, may or may not have murmur). There is a VSD. What is the likely diagnosis?

Back 62

TGA-Transposition of the great arteries

Front 63

A child with TGA that has a murmur has a _____________ as well.

Back 63

Ventricular septal defect

Front 64

TGA will show _______-hyperoxic challenge 100% FiO2 without increase of peripheral saturations or PaO2.

Back 64

hypoxia

Front 65

TGA will show Metabolic _______

Back 65

acidosis

Front 66

TGA CXR will show:
-________ with increased PVM
-Egg on a string = __________

Back 66

cardiomegaly
narrow mediastinum

Front 67

ECG will show ______ & _____

Back 67

RAD, RVH/CVH

Front 68

A newborn is noted to have profound cyanosis at birth. No murmur is heard EKG shows marked RVH. CXR demonstrates a large amount of interstitial fluid and pulmonary congestion. There is also an abnormal cardiac silhouette.

Back 68

Total Anomalous Pulmonary Venous Connection

Front 69

Total Anomalous Pulmonary Venous Connection is ___ of all Congenital Heart Disease

Back 69

1%

Front 70

Total Anomalous Pulmonary Venous Connection has a male: female ratio of _______.

Back 70

Male > Female (4:1)

Front 71

in _______________there is not a direct communication of the pulmonary veins to the left atrium

Back 71

Total Anomalous Pulmonary Venous Connection

Front 72

There are three types of Total Anomalous Pulmonary Venous Connection
1._____________
2._____________
3._____________

Back 72

Supracardiac 50%
Intracardiac 20%
Infracardiac (subdiaphragmatic) 20% - present in first 3 days of life.

Front 73

A baby is born that is cyanotic with congestive heart failure - tachypnea, dyspnea, hepatomegaly, tachycardia. S2 is widely split, increased P2. She has a gallop rhythm w/ no murmur. What is the likely diagnosis?

Back 73

TAPVC

Front 74

A 2 month old male infant presents for his well child check. He does not appear to be growing well (FTT). You note a large +4/6 SEM with a thrill that is harsh and located in the LLSB. You note mild cyanosis of the lips.
CXR shows a normal size heart with diminished pulmonary vascularity.
EKG show mark LVH

Back 74

Tricuspid Atresia

Front 75

Tricuspid Atresia is ____ of all Congenital Heart Disease

Back 75

1-3%

Front 76

In ___________ Tricuspid valve is absent. No outflow for venous blood from the heart. Blood shunted from a patent foramen ovale or large VSD. Hypoplastic right ventricle

Back 76

Tricuspid Atresia

Front 77

Severe cyanosis at birth or maybe normal depending on the size of VSD and PFO
Tachypnea and poor feeding.
Single S2
Murmur when VSD present
This presentation describes __________.

Back 77

Tricuspid Atresia

Front 78

A 3 week old infant is seen for turning blue with crying. Mom states no problems with the baby at delivery or in the newborn period. At the 2 week well visit a physiologic murmur is noted in the chart.
On examination the infant is tachypneic. A +2/6 SEM is noted at the ULSB and a +3/6 SEM is also noted in the LLSB.
CXR shows cardiomegaly and increased pulmonary vascularity and pulmonary venous congestion. EKG shows RVH

Back 78

Truncus Arteriosus

Front 79

Truncus Arteriosus is ____ of all Congenital Heart Disease

Back 79

<1%

Front 80

Truncus Arteriosus is associated with ________ and _____________

Back 80

Associated with DiGeorge syndrome and absent thymus

Front 81

In ___________ there is a single arterial trunk to the arterial and pulmonary system, almost always associated with a large VSD ventricular septal defect. There is a single valve bicuspid, tricuspid, quadracuspid.

Back 81

Truncus Arteriosus

Front 82

The four types of truncus arteriosus are differentiated by the position of the peripheral __________ on the arterial trunk.

Back 82

pulmonary arteries

Front 83

Those with TA may not have _______ at birth, depends on degree of PVR

Back 83

cyanosis

Front 84

Those with truncus Arteriosus develop ________
including:
-Tachypnea
-Poor feeding
-Failure to thrive

Back 84

congestive heart failure

Front 85

Those with TA have _______ pulses

Back 85

Bounding

Front 86

Those with TA have single S2 - with _______

Back 86

click

Front 87

Murmur for TA:
-Harsh systolic 2-4/6 LSB - VSD
-Diastolic decrescendo murmur at apex
-Truncal valve ________

Back 87

regurgitation

Front 88

A 2 day old female infant has been doing well in the newborn nursery. Suddenly she becomes lethargic and develops circulatory collapse.
Baby appears grayish and mottled. All peripheral pulses are absent. No murmur is heard.
CXR shows severe cardiomegaly, pulmonary congestion and increased pulmonary vascularity

Back 88

Hypoplastic Left Heart Syndrome

Front 89

Hypoplastic Left Heart Syndrome is ___ of Congenital Heart Disease

Back 89

1%

Front 90

Those with hypoplastic Left Heart Syndrome may do well initially until the ____ closes then shock, acidosis and hypotension with cardiac failure occurs

Back 90

PDA

Front 91

In those with Hypoplastic Left Heart Syndrome EKG reveals severe ____

Back 91

RVH

Front 92

HLHS involves mitral valve ______ vs atresia

Back 92

stenosis

Front 93

HLHS involves ________ left ventricle

Back 93

Hypoplastic

Front 94

HLHS involves Aortic valve ________ vs atresia

Back 94

stenosis

Front 95

HLHS involves, ______ ascending aorta and arch

Back 95

Hypoplastic

Front 96

Cardiac anomalies associated with HLHS are _______, _______, & ________.

Back 96

Atrial septal defect
Ventricular septal defect
Coarctation of the aorta

Front 97

Those with HLHS are Critically ill in the first few hours of life - dependent on timing of __________

Back 97

ductal closure

Front 98

The circulatory shock of HLHS results in ____ peripheral perfusion & ___
pulses

Back 98

Poor
weak

Front 99

HLHS results in severe cyanosis, Tachypnea, dyspnea
Single loud ___,No murmur, &
Gallop

Back 99

S2