Congenital Defects I

Front 1

What is situs solitus vs situs inversus?

Back 1

situs solitus - normal position; Situs inversus - lateral reversal;

Front 2

What is the ventricular sinus?

Back 2

the part of the ventricle including the AV valve apparatus

Front 3

Characterstics of the apical trabecular ventricular region?

Back 3

the part of the ventricle not involved in inflow or outflow

Front 4

Diff between morphologic right and left vent?

Back 4

Right - coarse apical ventricular; Left - fine apical ventricular

Front 5

What is a double outflow vent?

Back 5

both aorta and PA's connected to the same vent

Front 6

Hallmark of left atrium?

Back 6

elongated vestigial looking atrial appendage

Front 7

Hallmark of right atrium?

Back 7

blunt, triangular appendage with broad attachment

Front 8

What is concordance and discordance with regards to the heart?

Back 8

concordance, all the chambers are hooked up correctly; Discordance they are reversed

Front 9

What are the three different levels of cardiac septation?

Back 9

interatrial, atrioventricular, interventricular;

Front 10

Why is there a small atrioventricular septum?

Back 10

because MV is set higher than TV

Front 11

Where does the fetus get its oxygenated blood from and through what shunts does it bypass a lot of circulation?

Back 11

placental vein; Foramen Ovale, Ductus Arteriosus;

Front 12

What changes occur to fetal circulation at birth?

Back 12

Lungs expand dropping pulmonary circuit resistance, Left heart becomes higher resistance, FO closes, ductus arteriosus degens in response to lower PGE and higher O2

Front 13

Normal O2 sats of right and left heart?

Back 13

right heart - 70-80%; Left Heart - 95-100%;

Front 14

What are some of the determnining factors for magnitude of shunts?

Back 14

Size of defect, compliance of vents, pulmonary and systemic vasc resistance, Qs and Qp;

Front 15

What is the qualification for a shunt to be considered large?

Back 15

Qp:Qs = 2:1 or greater

Front 16

What are some factors that can form right to left shunts?

Back 16

right heart pressure higher than left heart (with a defect); Great vessels hooked up wrong;

Front 17

Sx of right to left shunts?

Back 17

Cyanosis, digital clubbing, erythrocytosis

Front 18

What are the five methods of detection we can use to detect intracardiac shunt?

Back 18

CXR, Echo, Oximetry, Cineangiography, MRI

Front 19

How can you use CXR to detect shunt?

Back 19

Increased lung vascularity = large L to R shunt

Front 20

How can you use Echo to detect shunt?

Back 20

visual anatomic defect, inject microbubbles, doppler

Front 21

How can you use oximetry to detect shunt?

Back 21

draw samples from each chamber via cath, look for abnormal O2 levels

Front 22

How can you use cineangiography to detect shunt?

Back 22

inject contrast materials, watch them cross the chambers

Front 23

How can you use MRI to detect shunt?

Back 23

can visualize defects and abnormal flow

Front 24

Deleterious effects of L to R shunts?

Back 24

Left heart failure (volume overload), Pulm infections and endocarditis, Pulmonary HTN

Front 25

What are the 2 mechs by which pulm HTN can be caused by a L to R shunt?

Back 25

hyperkinetic (high blood flow, normal resistance), Pulm vasc obstruction (pulm arterioles develop high resistance, can then reverse to R to L shunt once pressure high enough)

Front 26

Complications of R to L shunts?

Back 26

hypoxemia, Heart failure (can get right heart failure if RL shunt due to high pulm vasc resistance), arrythmias, paradoxial emboli

Front 27

Type of shunting usually seen in ASDs?

Back 27

left to right

Front 28

Sx of ASD?

Back 28

usually asymptomatic, not diagnosed until adulthood

Front 29

Changes in chamber size in ASD?

Back 29

RA and RV hypertrophy and enlargement (volume overload)

Front 30

Changes in chamber O2 sats in ASD?

Back 30

increased sat in right heart

Front 31

CXR signs of ASD?

Back 31

increased pulmonary vascularity

Front 32

ECG signs of the various septal defects?

Back 32

Secundum/Venosum - Right axis dev with RV hypertrophy; Primum - Left axis dev with RV hypertrophy;

Front 33

Heart sound abnormalities with ASD?

Back 33

fixed split S2 (P2 always late because defective overfilling is like permanent inspiration

Front 34

Murmus in ASD?

Back 34

Systolic ejection in P area (high flow), Diastolic flow (tricuspid) at LLSB from high flow;

Front 35

Coexistent heart defects in ASD?

Back 35

Mitral regurg

Front 36

Tx of ASD?

Back 36

closure by surgery or catheter occlusion

Front 37

Which PE finding is almost always pathognomic for ASD?

Back 37

wide fixed split S2

Front 38

What kind of film do you need to really visualize RV hypertrophy?

Back 38

lateral (obliterates retrosternal space

Front 39

What is the most common type of congenital heart defect?

Back 39

VSD (excluding congenital bicuspid aortic valves)

Front 40

Two types of VSDs?

Back 40

Muscular, Perimembranous (more common, 90%)

Front 41

Patients with VSDs will present how?

Back 41

usually asymptomatic; Can have Sx of CHF;

Front 42

Type of shunting seen in VSDs?

Back 42

Left to Right

Front 43

Changes in chamber size with VSDs?

Back 43

Left atrial and ventricular enlargement (volume overload)

Front 44

Why do you get volume overload in VSD?

Back 44

each time vent pumps, it pumps out the aorta and across to the right side of the heart, and that blood will come right back

Front 45

What will the oxygen of a VSD look like?

Back 45

increase oxygen in RV

Front 46

CXR findings of VSD?

Back 46

enlarged LA and LV; Increased pulmonary vascularity

Front 47

Heart sound abnormalities with VSD?

Back 47

S3 from increased mitral flow

Front 48

Murmurs in VSD?

Back 48

pansystolic across LLSB (Flow through VSD)

Front 49

Tx of VSD?

Back 49

If you can't control HF medically, Surgical closure with patch (membranous) or percutaneously (muscular)

Front 50

Someone who used to have VSD murmur no longer does. What happened?

Back 50

spontaneous closure (50%), P HTN has developed diminishing the shunt;

Front 51

When does the ductus arteriosus normally close and what causes it to close?

Back 51

1-2 days after birth; High O2, lack of Prostaglandins;