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32 Cards in this Set

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TRUE/FALSE - Congenital Heart Disease affects 8/1000 live births, with varying severity, but there is increased survival due to modern improvements.
Describe the formation of the primitive heart tube upto septation
1. 2 lateral endocardial tubes fuse with 1 end being venous and the other arterial;
2. constrict and dilatation forms TA, Primitive A & V, & sinous venosus;
3. Growth causes formation of U loop;
4. Septation of A & V & AV canal begins
Desribe the role of the ductus venosus.
Allows bypassing of the hepatic vasculature to the IVC and is shunted to the LA since higher in O2 (brain and myocardium).
Describe Atrial Septation.
septum primum leaves ostium primum; merges with endocardial cushions but leaves new ostium secundum; the Septum secundum grows down and with partial merger leaves opening, foramen ovale;
Describe the role of the ductus arteriosus.
Allows for bypassing of lungs since Oxygenation via fetal lungs not important.
What are the 3 shunts that are closed upon birth?
ductus arterisus (PGE decrease), ductus venosus (clamping of umbilical), foramen ovale (increased LA pressure)
What physical changes occurs to the RV and LV after birth?
RV loss of wall thickness, LV hypertrophy
Describe the basic mechanism of cyanotic congenital heart disease.
R to L shunt so that deoxygenated blood passes to tissue.
Describe the basic mechanism of acyanotic congenital heart disease.
L to R shunt leading to pulmonary artery pressure and volume increases
Describe 5 Acyanotic Congenital Lesions.
ASD; patent ductus arteriosus; Congenital Aortic Stenosis; Congenital Pulmonic Stenosis; Coarctation of the Aorta
Describe 2 forms of the relatively common congenital Atrial Septal Defect.
1. usually at foramen ovale (ostium secundum);
2. sometimes near AV valve (ostium primum);
TRUE/FALSE - Patent Foramen Ovale is a a true form of ASD.
False - usually closed unless another condition such as Pulmonary HTN
Describe the PE (3 sounds) findings for an ASD.
Often asymptomatic but with S2 fixed splitting, systolic murmur (increased flow across PV); mid diastolic murmur (increase flowed across TV)
Radiographic Presentation of ASD and treatment of ASD.
RA & RV dilatation; increased pulmonary vascular markings; Treatment is surgical repair.
What is the consequence of a Patent Ductus Arteriosus?
Pulmonary circulation, LA & LV dilatation because of volume overload
Describe the variable presentation of PDA? PE findings? Treatment?
from asymptomatic to CHF; PE finding of continous murmur; Treatment is occlusion!
Describe the clinical presentation of Congenital Aortic Stenosis.
4x more likely in males, high percentage have additional abnormalities, from asymptomatic to symptoms of HF
Describe the pathologic presentation of Congenital Aortic Stenosis.
abnormal bicuspid valve, LV hypertrophy,
What PE murmur findings are found in Congenital Aortic Stenosis shows? Treatment?
crescendo-decrescendo systolic murmur with ejection click, paradoxical splitting of S2; Treatment is endocarditis prophylaxis in mild forms with valvuoplasty in severe forms
Describe the clinical and pathologic presentation of congenital pulmonic stenosis.
RV hypertrophy but mild/moderate stenosis is usually asymptomatic and discovered by PE.
PE findings for congenital pulmonic stenosis.
If severe: Large venous "a wave" (~RV hypertrophy); widened splitting of S2; pulmonic ejection click with moderate stenosis
Treatment for pulmonic stenosis.
mild does not require treatment, more severe requires valvuloplasty; ABX prophylaxis for endocarditis
Describe the mechanism of Coarctation of the Aorta and its physiologic adaptations.
decrease in aortic lumen size leads to LV hypertrophy and dilatation of compensatory collateral blood vessels that bypass the obstruction
Describe the clinical presentation of Aortic Coarcatation.
Often in (XO); preductal/postductal with early infant HF in severe;
PE findings with aortic coarctation? Radiographic findings?
weak femoral pulse (due to elevated BP in the upper body); notching of the posterior ribs
Treatment of Coarctation of the Aorta.
Prostaglandin infusion (PDA); surgical correction with ABX prophylaxis for endoarteritis
Name 2 Cyanotic Lesions.
Tetralogy of Fallot, Transposition of the Great Arteries
VSD, subvalvular pulmonic stenosis, overriding aorta, & RV Hypertrophy suggest what congenital cyantoic lesion?
Tetralogy of Fallot (most common cyanotic lesion, boot shaped heart)
Treatment for Tetralogy of Fallot.
Surgical Correction + ABX prophylaxis for endocarditis
Treatment for Transposition of the Great Arteries.
Medical Emergency, Requires surgical correction via switching (also have to move the coronary arteries) or lethal!
What is Eisenmenger Syndrome?
Severe pulmonary vascular obstruction that results from chronic L to R shunt through congenital cardiac defect.
TRUE/FALSE - Characteristics of Eisenmenger Syndrome include cyanosis, hyerviscosity, increased pregnancy mortality and exertional dyspnea.