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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
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Left to Right
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How do you quantify left to right shunt
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Ratio of pulmonary blood flow to systemic blood flow --> Qp:Qs ratio
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Qp:Qs ratio in individuals without a shunt
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1
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Most common defects resulting in L to R shunt
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ASD, VSD, PDA
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With the exception of bicuspid aortic valve what it the most common congenital heart lesion
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VSD
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Equation of pressure gradient
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P = Q*R
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For the systemic circulation what is the pressure gradient
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Pressure gradient is between aorta and RA - mean aortic pressure - mean RA pressure
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For pulmonary circulation what is the pressure gradient
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Between pulmonary artery and pulmonary veins (LA) - mean PA pressure - mean PV pressure
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What is higher systemic or pulmonary vascular resistance
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Systemic (15-20)
(Pulmonary (1-2)) |
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Which VSD is evident right after birth - small or large? Why?
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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
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Why is large VSD not evident right after birth
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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.
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6 weeks old male presents with symptoms of CHF -tachypnea, poor growth and easy fatigue manifested by breathlessness with feeding - diagnosis
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Large ventricular septal defect
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What are the signs and symptoms of CHF in infancy are due?
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Left to right shunting secondary to excessive pulmonary blood flow
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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
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VSD
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Intensity and splitting of S2 in VSD depends on _
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pulmonary artery pressure
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Rumbling diastolic murmur is heard at the apex - what is the diagnosis
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Large left to right shunt
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Chest x ray of a newborn shows cardiomegaly and increased vascular pulmonary markings and pulmonary edema - diagnosis
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VSD
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Fick equation for pulmonary blood flow
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CO = Q = O2 consumption (mL/min) / O2 content pulmonar vein - O2 content pulmonary artery
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Fick equation for systemic blood flow
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CO = Qs = O2 consumption/ O2 content aorta - O2 content vein
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How do you determine oxygen content
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By measuring hemoglobin concentration and percent of hemoglobin which is saturated with oxygen - can be measured by pulsimetry or blood sample
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What happens in VSD with L atrium and L ventricle
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Distended because of increased pulmonary blood flow
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Large ventral septal defects should be closed by what age
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6 months
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How do you treat VSD prior to surgical closure
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Treat CHF symptoms with diuretic to alleviate pulmonary congestion and digoxin which alleviates symptoms
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If VSD is near aortic valve leaflets there is a danger of _
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Aortic regurgitation
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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
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Eisenmenger syndrome
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In ASD there is a shunt between _
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left atrium to right atrium
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Oxygenated blood from lungs returns to the right side of the heart and makes a return trip to lungs- what defect
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ASD
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Defects in atrial septum are most common in what region
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Fossa ovalis - secundum atrial septal defects
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Why is there left to right shunting in ASD
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Left ventricle after birth rapidly becomes more muscular and less compliant than right ventricle - causing progressive left to right shunting
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Which ventricle is volume overloaded in ASD
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RV
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Which ventricle is volume overloaded in VSD
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Left ventricle
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In VSD there is step up in saturation in _
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RV, PA
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In ASD there is step up in saturation in _
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RA, RV, PA
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Step up in saturation in RA is diagnostic of _
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ASD
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Is there an effect of ASD on pulmonary resistance after birth
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NO - unlike VSD there is very little or no effect on fall in pulmonary vascular resistance after birth
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Is there evidence of ASD right after birth
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NO - develops within few weeks or months
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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
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ASD
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Diastolic rumbling murmur is heard in patients with both VSD and ASD - how do you differentiate them
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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
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Normal fetal passageway that provides outlet for flow from R ventricle in fetus
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Ductus arteriosus
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Blood normally flows from pulmonary artery to aorta through _
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Ductus arteriosus
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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?
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Patent ductus arteriosus
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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
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PDA
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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
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PDA
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Name conditions that can result in wide pulse pressure
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Aortic regurgitation
PDA Surgically placed shunt between systemic artery and pulmonary artery |
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Patient presents with endocardial cushion defect - which disease is it strongly associated with?
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Downs
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In PDA there is shunt between _
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Aorta and pulmonary artery
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in VSD there is shunt between _
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LV and PA
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AV valves, inferior portion of atrial septum and posterior portion of ventricular septum originate from _
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Endocardial cushions
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Primum atrial septal defect with or without VSD originates from _
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Endocardial cushion defect
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Patients with this defect have left to right shunting at the atrial and ventricular level and CHF by 6-8 weeks of age
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AV canal (AV septal defect)
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Catheterization reveals step up from SVC to RA and further step up in RV - which defect?
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AV canal
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Passage of unoxygenated blood back into systemic circulation bypassing the lungs
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R to L shunt
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Which shunt results in cyanosis
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R to L shunt
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In patients with _ cyanosis is less easily observed while in patients with _ its more easily observed
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Less easily in anemic patients
More easily in patients with erythrocytosis |
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Two most common cyanotic heart defects
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Tetralogy of Fallot and transposition of great vessels
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4 defects of tetralogy of Fallot
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Pulmonary stenosis
RVH Overriding aorta VSD |
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Child presents in infancy with murmur due to subpulmonary obstruction and cyanosis - name defect
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Tetralogy of Fallot
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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
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Tetralogy of Fallot
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Why is pressure in pulmonary artery low in tetralogy of Fallot
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Obstruction between pulmonary arteries and R ventricle
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In tetralogy of Fallot pulmonary flow decreased or increased
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Decreased
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Chest x ray in child shows normal heart size, lung fields appear dark (decreased pulmonary vascularity), cardiac silhoette has boot shaped contour
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Tetralogy of Fallot
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Subpulmonic obstruction in tetralogy of Fallot is caused by _
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Cardiac muscle
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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
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Tetralogy of Fallot
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Older children with hypercyanotic spells - diagnosis? How can they abort attacks?
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Tetralogy of Fallot
Squatting |
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Why does squatting helps children with hypercyanotic spells
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Squatting increases systemic arterial resistance which effectively decreases R to L shunt into aorta and causes more blood to go into pulmonary circuit
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In the hospital setting severe hypercyanotic spell can be treated with _
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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
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Which drugs are contraindicated in child with hypercyanotic spell
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Any agent that increases myocardial contractility such as sympathomimetics - epinephrine, NE, isoproterenol - will increase dynamic obstruction
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Blalock Taussig shunt is surgical procedure done to correct _
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Tetralogy of Fallot
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Subclavian artery is transected and anastomosed directly to pulmonary artery - name procedure
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Blalock Taussig
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Complete repair of tetralogy of Fallot ivolves _
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Relieving pulmonary outflow obstruction and closing VSD
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Aorta comes from right ventricle and and pulmonary artery from left ventricle - name defect
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Transposition of great arteries
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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
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Transposition of great arteries
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Which shunt is usually present in kids with transposition of great vessels
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Patent foramen ovale
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Medication lifesaving in babies with severe tetralogy of Fallot or any other defect in which blood could not be delivered to pulmonary arteries
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Prostaglandin E
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Newborn presents with cyanosis and decreased systemic saturation is not reversed by giving oxygen
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Transposition of great vessels
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Single second heart sound is the sign of what defect
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Transposition of great vessels
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Diagnosis of transposition is made by _
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Echo
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Name defect that results in complete mixing - pulmonary and systemic venous return completely mixes in either heart or great vessels
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Truncus arteriosus
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Failure of separation of pulmonary artery and aorta
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Truncus arteriosus
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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
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Truncus arteriosus
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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
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Truncus arteriosus
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Chest x ray shows large heart with increased pulmonary vascular marking and pulmonary edema - defect
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Truncus arteriosus
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In this defect there is no access from RA to RV and RV is hypoplastic
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Tricuspid atresia
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EKG shows abnormally superior vector force indistinguishable from left anterior hemiblock except that it occur congenitally
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Tricuspid atresia
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Fontan operation is used in patients with what condition
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Tricuspid atresia
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Rise in right ventricular pressure in proportion to the degree of obstruction resulting in RVH gives you a diagnosis of _
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Pulmonary valve stenosis
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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
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Pulmonary valve stenosis
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EKG shows RVH - diagnosis
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Pulmonary valve stenosis
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Treatment of choice for pulmonic stenosis
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Balloon valvuloplasty
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Balloon valvuloplasty for treatment of pulmonic stenosis is not effective in kids with _
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Noonan syndrome
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Child presents with mild mental retardation, infantile hypercalcemia elfin facial features and outgoing personality - which heart defect most likely presents
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Williams syndrome - supravalvular aortic stenosis
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Lower oxygen saturation in lower body than in upper body is a sign of_
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Aortic stenosis
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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?
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Prostaglandin E
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There is high incidence of coarctation of aorta in patients with _
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Turners syndrome
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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
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Coarctation of aorta
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What does EKG show in patient with coarctation of aorta
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LVH
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Any infant presenting with shock like picture especially if they were previously thought to be well should be suspected to have _
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Left sided heart obstruction
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