Term
| what is the classic way of classifying congenital heart disease? |
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Definition
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Term
| what is the main cyanotic congenital heart disease we are going to look at? |
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Definition
| tetralogy of fallot (relatively common) |
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Term
| what are common congenital defects that will make it to adulthood? |
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Definition
| VSD, ASD, bicuspid Ao valve, PDA, MVP, PS, coarctation, congenital AS, ebsteins anomaly, and tetralogy (cyanotic) |
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Term
| what are VSD, ASD, and PDA referred to as? |
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Definition
| L -> R shunts, and are very common |
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Term
| can PDA be diagnosed easily? |
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Definition
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Term
| what is bicuspid aortic valve? |
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Definition
| a congenital problem where pts are born with 2 leaflets instead of 3. the pt presents with a diamond shape, *crescendo/decrescendo murmur* - can can have stenosis across the valve - leads to deterioration of the cardiovascular system |
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Term
| what are some of the more common congential heart defects? |
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Definition
| VSD, pulm stenosis, PDA, and atrial septal defect, etc |
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Term
| what is the approach to diagnosing congenital heart disease? |
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Definition
| incidence (make logical conclusions), natural hx (considere age/background), dx (check shunts, valves, gradients in heart, size of chambers, and extent of disease using ECHO, cardiac catheterization), anatomical variation (many defects are associated with 2ndary defects), tx (shunts can can be installed w/o sx) |
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Term
| what are the general complications of congenital heart disease? |
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Definition
| infective endocarditis, brain abscess (occur in underperfused/cyanotic situations - tetralogy of fallot), arrhythmia (sudden death), *eisemengers* (children with a R->L shunt have a pressure reversal, becomes a L->R), and functional limitations |
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Term
| how can eisemengers be used to treat pulmonary HTN? |
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Definition
| in pulmonary hypertension for children: seem to do better if create a right to left shunt, will develop eisemengers and live longer as opposed to if the shunt wasn’t being made |
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Term
| what is the hemodynamic method os classifying congenital heart disease? what isa gradient? |
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Definition
| shunts: L->R, R->L, or balanced. a gradient is a change in pressure through a valve or shunt. |
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Term
| what might cause a R->L shunt? |
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Definition
| a cyanotic, tetralogy of fallot situation, where pulmonary stenosis and a VSD cause blood to flow from R->L |
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Term
| what might cause a L->R shunt? |
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Definition
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Term
| what can cause eisemengers (non-interventional type)? what are symptoms? |
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Definition
| if a dr misses something like ASD, which is initially a L->R shunt, it can reverse to a R->L shunt (b/c of progressively increasing pulm pressure). this will usually become symptomatic in the pts 30s, present with clubbing/cyanosis, and can die relatively young. there is increased incidence of brain abscess (due to cyanosis) and sudden death rate is 14% |
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Term
| what is a good way to position pts for CXR, when trying to look at the heart? |
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Definition
| turning the pt a little to the right from the standard PA view, allows both ventricles to be more visible |
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Term
| what ventricle is seen predominately in the standard PA CXR? |
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Definition
| the L ventricle, which makes up the L border. the R ventricle is coming right out at you, so it is not visible |
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Term
| holosystolic murmurs are always ________? what defects are related? |
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Definition
| holosystolic murmurs are always abnormal. VSD, mitral regurgitation, and tricuspid regurgitation all will cause a holosystolic murmur |
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Term
| what is a mid systolic murmur usually indicative of? |
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Definition
| pulmonary artery or aortic stenosis (from the base of the heart) |
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Term
| what is an early systolic murmur indicative of? |
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Definition
| severe mitral regurgitation (ruptured at this point - nothing left) |
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Term
| what is an late systolic murmur indicative of? |
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Definition
| unusual mitral regurgitation |
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Term
| what is the "tetralogy" of fallot? |
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Definition
| VSD, PS, ->results in-> RVH, and over-riding aorta (aorta doesn’t seem to attach at base of septum) |
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Term
| how do pressures in the R ventricle compare in terms of VSD vs tetralogy of fallot? |
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Definition
| pressure in the R ventricle in tetralogy of fallot is high, while pressure in the R ventricle in VSD is low |
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Term
| what are the different types of VSD? |
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Definition
| membranous, which usually creates a large connection. muscular, which usually creates a high pitched murmur - also *can close spontaneously |
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Term
| where is VSD best auscultated? |
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Definition
| the base of the heart, pulmonary area, and the L sternal border (holosystolic) |
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Term
| what are some kinds of ASD? what is a common risk with this condition? |
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Definition
| patent foramen ovale, sinus venosus. pts are at risk for migranes, emoboli that can cross from the R atrium -> L ventricle and yield a peripheral embolus on the L side of the system |
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Term
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Definition
| not blatantly apparent, very subtle/standard murmur due to increased flow across the pulmonary valve. pts may be short of breath, with an enlarged heart. upon inspiration, the aortic and pulmonic valve sounds (s2) will separate ("splitting"), but will come back together upon expiration. there are also 2 types: secundum (most common, usually patent foramen ovale) and primum (less common, can involve mitral valve) |
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Term
| what is a patent ductus arteriosus? |
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Definition
| connection between the L pulm artery and aorta |
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Term
| what is significant about auscultating a PDA murmur? |
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Definition
| continuous machine gun murmur - due to flow of high aortic pressure to the pulmonary artery |
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Term
| what is the prognosis for PDA? |
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Definition
| good after usually easy sx |
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Term
| what is the 1/3 rule with bicuspid aortic valve? |
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Definition
| 1/3 degenerate to aortic insufficiency, 1/3 degenerate to aortic stenosis, and 1/3 will degenerate to both |
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Term
| what commonly happens to bicuspid aortic valves? what is a fish mouth? might the L ventricle be affected? |
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Definition
| bicuspid aortic valves will usually calcify, become fibrotic, or contract creating a "fish mouth" looking opening. and the L ventricle may also become hypertrophic |
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Term
| why is coarctation of the aorta often missed? what is coarctation of the aorta? |
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Definition
| b/c pts are only treated for HTN. coarctation of the aorta is a narrowing of the aorta distal (before) to the L subclavian artery. |
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Term
| how would coarctation of the aorta appear on a CXR? |
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Definition
| poor flow, high pressure in the upper extremities (should usually be lower in the upper vs lower extremities) |
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Term
| how does coarctation of the aorta sound? |
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Definition
| systolic murmur, the gradient is not at the aortic valve - so the murmur is heard better posteriorly |
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Term
| how is coarctation of the aorta treated? |
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Definition
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Term
| does pulmonary stenosis favor one gender over another? |
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Definition
| yes it seems to favor women |
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Term
| where is pulmonary stenosis heard? how does it sound? what is the rate of dx? |
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Definition
| at the R sternal border, presenting as a crescendo and decrescendo murmur across the narrowed valve. it often will go undiagnosed, pts will live to adulthood |
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Term
| what is the problem with hypertrophic cardiomyopathy? |
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Definition
| the walls of the heart become over-thickened - outstripping blood supply (angina, SOB b/c pressure is high and this is translated to the lungs) and decreasing capacity. this can cause sudden death via arrhythmias. |
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Term
| what is another name for hypertrophic cardiomyopathy? |
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Definition
| IHSS (idiopathic subaortic stenosis) |
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Term
| how does a heart affected by hypertrophic CMP appear? |
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Definition
| asymmetrically thickened walls |
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Term
| can hypertrophic CMP be inherited? |
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Definition
| yes, this can be autosomally dominant 60% of the time and result in sudden death |
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Term
| how is hypertrophic CMP diagnosed? |
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Definition
| easily via echo - can then measure heart walls - should be ~ 1 cm thick |
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Term
| what can happen during systole with hypertrophic CMP? |
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Definition
| the mitral valve can be pulled up and hit the septum -> creates a gradient |
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Term
| what is the benefit of sx to correct hypertrophic CMP? |
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Definition
| sx slice off some of the hypertrophic muscle of the septum, but there is a high sx mortality and it only makes it a little less symptomatic |
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Term
| can drugs help with hypertrophic CMP? |
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Definition
| yes, beta blockers/Ca+ blockers |
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Term
| what is a new prodecure that has been developed for hypertrophic CMP? |
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Definition
| a catheter is placed in the septum that injects alcohol locally in an attempt to create cell death |
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