Fiser Chapter 26 CARDIAC Flashcards Preview

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Flashcards in Fiser Chapter 26 CARDIAC Deck (44)
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1

Shunt causing cyanosis

R to L shunt

2

Children squatting does what

Increases SVR and decreases R to L shunt

3

Cyanosis from R to L shunt can lead to what

Polycythemia, stroke, brain abscess, endocarditis

4

Eisenmenger's syndrome

L -> R shunt switches to R -> L shunt

Sign of increasing pulmonary vascular resistant and pulmonary HTN, and is generally irreversible

5

Shunt causing CHF

L to R shunt

Manifests as failure to thrive, tachycardia, tachypnea, hepatomegaly

6

First sign of CHF in children

Hepatomegaly

7

Causes of L to R shunts

VSD
ASD
PDA

8

PDA causes what kind of shunt

L to R

9

Causes of R to L shunts

Tetralogy of Fallot

10

Ductus arteriosus

Connection between descending aorta and Left pulmonary artery; blood shunted away from lungs in utero

11

Ductus venosum

Connection between portal vein and IVC; blood shunted away from liver in utero

12

Fetal circulation at placenta

2 umbilical arteries (take blood away from fetus)

1 umbilical vein (brings blood to fetus)

13

Most common congenital heart defect

VSD causing a L -> R shunt

80% close spontaneously by 6 months

Large VSDs usually cause symptoms after 4-6 weeks old, as PVR decreases and shunt increases

Cx: CHF (tachypnea, tachycardia) and FTT (failure to thrive)

Tx: Diuretics, digoxin, repair

14

VSD timing of repair

FTT: most common reason for earlier repair

Medium (shunt 2-2.5): 5yo

Large (shunt > 2.5): 1yo

15

ASD types

Ostium secundum is most common; centrally located

Ostium primum (or atrioventricular canal defects or endocardial cushion defects); can have mitral valve and tricuspid valve problems; frequent in Down's syndrome

16

ASD

L -> R shunt

Usually symptomatic when shunt > 2 -> CHF (SOB, recurrent infections)

Can get paradoxical emboli in adult hood

Tx: Diuretics and digoxin

17

ASD timing of repair

1-2yo

If canal defects: 3-6 months old

18

Tetralogy of Fallot

PROV:
-Pulmonic stenosis
-R ventricular hypertrophy
-Overriding aorta
-VSD

R to L shunt -> cyanosis

Tx: Beta blocker, repair at 3-6 months old

19

Most common congenital heart defect that results in cyanosis

Tetralogy of Fallot

20

Tetralogy of Fallot repari

-RV outflow tract obstruction removal, RVOT enlargement, and VSD repair

21

PDA

L to R shunt

Tx: indomethacin to close, rarely successful beyond neonatal period, requires L thoracotomy for repair if persists

22

MCC death in US

CAD

23

CAD risk factors

-Smoking
-HTN
-Male
-Family hx
-HLD
-DM

24

CAD medical tx

-Nitrates, smoking cessation, weight loss, statins, ASA

25

Coronary arteries

LMA branches into LAD and LCx

26

Where are most atherosclerotic coronary lesions?

Proximal

27

MI complications

-Ventricular septal rupture
-Papillary muscle rupture

28

3-7 days after MI, patient has hypotension, pansystolic murmur, and a step-up in O2 content between R atrium and pulmonary artery

Ventricular septal rupture

Dx: Echo

Tx: IABP and patch over septum

29

3-7 days after MI, patient has severe mitral regurgitation with hypotension and pulmonary edema

Papillary muscle rupture

Dx: Echo

Tx: IABP, replace valve

30

Incidence in restenosis in CAD revascs

Drug-eluting stent: 80% at 1 year

Saphenous vein graft: 80% at 5 years

Internal mammary artery (off subclavian): 95% 20 year patency when placed to LAD; collateralizes with superior epigastric artery