59 Questions
Why are defects associated with ASD such as sinus venosus defect and patent foramen ovale considered not true ASD?
Because they are morphologically distinct and not associated with absent anatomic atrial septum tissue.
In the case of uncomplicated ASD, why is oxygenated blood shunted from the left atrium into the right atrium but not vice versa?
As a result of LA pressure exceeding RA pressure.
What causes the appearance of cyanosis in ASD patients?
An increase in LA pressure due to pulmonary hypertension.
Why does the valve of the foramen ovale remain closed in ASD patients despite not being fully sealed?
Because LA pressure is higher than RA pressure.
What is the pathophysiology behind paradoxical embolism in ASD patients?
Thrombus travels from systemic vein to RA causing systemic embolism.
What differentiates morphologically distinct defects like sinus venosus defect from true ASD?
Involvement of fusion of atrial septa.
Why does cyanosis occur in ASD patients when RA pressure increases?
Because R to L shunt diverts deoxygenated blood to arterial circulation.
What change occurs in pulmonary resistance after birth?
It decreases and becomes 10 times less than systemic resistance
What facilitates the left-to-right directed shunt at the atrial level?
Increase in LV thickness
What determines the direction of shunt in cases of ASD?
Pressure difference between vena cava and pulmonary veins
What is the primary cause of hypoxemia and cyanosis in complicated ASD?
Development of right-to-left shunt
What happens to the direction of shunt if severe pulmonary vascular disease develops?
It reverses from left-to-right to right-to-left
What symptoms might be observed in infants with ASD?
Dyspnea on exertion and fatigue
What change occurs over time due to the overload on RA & RV in ASD?
Enlargement of both chambers
'In perinatal life, the pulmonary resistance is equal to the ____ resistance.' How should this sentence be completed?
Systemic
What would you suspect if the systolic pressure in the right arm is 15 to 20 mm Hg greater than that in a leg?
Coarctation distal to the takeoff of the left subclavian artery
What characterizes Tetralogy of Fallot?
Ventricular septal defect
Why are the femoral pulses weak and delayed in coarctation?
Aortic obstruction
What do you expect in terms of pulse pressure between arms and legs in a normal individual?
Higher in legs
What causes subvalvular pulmonic stenosis in Tetralogy of Fallot?
Abnormal displacement of the infundibular septum
Where does coarctation proximal to the left subclavian artery cause an increase in systolic pressure?
Right arm
Which form of cyanotic congenital heart disease is most common after infancy?
Tetralogy of Fallot
What anomaly characterizes Tetralogy of Fallot due to the displacement of the infundibular septum?
Pulmonary stenosis
What happens when the pulmonary vascular resistance falls after birth in the context of a ventricular septal defect (VSD)?
The right ventricle (RV) experiences volume overload.
How does an increased blood return to the left ventricle (LV) affect the stroke volume after birth in the context of a large VSD?
Increases via the Frank-Starling mechanism.
What is one potential consequence of prolonged volume overload in the LV due to a large VSD?
Chamber dilatation.
In what circumstance may an intracardiac shunt reverse its direction, leading to systemic hypoxemia and cyanosis?
Pulmonary vascular resistance exceeding systemic resistance (Eisenmenger syndrome).
What happens to the shunting when pulmonary resistance equals systemic resistance in the context of a VSD?
The shunting will be minimized.
How does a nonrestrictive defect influence the left-to-right shunt in a VSD?
Decreases the left-to-right shunt.
What is a potential outcome when pulmonary vascular resistance falls below systemic resistance?
Systemic hypoxemia and cyanosis.
In what scenario could an overload of the right ventricle, pulmonary circulation, left atrium, and left ventricle occur?
With large VSDs.
What is the likely reason behind the harsh systolic ejection murmur in transposition of the great arteries (TGA)?
Turbulent blood flow through the stenotic right ventricular outflow tract
Why is there usually no distinct murmur related to the ventricular septal defect (VSD) in transposition of the great arteries (TGA)?
The VSD is typically large and generates little turbulence
Which diagnostic study finding helps differentiate transposition of the great arteries (TGA) with other congenital heart defects?
Appearance of a 'boot-shaped' heart on chest radiography
What does transposition of the great arteries (TGA) do to the circulatory system?
Separates the systemic and pulmonary circulations by placing them in parallel
What is the pathophysiological consequence of TGA on blood oxygenation?
Desaturation of blood from the venous system
How does TGA differ from normal anatomy in terms of great vessel origin?
The aorta originates from the right ventricle and the pulmonary artery from the left ventricle
Why is there a lack of congestion in the lungs in transposition of the great arteries (TGA)?
'Washed out' lungs result from no lung congestion due to pulmonic stenosis
What does transposition of great arteries do to pulmonary blood flow?
Decreases blood flow to the lungs
What is a potential consequence of prolonged volume overload in the LV due to a large VSD?
Aortic valve stenosis
What is the most common physical finding in coarctation of the aorta?
A harsh holosystolic murmur
What does an excessive diverticulation of the muscular septum lead to?
Left ventricular hypertrophy
What symptom is NOT commonly associated with right ventricular hypertrophy?
Cyanosis
Which diagnostic study finding helps differentiate left ventricular hypertrophy from other conditions?
Prominent pulmonary vascular markings on chest radiographs
What structural development characterizes aortic stenosis?
Bicuspid valve structure
What is the primary reason for left ventricular hypertrophy in aortic stenosis?
Impaired aortic orifice
What pathophysiological consequence is associated with untreated severe pulmonic stenosis?
Right-sided heart failure
What is the result of right ventricular outflow obstruction in pulmonic stenosis?
Increased right ventricular pressure
In coarctation of the aorta, where does an increase in systolic pressure occur due to proximal narrowing?
Descending aorta
What symptom is most commonly seen in infants less than 1 year old with pulmonary valve stenosis?
Tachycardia
Which physical examination finding is characteristic of right ventricular hypertrophy?
Palpable RV heave over the sternum
What diagnostic study finding is associated with left ventricular hypertrophy?
Enlarged LV and dilated ascending aorta
In coarctation of the aorta, where does proximal stenosis cause an increase in systolic pressure?
Upper extremities
What symptom is a hallmark of severe pulmonary stenosis in adults?
Angina pectoris
Why do children with a certain condition learn to alleviate their symptoms by squatting down?
To increase systemic vascular resistance by kinking the femoral arteries.
What is a common manifestation of a high mixing through a ventricular septal defect (VSD) in a certain condition?
Clubbing due to extreme hypoxia.
What is the primary reason for irritability, cyanosis, and hyperventilation in a specific condition?
Decreased systemic resistance due to exercise.
What is one mechanism that can lead to a decrease in systemic hypoxemia in patients with a certain condition?
Increase in systemic resistance due to exercise.
What is the reason behind children with a certain condition experiencing teratology spells?
Decreased systemic resistance due to exertion.
Explore the classification of atrial septal defects, including types like sinus venosus defect and patent foramen ovale. Understand the difference between true atrial septal defects and defects associated with ASD.
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