Atrial Septal Defects Classification
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Questions and Answers

Why are defects associated with ASD such as sinus venosus defect and patent foramen ovale considered not true ASD?

  • Because they involve the fusion of the atrial septa.
  • Because they lead to cyanosis due to R to L shunt.
  • Because they result in paradoxical embolism.
  • Because they are morphologically distinct and not associated with absent anatomic atrial septum tissue. (correct)
  • In the case of uncomplicated ASD, why is oxygenated blood shunted from the left atrium into the right atrium but not vice versa?

  • Due to elevated right atrial pressure.
  • Because of the closure of the valve of the foramen ovale.
  • Caused by the failure of the septum primum to close.
  • As a result of LA pressure exceeding RA pressure. (correct)
  • What causes the appearance of cyanosis in ASD patients?

  • Closure of the valve of the foramen ovale.
  • A decrease in RA pressure leading to cyanosis.
  • Presence of systemic embolism.
  • An increase in LA pressure due to pulmonary hypertension. (correct)
  • Why does the valve of the foramen ovale remain closed in ASD patients despite not being fully sealed?

    <p>Because LA pressure is higher than RA pressure.</p> Signup and view all the answers

    What is the pathophysiology behind paradoxical embolism in ASD patients?

    <p>Thrombus travels from systemic vein to RA causing systemic embolism.</p> Signup and view all the answers

    What differentiates morphologically distinct defects like sinus venosus defect from true ASD?

    <p>Involvement of fusion of atrial septa.</p> Signup and view all the answers

    Why does cyanosis occur in ASD patients when RA pressure increases?

    <p>Because R to L shunt diverts deoxygenated blood to arterial circulation.</p> Signup and view all the answers

    What change occurs in pulmonary resistance after birth?

    <p>It decreases and becomes 10 times less than systemic resistance</p> Signup and view all the answers

    What facilitates the left-to-right directed shunt at the atrial level?

    <p>Increase in LV thickness</p> Signup and view all the answers

    What determines the direction of shunt in cases of ASD?

    <p>Pressure difference between vena cava and pulmonary veins</p> Signup and view all the answers

    What is the primary cause of hypoxemia and cyanosis in complicated ASD?

    <p>Development of right-to-left shunt</p> Signup and view all the answers

    What happens to the direction of shunt if severe pulmonary vascular disease develops?

    <p>It reverses from left-to-right to right-to-left</p> Signup and view all the answers

    What symptoms might be observed in infants with ASD?

    <p>Dyspnea on exertion and fatigue</p> Signup and view all the answers

    What change occurs over time due to the overload on RA & RV in ASD?

    <p>Enlargement of both chambers</p> Signup and view all the answers

    'In perinatal life, the pulmonary resistance is equal to the ____ resistance.' How should this sentence be completed?

    <p>Systemic</p> Signup and view all the answers

    What would you suspect if the systolic pressure in the right arm is 15 to 20 mm Hg greater than that in a leg?

    <p>Coarctation distal to the takeoff of the left subclavian artery</p> Signup and view all the answers

    What characterizes Tetralogy of Fallot?

    <p>Ventricular septal defect</p> Signup and view all the answers

    Why are the femoral pulses weak and delayed in coarctation?

    <p>Aortic obstruction</p> Signup and view all the answers

    What do you expect in terms of pulse pressure between arms and legs in a normal individual?

    <p>Higher in legs</p> Signup and view all the answers

    What causes subvalvular pulmonic stenosis in Tetralogy of Fallot?

    <p>Abnormal displacement of the infundibular septum</p> Signup and view all the answers

    Where does coarctation proximal to the left subclavian artery cause an increase in systolic pressure?

    <p>Right arm</p> Signup and view all the answers

    Which form of cyanotic congenital heart disease is most common after infancy?

    <p>Tetralogy of Fallot</p> Signup and view all the answers

    What anomaly characterizes Tetralogy of Fallot due to the displacement of the infundibular septum?

    <p>Pulmonary stenosis</p> Signup and view all the answers

    What happens when the pulmonary vascular resistance falls after birth in the context of a ventricular septal defect (VSD)?

    <p>The right ventricle (RV) experiences volume overload.</p> Signup and view all the answers

    How does an increased blood return to the left ventricle (LV) affect the stroke volume after birth in the context of a large VSD?

    <p>Increases via the Frank-Starling mechanism.</p> Signup and view all the answers

    What is one potential consequence of prolonged volume overload in the LV due to a large VSD?

    <p>Chamber dilatation.</p> Signup and view all the answers

    In what circumstance may an intracardiac shunt reverse its direction, leading to systemic hypoxemia and cyanosis?

    <p>Pulmonary vascular resistance exceeding systemic resistance (Eisenmenger syndrome).</p> Signup and view all the answers

    What happens to the shunting when pulmonary resistance equals systemic resistance in the context of a VSD?

    <p>The shunting will be minimized.</p> Signup and view all the answers

    How does a nonrestrictive defect influence the left-to-right shunt in a VSD?

    <p>Decreases the left-to-right shunt.</p> Signup and view all the answers

    What is a potential outcome when pulmonary vascular resistance falls below systemic resistance?

    <p>Systemic hypoxemia and cyanosis.</p> Signup and view all the answers

    In what scenario could an overload of the right ventricle, pulmonary circulation, left atrium, and left ventricle occur?

    <p>With large VSDs.</p> Signup and view all the answers

    What is the likely reason behind the harsh systolic ejection murmur in transposition of the great arteries (TGA)?

    <p>Turbulent blood flow through the stenotic right ventricular outflow tract</p> Signup and view all the answers

    Why is there usually no distinct murmur related to the ventricular septal defect (VSD) in transposition of the great arteries (TGA)?

    <p>The VSD is typically large and generates little turbulence</p> Signup and view all the answers

    Which diagnostic study finding helps differentiate transposition of the great arteries (TGA) with other congenital heart defects?

    <p>Appearance of a 'boot-shaped' heart on chest radiography</p> Signup and view all the answers

    What does transposition of the great arteries (TGA) do to the circulatory system?

    <p>Separates the systemic and pulmonary circulations by placing them in parallel</p> Signup and view all the answers

    What is the pathophysiological consequence of TGA on blood oxygenation?

    <p>Desaturation of blood from the venous system</p> Signup and view all the answers

    How does TGA differ from normal anatomy in terms of great vessel origin?

    <p>The aorta originates from the right ventricle and the pulmonary artery from the left ventricle</p> Signup and view all the answers

    Why is there a lack of congestion in the lungs in transposition of the great arteries (TGA)?

    <p>'Washed out' lungs result from no lung congestion due to pulmonic stenosis</p> Signup and view all the answers

    What does transposition of great arteries do to pulmonary blood flow?

    <p>Decreases blood flow to the lungs</p> Signup and view all the answers

    What is a potential consequence of prolonged volume overload in the LV due to a large VSD?

    <p>Aortic valve stenosis</p> Signup and view all the answers

    What is the most common physical finding in coarctation of the aorta?

    <p>A harsh holosystolic murmur</p> Signup and view all the answers

    What does an excessive diverticulation of the muscular septum lead to?

    <p>Left ventricular hypertrophy</p> Signup and view all the answers

    What symptom is NOT commonly associated with right ventricular hypertrophy?

    <p>Cyanosis</p> Signup and view all the answers

    Which diagnostic study finding helps differentiate left ventricular hypertrophy from other conditions?

    <p>Prominent pulmonary vascular markings on chest radiographs</p> Signup and view all the answers

    What structural development characterizes aortic stenosis?

    <p>Bicuspid valve structure</p> Signup and view all the answers

    What is the primary reason for left ventricular hypertrophy in aortic stenosis?

    <p>Impaired aortic orifice</p> Signup and view all the answers

    What pathophysiological consequence is associated with untreated severe pulmonic stenosis?

    <p>Right-sided heart failure</p> Signup and view all the answers

    What is the result of right ventricular outflow obstruction in pulmonic stenosis?

    <p>Increased right ventricular pressure</p> Signup and view all the answers

    In coarctation of the aorta, where does an increase in systolic pressure occur due to proximal narrowing?

    <p>Descending aorta</p> Signup and view all the answers

    What symptom is most commonly seen in infants less than 1 year old with pulmonary valve stenosis?

    <p>Tachycardia</p> Signup and view all the answers

    Which physical examination finding is characteristic of right ventricular hypertrophy?

    <p>Palpable RV heave over the sternum</p> Signup and view all the answers

    What diagnostic study finding is associated with left ventricular hypertrophy?

    <p>Enlarged LV and dilated ascending aorta</p> Signup and view all the answers

    In coarctation of the aorta, where does proximal stenosis cause an increase in systolic pressure?

    <p>Upper extremities</p> Signup and view all the answers

    What symptom is a hallmark of severe pulmonary stenosis in adults?

    <p>Angina pectoris</p> Signup and view all the answers

    Why do children with a certain condition learn to alleviate their symptoms by squatting down?

    <p>To increase systemic vascular resistance by kinking the femoral arteries.</p> Signup and view all the answers

    What is a common manifestation of a high mixing through a ventricular septal defect (VSD) in a certain condition?

    <p>Clubbing due to extreme hypoxia.</p> Signup and view all the answers

    What is the primary reason for irritability, cyanosis, and hyperventilation in a specific condition?

    <p>Decreased systemic resistance due to exercise.</p> Signup and view all the answers

    What is one mechanism that can lead to a decrease in systemic hypoxemia in patients with a certain condition?

    <p>Increase in systemic resistance due to exercise.</p> Signup and view all the answers

    What is the reason behind children with a certain condition experiencing teratology spells?

    <p>Decreased systemic resistance due to exertion.</p> Signup and view all the answers

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