2] Pediatric <3 Disorders Flashcards
(108 cards)
1
Q
What is incidence
A
of new cases
2
Q
Incidence of peds and heart conditions
A
Congenital heart defects occur in about 1% = 40,000/year
3
Q
What is prevalence
A
Total # of cases of diseases in a period of time
4
Q
Prevalence of congenital heart disease
A
1 million kids
1.4 million adults
5
Q
15% of babies born with CHD have ?
A
Other genetic conditions
6
Q
How can you identify kids with CHD?
A
Newborn screening - add pulse ox
7
Q
Cause of CHD?
A
Unknown
8
Q
What’s the genetic association with CHD?
A
Down syndrome
9
Q
The heart begins as
A
Two strands
10
Q
The heart has two adjacent tubes at
A
Day 18
11
Q
The two heart tubes fuse at
A
Day 21
12
Q
The heart is beating on
A
Day 22
13
Q
Single atria chamber and single ventricular chamber pump
A
Blood by day 27
14
Q
Ventricle forms the
A
Truncus arteriosus
15
Q
What grows in the truncus arteriosus
A
Septum
16
Q
Septum forms
A
Aorta and pulmonary artery
17
Q
Atria wall forms an opening when? And what?
A
Days 27-37 and foramen ovale
18
Q
Heart is completely developed by
A
Weeks 7-10
19
Q
What’s formed by weeks 7-10
A
Ductus arteriosus
20
Q
What kind of resistance is in the fetal lungs and why
A
Higher resistance and fluid follow spath of least resistance
21
Q
Connection from the pulmonary artery to the aorta
A
Ductus arteriosus
22
Q
What’s between the atria
A
Foramen ovale
23
Q
What happens as the baby takes first breath and air fills the lungs
A
Pulmonary arteries and capillaries DIATE and fluid moves into arterioles
24
Q
Resistance is what in lungs
A
Lower
25
What happens to foramen ovale ?
Closes due to high pressure on L side
26
When does foramen ovale fuse
Before month 3
27
When oxygen levels rise, muscle in the ductus arteriosus contracts and
DA closes 10-15 hours after birth
28
2 types of congenital heart defects
Cyanotic vs acyanotic
29
Low oxygen saturation
- tetralogy of Fallot
- hypoplastic left heart syndrome
Cyanotic
30
Normal oxygen saturation’s
Acyanotic
31
Volume issues to lungs
Acyanotic
32
Right to left shunt
Cyanotic
33
Left to right shunt
Acyanotic
34
Correction of aorta
PDA
ASD
VSD
Acyanotic
35
Signals increase for RC formation in which defect
Cyanotic
36
Increased risk for cerebrovascular insult
Cyanotic
37
What is ASD
Atrial septal defect
38
Which way does the shunt go for ASD
Left to right shunt
39
Characteristics of ASD
L heart is less compliant.
Mor epressure on L side.
Which results in increased blood flow to R side
40
Sx of ASD
Dysrythmia
SOB
FTT/poor weight gain
Exercise intolerance
41
What does ASD present like in adults
• In adults, may present with SOB, leg swelling, dysrhythmia’s in 30’s or stroke.
42
How is ASD repaired
By sewing the opening closed or with a patch
43
What is VSD
Ventricular septal defect
44
40% of congenital heart diseases
VSD
45
Shunt for VSD
Most commonly results in L to R shunt
46
VSD results in
R sided HF
Irreversible lung damage
Turbulent blood flow that damages aortic valve
47
Some may close on their own
– If symptomatic (same sx as ASD), requires patch
• Can now be done percutaneous
– If asymptomatic, will be repaired if large and there is a lot ofblood flow to the lungs
Tx for VSD
48
What is PDA
Patent ductus arteriosis
49
What does the PDA connect
Pulmonary artery to the aorta
50
In PDA, failure to close results in blood flowing
From aorta to PA and lungs
51
PDA has an increased risk of
Endocarditis
52
a medicine that helps close
PDAs in premature infants. This medicine triggers the PDA to
constrict or tighten, which closes the opening. Indomethacin usually doesn't work in full-term infants.
Indomethacin
53
What’s another medium used to close PDAs in premature infants
Ibuprofen
54
What is COA
Coarctation of the aorta
55
What does COA mean
Narrowing where the DA attached to aorta
56
Can occur in isolation or with other congenital heart abnormalities (VSD)
COA
57
Sx of COA
Decreased blood flow to body leads to organ damage and diminished pulse
58
FTT
• HTN
• Heart failure
Other Sx of COA
59
Treatment for COA
Surgery
60
Acyanotic defects (4)
ASD
VSD
COA
PDA
61
2 CYANOTIC congenital conditions
TOF
| HLHS
62
Muscle that separates Aortic valve from pulmonary valve is not in theright location.
TOF
63
What does TOF stand for
Tetralogy of Fallot
64
4 deficits of TOF
1] Obstructs pulmonary flow
2] VSD
3] aorta lies over VSD (overriding aorta)
4] R ventricular hypertrophy
65
Obstruction of pulmonary flow with TOF causes
Decreased oxygen- cyanosis
66
What’s an overriding aorta with TOF
Aorta shifted to the R and sits over the VSD
67
Surgery for TOF
Shunt to address obstruction- connects a small branch off aorta to pulmonary artery
68
What happens with a full repair in TOF
VSD repair with patch that reduces pulmonary flow obstruction
69
Long term issues of TOF
If pulmonary valve is leaky- exercise intolerance need for surgery as adult.
Dysryhtmia.
Risk for endocarditis.
70
What does HLHS stand for
Hypoplastic left heart syndrome
71
What is HLHS
Underdevelopment of the L side of the heart
72
If HLHS is found early?
Prostaglandins is given to keep ductus arteriosis open
73
HLHS can be picked up on
Prenatal ultrasound
74
Surgical options for HLHS
Transplant or staged reconstruction
75
Where is the apical pulse
4th ICS
76
Typical newborn HRs are at ?
100-180 b/m
77
Femoral pulse- hyperdynamic pulses may indicate
PDA
78
Shape of thorax at 0-3 months
Triangle
79
Shape of thorax after 3 months
Rectangle
80
Direction of ribs 0-6 months
Horizontal
81
Direction of ribs 6-12 months
Angled down
82
Primary muscles used for inspire at 0-3 months
Diaphragm
83
Primary muscles used for inspire 3-6 months
Diaphragm and accessory muscles
84
Primary muscles used for inspiration at 6 - 12 months
Diaphragm and intercostals
85
Kids start sitting at
6 months
86
After correction of underlying problem and medical clearance, the AHA recommends ?
30 minutes of light to moderate exercise
87
Would static be good for CHD?
Static exercises cause a higher blood pressure response, especially with valslava maneuver.
88
What happens with static exercises ?
Puts an afterload pressure on the LV
89
What about dynamic exercises with CHD?
Dynamic exercises cause an increase in volume to the left ventricle.
90
Equation for dynamic exercises
For every 1/min increase in oxygen uptake, there is a 5-6 L/m COincrease needed
91
What happens with dynamic exercises ?
Puts a VOLUME load on the LV
92
If they have ASD and no PH, they can
Participate in all sports
93
AD with PH can
Participate in class IA sports
94
ASD with PH, R to L shunt can ?
No participation in competitive sports but possibly IA after Evaluation
95
ASD treated: Post-op 3-6 months, no PH ,no RV Dysfunction, No Dysrhythmia can ?
Participate in all sports
96
Small VSD, no PH can
Play all sports
97
Large VSD and PH can
Pay IA sports
98
3-6 months post op, no dysrhythmia, no PH
All sports
99
3-6 months post op with PH can play
IA ports
100
3-6 months post op with atrial or ventricular tachycardias
Must be evaluated by an
| electrophysiologist before any sportacctivity
101
If cyanotic heart disease is stable on CPET and no dysrhythmias or significant desaturation may
May be considered for IA sports
102
With Marfan syndrome you have to have 1 copy of
• Autosomal dominant connective tissue disorder
103
What happens in Marfan syndrome?
Abnormalities in microfibrils diminish structuralintegrity of vessel walls
104
Can cause compression of RA/RV and decreases vital capacity
Excavatum (depression) in Marfan
105
Rigid chest wall, increased energy
| consumption for breathing, alveolar hypoventilation, Cor pulmonale
Carinatum (pigeon chest) in Marfan
106
Wrap 1st and 5th digits around opposite wrist. (+) if overlap
+ stein berg
107
Scoliosis
• Limited elbow extension
• Visual changes
• Flat feet
Marfan syndrome
108
People with Marfan syndrome may participate in low/moderate static and dynamic sports (IA and IIA) unless they have:
Aortic root dilation
– Moderate or severe Mitral regurgitation
– LV systolic dysfunction c. L
