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Person Peds > Bernstein #1 > Flashcards

Bernstein #1 Flashcards

1
Q

What are the 3 most common cardiac problems in PEDS

A
  • Bicuspid aortic valve
  • VSD
  • ASD (secundum)
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2
Q

What is the most common cyanotic lesion?

A

Tetralogy of fallot 6%

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3
Q

In the 1st week of life, what is the most frequent cyanotic defect?

A

D-transposition of the great arteries

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4
Q

What is levocardia?

A

Heart in right place, but other organs are reversed

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5
Q

What is dextrocardia?

A

Heart pointed wrong direction to the right.

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6
Q

What is mesocardia?

A

Midline heart

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7
Q

What is situs solitus?

A

Normal arrangement of organs
-Liver right
Stomach left

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8
Q

What is situs inversus?

A

complete reversal of organs

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9
Q

What is situs ambiguous?

A

Reversal of some organs

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10
Q

Anything other than situs solitus (normal arrangement) suggest what?

A

High likelihood of Congenital heart disease

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11
Q

Fetal circulation is ______ rather than in ________.

A

Parallel

series

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12
Q

in fetal circulation what delivers blood to both pulmonary and systemic circulation?

A

Right ventricle

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13
Q

In fetal circulation, the LV sends blood where?

A

Systemic

Placental circulation

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14
Q

In fetal circulation where does O2 blood come from?

A

Placenta

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15
Q

What route does placental blood take to bypass liver and go straight to the IVC?

A

Ductus venosus

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16
Q

in fetal circulation, What causes 90% of blood from the RV to pass the PA and head straight to the descending aorta?

A
  • Ductus Arteriosus

- High PVR

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17
Q

What is preferential streaming in fetal circulation?

A

Umbilical venous blood w/ higher O2 content is given to the Brain, Heart and upper limbs.

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18
Q

ascending aorta O2 sats

A 
pO2 = 20-22 mmHg 
O2 = 65%
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19
Q

Descending aorta sats

A 
pO2 = 20-22 mmHg
O2 = 55%
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20
Q

What facilitates O2 uptake in the placenta?

A

Lower p50 of fetal hemoglobin

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21
Q

In fetal circulation which ventricle has a higher output?

A

RV

- 1.3:1 RV/LV output

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22
Q

Why does RV have more output in fetal circulation?

A

Greater size and thickness

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23
Q

How much output does the RV have in fetal circulation?

A

450 ml/kg/min

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24
Q

During transitional circulation, an increase of alveolar O2 from spontaneous ventilation leads to what?

A
  • ↓ Pulmonary vascular resistance

- ↑ pulmonary blood flow

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25
Q

What increase as the placenta is gone?

A

SVR

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26
Q

What causes the drop in systemic venous return to the IVC?

A

Umbilical venous flow is removed

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27
Q

What increases LA pressure during transitional circulation?

A

Increased pulmonary blood flow and pulm venous return

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28
Q

As LA pressure exceeds RA pressure what is closed? and what stops?

A

Foramen Ovale

Atrial shunting

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29
Q

When does the ductus arteriosus close?

A

10-15 hours after birth

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30
Q

What 3 things cause closure of the ductus arteriosus?

A
  • ↑ O2 tension
  • ↓ prostaglandins
  • Bradykinin
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31
Q

FO can reopen if what happens?

A

Increased RA pressure

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32
Q

What can cause increased RA pressure?

A
  • Crying
  • Pain
  • Hypoxia
  • hypercarbia
  • acidosis
  • Lung disease
  • sepsis
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33
Q

How long does it take to close the FO and how does it happen?

A

3 months to a year

-Septum primum and septum secundum adhere

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34
Q

When does functional and antomic closure of the ductus arteriosus happen?

A

72 hours of life

- 1 to 3 months

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35
Q

Anatomic closure of the ductus arteriosus happens with the formation of what?

A

ligamentum arteriosum

36
Q

What are CHD patients dependent on?

A

Ductus arteriosus patency

37
Q

What can be done to keep ductus arteriosus patent?

A
  • Prostglandin E1 (alprostadil) infusion

- ↓ O2 tension

38
Q

Side effects of alprostadil

A
  • Resp depression
  • Apnea
  • Fever
  • Seizures
39
Q

Signs of PDA

A
  • Hyperactive precordium
  • Bounding pulse
  • Wide pulse pressure
  • Hepatomegaly
  • tachypnea
  • Tachycardia
40
Q

What med to close PDA?

A

Indomethacin (prostaglandin inhibitor)

41
Q

What are normal blood volumes for premie, < 3 months, 3-12 mo, and > 12 months?

A 
Premie = 100-120 ml/kg
12 = 70
42
Q

Why do increases in preload and afterload have negligible effects on PEDS CO?

A
  • Fewer contractile elements
  • Deficiency of elastic elements
  • Reduced compliance
43
Q

What is ventricular interdependence?

A

-Change in ventricular pressure to 1 ventricle effects the other

44
Q

What causes ventricular interdependence?

A
  • Low ventricle compliance

- Equal ventricle muscle mass

45
Q

Why would you pretreat a neonate w/ atropine prior to intubation?

A

Incomplete autonomic innervation leads to bradycardia upon stimulation.
-CO is dependent on HR

46
Q

What does not change in a newborn?

A

Stroke volume

47
Q

The hallmark of intravascular fluid depletion in neonates and infants is?

A

hypotension without tachycardia

48
Q

A concern for paradoxical air embolism may occur in the neonate because of?

A

patent foramen ovale

49
Q

What is your map goal in the first few weeks of life?

A

estimated gestational age in weeks

50
Q

Normal VS for infants.

A

HR 120-160
RR 30-60
Premie bp 5-/25
Neonate bp 7-/40

51
Q

When does PVR reach adult levels?

A

6 months

52
Q

What environmental factors can lead to CHD?

A
  • Maternal disease
  • Maternal Meds
  • Drug abuse
  • Maternal diabetes
  • ETOH
53
Q

What do volume overload lesions cause?

A

Left to right shunting

54
Q

What are the 5 volume overload lesions?

A
  • ASD
  • VSD
  • AVSD
  • PDA
  • Truncus Arteriosus
55
Q

Where can volume overload lesions occur?

A
  • Atrial
  • Ventricular
  • Great artery
56
Q

What happens if shunt is proximal / distal to the mitral valve?

A 
Proximal = right heart dilation
Distal = Left heart dilation
57
Q

How to treat overload lesions

A

-diuretic therapy
-Afterload reduction
Both control pulmonary overcirculation

58
Q

What are the 3 types pf ASD?

A
  • Secundum
  • Primum
  • Sinus venosus
59
Q

What is most common ASD and where is it found?

A
  • Secundum

- Fossa ovalis

60
Q

Where is the primum located and what is it a form of?

A
  • Lower in atria

- ASVD & MV cleft

61
Q

What is the least common ASD, where is it located and what is it associated with?

A
  • Sinus venosus
  • High in atria
  • Partial anomalous venous return
62
Q

Clinical symptoms of ASD

A
  • Most asymptomatic
  • Fatigue
  • Cyanosis w/ pulm HTN
63
Q

What causes the diastolic and systolic murmurs in ASD?

A

Systolic - ↑ flow across pulmonary valve

Diastolic - ↑ flow across tricuspid

64
Q

How do you treat ASD?

A

Closure if Qp:Qs ratio is > 2:1

65
Q

When are ASD closed?

A
  • elective between 2-5

- Earlier w/ CHF or pulm HTN

66
Q

When is it considered too late to close an ASD?

A

-Pulm HTN w/ shunt reversal

67
Q

Is endocarditis prophylaxis required for ASD?

A

No

68
Q

what are the 4 types of VSD?

A
  • Membranous
  • Infundibular
  • Muscular
  • AVSD
69
Q

What is the most common VSD

A

Membranouos

70
Q

VSD that involves RV outflow tract.

A

Infundibular

71
Q

Which VSD can be single or multiple?

A

Muscular

72
Q

AVSD almost always involves what?

A

AV valvular abnormalities

73
Q

What causes the left to right shunt in VSD?

A

PVR being greater than SVR

74
Q

What do VSD lead too?

A
  • ↑ RV and pulmonary pressure

- Hypertrophy of LA and LV

75
Q

What is considered a small - moderate VSD, and how do they close?

A
  • 3-6mm

- 50% will close spontaneously by 2yo

76
Q

______ to ________ VSD always have symptoms and require surgical repair

A

moderate

Large

77
Q

What symptoms are seen w/ VSD?

A
  • CHF
  • Failure to thrive
  • Resp infections
  • exercise intolerance
  • hyperactive precordium
78
Q

What is needed for small VSD?

A

-endocarditis prophylaxis

79
Q

What is needed for medical treatment of symptomatic VSD?

A
  • afterload reduction

- Diuretics

80
Q

What are the surgical indications for VSD\?

A
  • Large w/ medically uncontrolled symptoms
  • Age 6-12 months = pulm htn
  • Age >24 months = Qp:Qs ratio >2:1
81
Q

Why do supracristal VSD of any size require surgery?

A

Risk of developing AV insuffiency

82
Q

AVSD results from what?

A

Incomplete fusion of endocardial cushions

83
Q

AVSD is more common in what genetic disease?

A

Down’s syndrome 25%

84
Q

Incomplete AVSD may be indistinguishable from what?

A

ASD

85
Q

AVSD symptoms

A
  • CHF in infants
  • Pulmonary infections
  • Failure to thrive
  • fatigue
  • Late cyannosis
86
Q

Surgery is always required with what CHD?

A

AVSD

-done during infancy

87
Q

How to treat AVSD

A
  • Treat congestive symptoms

- Pulmonary Banding <5kg

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