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Cardiac Congenital Defects Flashcards

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1
Q

What maternal conditIons should a pre-natal echo be performed?

A

diabetes, collagen vascular dx, drug or teratogen exposure in 1st trimester, in utero infection (TORCH)

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2
Q

What family conditions should a pre-natal echo be performed?

A

hx of congenital heart dx/ genetic anomalies

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3
Q

How likely is it for a women to have another baby with CHD?

A

5-10%

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4
Q

What is the flow of fetal circulation?

A

from the placenta to the ductus venosus to the IVC into the right atrium through the foramen ovale. To the left atrium-> left ventricle-> aorta.
In in the right ventricle to the ductus arterious to the descending aorta -> placenta

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5
Q

What changes occur after birth?

A

decreased PVR
Increased SVR
Left side becomes dominant

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6
Q

What hole is the first to close?

A

Foramen ovale (1st hr)

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7
Q

How long does it take the ductus arteriosus to close?

A

10-15 hrs in term infant and fully in 2-3wks

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8
Q

Changes after birth occur for how long?

A

6-8wks

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9
Q

Ayanotic diseases?

A

ASD, VSD, PDA, Coarctation of Aorta

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10
Q

Cyanotic diseases?

A

Tetrology of Fallot, TGA, HLHS

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11
Q

Diseases that causes increased pulmonary blood flow?

A

ASD, VSD, PDA

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12
Q

Diseases that causes obstruction of blood flow?

A

Coarctation of Aorta

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13
Q

Diseases that causes decreased pulmonary blood flow?

A

Tertrology of Fallot

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14
Q

Diseases that cause mixed blood flow?

A

TGA and HLHS

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15
Q

What are 5 symptoms of Acyanotic congenital defects?

A 
Fatigue
Murmur
Risk of Endocarditis
CHF
Growth Retardation
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16
Q

What is ASD?

A

a hole in the heart between the atria’s

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17
Q

Which shunt is seen in ASD?

A

L->R

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18
Q

Which arrhythmia’s is seen in ASD?

A

A fib and A flutter

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19
Q

In ASD which dysfunction can result over time?

A

RV

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20
Q

What is the difference between ASD and PFO?

A

PFO is normal in utero and closes within the first few hours of life. ASD is failure of the septal tissue to form, a greater risk of blood clots

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21
Q

What percentage of children with CHD have ASD?

A

30-50% F:M 2:1

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22
Q

How is ASD diagnosed?

A

widely split and fixed S2

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23
Q

What is seen on CXR for ASD?

A

often normal, cardiomegaly

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24
Q

What is seen on EKG for ASD?

A

RVH, RAD

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25
What are the signs/symptoms of ASD?
usually asymptomatic-unless untreated Dyspnea on exertion child Heart failure is rare
26
What does HOLES stand for in ASD?
``` H-heart failure & lung HTN O-often experience lung infections L-low growth rate E- extra heart sound S- stroke ```
27
What is the treatment for ASD?
spontaneous closure catheter placed occlusion device surgical closure
28
What is a post surgical risk for ASD?
Postpericardiotomy syndrome
29
What is VSD?
A hole in the ventricles
30
When do VSD present?
may not have many symptoms until 4-6wks of age
31
What may delay decrease in PVR?
Down's syndrome, respiratory viruses, and meconium aspiration
32
What can worsen VSD?
oxygen therapy
33
What is the most common VSD?
perimembranous (70%)
34
How is VSD diagnosis?
Holosystolic murmur Diastolic flow rumble Increased precordial activity
35
What is seen on a EKG for VSD?
RVH +/- LVH
36
CXR for VSD?
Cardiomegaly or increased pulmonary vascular markings
37
What can VSD cause?
Eisenmenger syndrome
38
Med Txt for VSD?
Diuretics and ACE Inhibitors for CHF symptoms | Optimize caloric intake- for tachypnneic and PO intolerance
39
Surgical Txt for VSD?
Pulmonary artery banding- palliative | Surgical Patch repair
40
What drug is commonly used to keep a ductus arteriosus open?
Prostaglandins PGE-1
41
What are PGE1 risks?
apnea, hypotension, fever
42
What vitals should be monitor when PGE1 are admin?
pre and post ductal O2 stats
43
What is patent ductus arteriosus?
connection between pulmonary artery and aorta
44
When does the patent ductus arteriosus usually close?
on DOL 1
45
Symptoms of PDA?
wide pulse pressure | symptoms of CHF and pulmonary HTN
46
What are risk of PDA?
risk of FTT or NEC or TPN
47
Diagnosis of PDA?
Continuous "machine-like" murmur
48
Findings on PDA EKG?
LV or atrial enlargement
49
Findings on CXR for PDA?
normal or increased pulmonary vascular markings
50
Treatment for patent ductus arteriosus?
surgical ligation- thoractomy catheterization device closure- amplatzer or coiling Indomethacin (if caught early)
51
What should be monitored in Indomethacin admin?
kidney function and bleeding risk
52
What is a big surgical risk in PDA?
Vocal cord paralysis/paresis
53
What is coarctation of the Aorta?
Thoracic aorta narrowing commonly juxtaductal
54
What is the biggest associated condition of coarctation?
Bicuspid Aortic Valve (60%)
55
Diagnosis of coarctation in infancy?
heart failure after PDA closes
56
Diagnosis of coarctation in older children?
HTN, decreased femoral pulses
57
Heart sound heard in coarctation?
occasional murmur or click
58
Signs and symptoms of coarctation?
poor feeding and weight gain higher BP in UE vs. LE Decreased femoral pulses
59
What is the SEM best heard?
@ site of obstruction, on the scapular area on the back
60
CXR for coarctation?
rib notching and "3" sign
61
EKG for coarctation?
normal
62
Med txt for coarctation?
PGE-1
63
Interventional txt for coarctation?
ballon aortoplasty | transcatheter stent placement (older pt)
64
Surgical txt for coarctation?
extended end-to-end repair Left subclavian flap repair Subclavian translocation Synthetic patch angioplasty
65
What are postoperative concerns in coarctation?
systemic hypertension often encountered | post-coarctectomy syndrome
66
T/F re-coarctation is common
TRUE, typically mild

Pediatrics (7 decks)

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