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Cardiology 2 > Clin Med - Congenital Heart Disease > Flashcards

Clin Med - Congenital Heart Disease Flashcards

(41 cards)

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1
Q

What is patent ductus arteriosus? (PDA)

A

Blood flowing from aorta to pulmonary artery.

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2
Q

What keeps PDA open?

A

Prostaglandins

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3
Q

What closes PDA?

A

A prostaglandin inhibitor (indomethacin)

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4
Q

What triggers the closure of PDA?

A

Highly oxygenated blood.

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5
Q

Who is at risk for non-closure?

A

High altitude births and premature babies at risk for non-closure.

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6
Q

When do normal PDAs close?

A

Small PDA normal for 24-48h after birth

  • 20% closed @ 24h
  • 80% closed @ 48h
  • 100% closed @ 96h
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7
Q

What neonates are at greater risk?

A

neonates whose mother contracted Rubella in 1st Trimester are at greater risk.

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8
Q

PDA in adults

A
  • Very Rare
  • Typically Asymptomatic till middle age (most are small and well tolerated)
  • Again, think about Right Sided Congestive Heart Failure
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9
Q

PDA Physical Exam & Murmur

A
  • Widened Pulse Pressure
  • Bounding Peripheral Pulses
  • Continuous, Machine-like murmur over Pulmonic area (Left Upper Sternal Border)
  • -A Thrill is COMMON
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10
Q

When should you refer PDA?

A

All adults with a PDA should be referred to a cardiologist.

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11
Q

What is VSD?

A

Ventricular Septal Defect - the MOST COMMON congenital heart defect

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12
Q

What kind of shunting is VSD?

A

Left to right shunt.

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13
Q

What co-morbidity is VSD associated with?

A

Down’s Syndrome

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14
Q

Size of VSD

A

Small defects are louder. The smaller the VSD, the louder the murmur.

Small VSDs are typically asymptomatic.

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15
Q

Term for acyanotic turning cyanotic

A

Eisenmenger physiology

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16
Q

What is Eisenmenger physiology?

A

Often associated with Large VSD and Long standing VSD and ASD (even PDA).

Pulmonary HTN causes the pulmonary resistance to exceed that of the systemic resistance and left-to-right shunts are reversed causing cyanosis in typically acyanotic defects

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17
Q

Ventricular Septal Defect : Murmur

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A
  • Classic Murmur: Pan/Holo systolic, harsh, vibratory murmur at Left Lower Sternal Border (LLSB)
  • Increases with squatting and hand grip.
18
Q

Ventricular Septal Defect : Imagining

Study These Flashcards
A

ECHO IS DIAGNOSTIC

19
Q

Ventricular Septal Defect : Treatment

Study These Flashcards
A
  • Control the Congestive Heart Failure with diuretics and digoxin
  • Surgery if infant has growth failure, medications not working, or impending pulmonary hypertension
20
Q

VSD: When to Refer

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A

All patients with a VSD should be referred to a cardiologist to determine need for long term follow up and surgical intervention

21
Q

Key to Coarctation of Aorta

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A

PULSES!! You HAVE to palpate the brachial and femoral pulses at each Well Child Check.

*Co. of A. will have weak femoral pulses

22
Q

When should you begin taking a child’s BP?

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A

At and after 3y.o.

Co. of A. should be suspected in young patients with elevated blood pressure

23
Q

Co. of A. : Physical Exam Findings

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A
  • BP of Upper extremities is GREATER than that of the lower extremities. (Lower BP can be normal or low)
  • Weak Femoral Pulse
  • Look for signs of Left Sided Congestive Heart Failure (rales/crackles, cough, fatigue)
24
Q

What are the 4 components to tetralogy of fallot?

Study These Flashcards
A

4 components

  • Overriding Aorta
  • Pulmonary Stenosis
  • Ventricular Septal Defect (VSD)
  • Right Ventricular Hypertrophy
25
Significance of tetralogy of fallot
Most COMMON CYANOTIC CONGENITAL HEART DEFECT Right-to-Left Shunt
26
X-ray findings tetralogy of fallot
“Boot-Shaped” heart
27
Tetralogy of Fallot Hx
- H/o Blue Spells (Tet Spells) & -Dyspnea - Crying - Feeding - Relieved by assuming a squatting position
28
When to refer a murmur to pediatric cardiologist:
- Greater than Level III - Diastolic (NEVER GOOD) - Worsens with Standing
29
What kind of ECHO?
TEE vs TTE TEE: looks a the back of the heart, so mitral valve disease and endocarditis
30
What moms are more likely to have child with congenital heart disease?
Gestational Diabetic Moms
31
When would you not want to give indomethacin?
Transposition of Great Vessels - you want the PDA open.
32
What type of shunting is atrial septal defect (ASD)?
Left to Right Shunt due to greater pressure gradient from the system circulation on the Left Side.
33
Atrial Septal Defect – Children
ASD will typically closes spontaneously during the first year of life. - Typically asymptomatic - May have mild fatigue - Frequent Respiratory Infections
34
Symptomatic ASD
Requires surgical correction. - Evidence of Right Ventricular Hypertrophy - Signs of Right Sided Congestive Heart Failure (CHF) - Exercise intolerance (easily fatigued)
35
Atrial Septal Defect - Adults
- In 25% of adults, the foramen ovale remains patent. - Can cause paradoxic emboli and subsequently cerebrovasular events (consider this in your deferential when a pt is <55 and has had a stroke) - Typically asymptomatic till their 30s or 40s [be mindful of signs of Right Sided Congestive Heart Failure (CHF) due to Pulmonary Hypertension (HTN)] - Symptomatic = Surgical Correction
36
ASD Diagnostic Heart sounds & Murmur
-Wide Fixed Split S2 -Systolic ejection murmur in pulmonic area (Left Upper Sternal Border) -Mid-Diastolic Rumble at the Lower Left Sternal Border (due to added flow over tricuspid valve)
37
ASD Labs and Imaging
- EKG could show Right Ventricular Hypertrophy - ECHO IS DIAGNOSTIC and will reveal the left-to-right shunt of oxygenated blood btw atria as well as, Right Ventricular Hypertrophy (RVH) and Right sided volume overload *get TransThoracic Echocardiagram (TTE)
38
ASD Treatment
Unless very small, ASD’s should undergo surgical repair. Surgical Repair is an absolute if there are any signs of Right Sided over load. - Pulmonary HTN - Exercise Intolerance - Right Ventricular Hypertrophy (RVH) - Pedal Edema due to Congestive Heart Failure (CHF)
39
ASD When to Refer?
- At initial discovery on TTE, to investigate any other structural abnormalities of the heart. - Symptomatic patients - Pt <55 y.o. with an apparent paradoxic embolic event and an ASD
40
Fetal circulation
1. Umbilical VV drains high oxygen blood via ductus venous to IVC. 2. The IVC drains to RA --> LA via foramen ovale. 3. The SVC drains low oxygen blood to the RA, making the RA mixed oxygen blood. 4. RA --> RV --> pulmonary trunk --> lungs, but some of the blood is shunted via ductus arteriosus to the aorta. 5. Blood in the aorta mixes with blood from the LV and goes to internal iliac AA and tissues. 6. The umbilical AA sends blood back to the placenta.
41
Neonate circulation
Circulation resembles that of an adult after the baby is born. 1. IVC --> RA --> RV --> pulmonary trunk [ductus arteriosus is no longer present] --> lungs 2. lungs --> pulmonary veins --> LA --> LV --> aorta --> tissues

Cardiology 2 (13 decks)

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