Congenital Heart Disease

Question 1

What is the prevalence of congenital heart defects?

Answer 1

5-8 per 1,000 live births

Question 2

___ are more likely to have severe cardiac defects.

Answer 2

Boys

Question 3

What are two big risk factors for congenital heart disease?

Answer 3

Maternal diabetes and having a first-degree relative with a congenital heart disease

Question 4

What are the first and second most common congenital heart defects?

Answer 4

1st = VSD; 2nd = PDA

Question 5

The ductus arteriosus is held open with __________.

Answer 5

prostaglandins

Question 6

PDA severity depends on ____________.

Answer 6

diameter of the opening, pressure difference between the aorta and the pulmonary artery, and the difference in resistance

Question 7

What are some symptoms of PDA?

Answer 7

Pulmonary edema, congestive heart failure, feeding intolerance (occasional bowel ischemia), renal insufficiency, pneumonia, diaphoresis, and stroke

Question 8

Presenting signs of PDA include _______.

Answer 8

bounding pulse, increased work of breathing, machine-like murmur along the left upper sternal border, and wide pulse pressure

Question 9

There are two holes and two septa that develop throughout embryology: ___________.

Answer 9

the ostium primum is divided by the septum primum, and the ostium secundum is divided by the septum secundum

Question 10

The septum secundum develops on the ______ side of the septum.

Answer 10

right

Question 11

________ type of ASD is most common.

Answer 11

Secundum

Question 12

Secundum ASDs form from too large an _______ or too small a _______.

Answer 12

ostium secundum; septum secundum

Question 13

Why don’t ASDs present immediately after birth?

Answer 13

The pulmonary resistance is higher in utero, so there isn’t as much of a difference between the right and left sides of the heart. Once the child grows, the pulmonary resistance lowers and the shunt begins.

Question 14

The ______ ventricle is more compliant.

Answer 14

right

Question 15

The most common type of VSD is __________.

Answer 15

perimembranous VSD

Question 16

In VSDs, louder murmurs can indicate __________.

Answer 16

closure of the opening

Question 17

In VSD, murmurs that go away can indicate ____________.

Answer 17

equalization of pressure–a bad thing

Question 18

ECGs of those with VSD can show ___________.

Answer 18

hypertrophy and/or right axis deviation

Question 19

What is the tetrology of Fallot?

Answer 19

(1) VSD; (2) aorta sitting directly over the VSD; (3) right ventricular hypertrophy; (4) right ventricular outflow tract obstruction

Question 20

In tetrology of Fallot, what is RV outflow tract obstruction?

Answer 20

It is narrowing of the infundibulum of the pulmonary artery, leading to decreased pulmonary blood flow

Question 21

Right-to-left shunts in tetralogy of Fallot result from __________.

Answer 21

higher resistance in the pulmonary artery

Question 22

Tet spells, which are uncommon, are thought to arise from ___________.

Answer 22

vasospasm of the pulmonary artery

Question 23

What is the typical presentation of TOF?

Answer 23

Blue baby with loud murmur

Question 24

Any unrepaired cyanotic heart disease can lead to ____________.

Answer 24

cerebral abscesses

Question 25

What does squatting do, in TOF?

Answer 25

It increases systemic vascular resistance.

Question 26

Hypertension is rare in children. As such, if a child has hypertension, think of two things: ____________.

Answer 26

coarctation of the aorta and kidney problems

Question 27

Why should you check femoral pulses in young children?

Answer 27

To detect coarctation of the aorta

Question 28

With large PDAs, the __________ can be enlarged on X-ray.

Answer 28

left atrium and left ventricle

Question 29

In symptomatic PDA in a neonate, first give ___________.

Answer 29

cyclo-oxygenase inhibitors (IV indomethacin or IV ibuprofen)–but only after waiting until 48 hours after birth

Question 30

In symptomatic PDA in an older child, treat with ____________.

Answer 30

percutaneous occlusion

Question 31

Untreated PDA can result in two worrisome syndromes: ____________.

Answer 31

Eisenmenger's and endocarditis

Question 32

In terms of murmurs, ASD often presents with ____________.

Answer 32

systolic ejection murmurs in the pulmonic valve and diastolic rumble in the tricuspid valve from too much blood flow as well as delayed P2 from too much blood

Question 33

On X-ray and echo, ASD presents with ___________.

Answer 33

enlarged pulmonary artery

Question 34

In ASD, _______ are sometimes given to treat fluid overload.

Answer 34

diuretics

Question 35

Those with __________ can also have hepatomegaly.

Answer 35

ASD

Question 36

Radiographically, VSD presents with ____________.

Answer 36

cardiomegaly, enlargement of the pulmonary arteries, and excessive pulmonary vascularization

Question 37

To treat the symptoms of congestive heart failure in VSD, give __________.

Answer 37

digoxin and ACE inhibitors

Question 38

What murmur is associated with large VSDs?

Answer 38

blowing holosystolic at LLSB