Flashcards in Congenital Heart Disease Deck (44):
The majority of heart disease in children is
Congenital (5 to 8 of every 1000 live births)
The three causes of congenital heart disease
Genetic, Environmental, multifactorial (combo of genetic and environmental)
Multifactorial makes up the majority
What does congenital mean
A disease that exists at birth or develops during the first month of life.
Syndromes with Congenital Heart Disease
Down, Turner, Marfan, Noonan, 18, 13,
Infections that can lead to congenital heart disease
Diseases that lead to congenital heart disease
Drugs that lead to CHD
Thalidomide, Accutane, Trimethadione
Toxins that lead to CHD
ALcohol and cocaine
One mechanism that can lead to CHD is altered flow patterns during cardiac development
Decreased right heart flow during cardiac development leads to
Tricuspid Atresia (TAT), Pulmonary Stenosis Valvular (PSV), Atrial septal defect (ASD)
Decreased Left Heart Flow
Atrial Septal Defect (ASD), Coarctation of the Aorta, Mitral Atresia (MAT)
At birth, systemic resistance does what?
At birth, pulmonary resistance does what?
decreases (lungs expand)
At 24 hours, pulmonary resistance is (blank) of systemic resistance
Most common CHD
Ventricular septal defect...by a long shot.
Then atrial septal defect, pulmonary stenosis
The various CHD abnormalities can be grouped into three categories. They are
abnormalities causing a Left to right shunt, Right to left shunt, and obstruction
Dusky blueness of skin. What shunt is it?
Right to left shunt. blood avoids pulmonary circulation
Left to right shunt
Expose the low pressure, low reisistnace pulmonary vasculature to increased volume and increased pressure. Leads to increased pulmonary vascular resistance which leads to right heart hypertrophy and eventually failure. With time, this increased resistance can cause reversal of the shunt to right to left.
Most common shunt
Left to right...ASDs, VSDs, PDA (patent ductus arteriosus)
What does the Foramen ovale do in fetal circulation
Allows blood to flow from the right atrium to the left. Bypasses the fetal lungs.
pulmonary hypertension associated with
Left to right shunt. This pulm HTN can lead to a reversal of shunting and thus cyanosis. Seen earlier and more frequently at this severity in VSDs than ASDs.
Whats the point of the ductus arteriosus during intrauterine life?
Its like a bridge between the pulmonary artery and the aorta. It permits blood flow from the pulm arteries to the aorta so that blood can bypass the unoxygenated lungs.
When is the ductus usually obliterated
First few months of life
High pressure left to right shunts. Sounds like machinery in systole
Cyanotic CHD (right to left shunt) associated with what conditions
tetralogy of fallot and transposition of the great vessels
Physiologic murmurs in toddlers
Still's, venous hum, pulmonary flow, carotid bruit
Adult phyiologic murmurs
Are Physiologic murmurs ver in diastole
Are physiologic murmurs ever associated witha thrill
Physiologic murmurs localized to left sternal border
AV valve murmur during systole
regurgitation...mi, tri, sys, regurg
AV valve during diastole
Semilunar valves during sys
Semilunar during diastole
Murmurs of relative stenosis occur when?
When abnormally large amounts of blood flow pass across a structurally normal valve.
When is cyanosis typically observed
When the concentration of desaturated Hgb is above 4 gm/dl
Cardiac vs. non cardiac causes of cyanosis
Cardiac cause = perfusion of systemic circulation with desaturated blood.
Non-cardiac causes of cyanosis
Peripheral vasoconstriction, desaturation of pulmonary venous blood
Desaturation of pulmonary venous blood (hypoventilation, pneumonia, pneumothorax)
Hyperoxia test tells you what
Whether the Cyanosis is a problem of the heart or a problem of the lungs. Administer 100% FiO2 by hood or ETT. If PO2 is less than 100, the probability of congenital heart disease goes way up.
Cyanotic heart defects
Tunk, tran, tri, tet, tot
Trunkus arteriosus, transposition of the great arteries, Tricuspid atresisa,
Tetralogy of Follot
Total anomalous pulmonary venous return
Is an unrestrictive VSD in a newborn likely associated with a murmur