Congenital Heart Disease I Flashcards Preview

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Flashcards in Congenital Heart Disease I Deck (30)
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1

What are prostaglandins a product of?

arachidonic acid

1

What could happen if a large PDA is left untreated?

pulmonary venous occlusive disease (***Eisenmenger’s syndrome- irreversible pulmonary hypertension) increased risk of subacute bacterial endocarditis

2

How does the ductus arteriosus close?

1. fewer elastic fibers and more SM in the ductus 2. increased PaO2 after birth causes contraction of SM 3. removal of placenta removes prostaglandins that kept it open en utero

2

DX? Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death

PDA

3

What is a shunt?

a connection between two chambers/vessels

4

How will a small PDA present?

usually baby will be asymptomatic

4

What are the physical exam findings in a large PDA with L to R shunting?

wide pulse pressure bounding pulses (palpable palmar pulses) increased work of breathing hyperactive precordium murmur

5

In whom is the incidence of PDA increased?

premees (70% of all babies born at

5

What is the classic murmur in PDA?

Continuous or machinery-sounding murmur along the left upper sternal border possible diastolic rumble

7

How old is the baby when a patent ductus arteriosus is considered persistent?

1 year

9

Usually a PDA is a _____ (direction) shunt.

L to R

9

What does PDA stand for?

persistent ductus arteriosus

10

What is the incidence of PDA?

5-12% of all congenital heart defects

11

DX? wide pulse pressure bounding pulses (palpable palmar pulses) increased work of breathing hyperactive precordium murmur

signs of PDA

13

____ is the most potent agent for maintaining ductal patency.

PGE2

14

In whom is the incidence of PDA increased?

premees (70% of all babies born at

15

How does a moderate/large PDA present?

Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death

15

How does a moderate/large PDA present?

Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death

16

DX? Continuous or machinery-sounding murmur along the left upper sternal border possible diastolic rumble

PDA

18

When is a the PDA a R to L shunt?

in premees, babies with lung disease, or babies born at high altitude (all causes of elevated pulm vascular resistance)

19

DX? Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death

PDA

20

What does PDA stand for?

patent ductus arteriosus

21

What is a connection between two chambers/vessels?

a shunt

22

How is the ductus arteriosus kept open when needed?

IV PGE2

23

How is PDA treated?

COX inhibitors (IV indomethacin) surgical ligation or percutaneous occlusion

25

What is a shunt?

a connection between two chambers/vessels

26

Where does the ductus arteriosus derive from?

left 6th aortic arch

28

How does a moderate/large PDA present?

respiratory effects (difficulty weaning off ventilator, pulmonary edema/hemorrhage) CHF feeding intolerance, bowel ischemia, necrotizing enterocolitis renal insuff intraventricular hemorrhage or stroke death

29

Older infant or young child with a ______ may present with a hoarse cry, history of pneumonias, failure to thrive, increased work of breathing and diaphoresis with activity/feeding.

large PDA

30

When does closure of the ductus arteriosus normally occur?

functional closure at 10-15 hrs after birth (delayed at altitude, tho) anatomic closure by 2-3 week of life