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Year 2 Cardiovascular > Cyanotic heart defects > Flashcards

Flashcards in Cyanotic heart defects Deck (26):
1

what are the respiratory causes of desaturation?

V/Q mismatch
obstruction
weakness of respiratory muscles

2

how do you augment pulmonary blood flow?

keep the PDA open

3

what is the use of the hyperoxitest?

to determine if cause of cyanosis is due to the heart or lungs

4

what is the role of PGE-1?

maintain patency of ductus arteriosus

5

what are the five Ts of cyanotic heart disease?

truncus arteriosus (1)
transposition of the great arteries (2)
tricuspid atresia (3)
tetralogy of fallot (4)
total anomalous pulmonary venous return (5)

6

what are the PE findings (2) in D-transposition?

1. cyanotic full term male in no apparent distress
2. S2 is single and loud because aorta is anterior to PA

7

what test confirms the anatomy in D-transposition?

echo

8

what is the medical management for D-transposition (5)?

1. PG
2. correct acidosis
3. oxygen
4. balloon atrial septostomy
5. anti-congestive

9

what is the rashkind procedure used for? how does it work?

D-transposition

special catheter advanced into heart via umbilical or femoral vein and advanced across restrictive patent foramen ovale - balloon is ripped back into RA

10

what are the four anomalies of tetralogy of fallot?

1. large VSD
2. overriding aorta
3. RV outflow obstruction (sub-pulmonary / pulmonary stenosis)
4. RV hypertrophy

11

what is the pathophysiology of tetralogy of fallot (3)?

1. RV outflow obstruction limits pulmonary blood flow
2. right to left shunt across VSD into aorta
3. degree of cyanosis depends a lot on the degree of RV outflow obstruction

12

what is present at birth in children with tetralogy of fallot?

cyanosis
murmur (RV outflow obstruction - not from VSD)

13

what are the EKG findings in tetralogy of fallot?

RAD
RVH

14

what is the classic morphology of the heart on CXR in tetralogy of fallot?

boot shaped

15

what is the pathophysiology of tet spells?

spasm of RV outflow tract increases right to left shunt across VSD, leading to worsening cyanosis and acidosis

16

what is the anatomy (4) of tricuspid atresia?

1. absent tricuspid valve
2. RV is hypoplastic
3. majority of cases have either pulmonary atresia or pulmonary stenosis
4. small VSD is often present

17

what is the pathophysiology of tricuspid atresia?

1. RA blood must cross atrial septum (complete mixing in LA)
2. pulmonary blood flow is usually limited

18

what test is significant for tricuspid atresia? why?

EKG - shows left superior axis

19

what is main source of pulmonary blood flow in tricuspid atresia?

ductus arteriosus

20

what is the ultimate surgical goal for tricuspid atresia?

fontan procedure

21

what is fontan circulation? what drives blood to lungs?

IVC and SVC directly to pulmonary arteries

systemic venous pressure

22

what is the anatomy in truncus arteriosus (2)?

1. only a single arterial trunk leaves the heart, giving rise to systemic, pulmonary, and coronary circulations
2. large VSD is present directly below the arterial trunk

23

what is the pathophysiology of truncus arteriosus (3)?

1. both ventricles empty into great artery
2. pulmonary over-circulation (PVR less than SVR)
3. pressure overload to lungs

24

what is the surgical management for truncus arteriosus?

1. direct LV flow out the truncal valve via patch closure of VSD
2. disconnect and attach to RV-PA conduit

25

what is the pathophysiology (2) of total anomalous pulmonary venous return?

1. complete mixing in RA
2. veins can be obstructed

26

which test is helpful in evaluating for obstruction in total anomalous pulmonary venous return?

CXR