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cardio physiology > heart disease in children > Flashcards

heart disease in children Flashcards

1
Q

KNOW: The etiology of Congenital Heart Disease is most frequently MULTI-FACTORIAL meaning?

A

(a combination of genetic and environmental factors both contribute) - 87%

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2
Q

KNOW: An unrestrictive VSD in a newborn infant is likely to be associated with little or no ________

A

murmur.

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3
Q

KNOW: An unrestrictive VSD in a 2 month old infant with normal pulmonary resistance is likely to be associated which two murmurs?

A

with a IV/VI systolic murmur at the mid LSB, and a II/VI diastolic rumble at the apex.

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4
Q

KNOW: The mechanism for the systolic murmur at the left upper sternal border in a patient with an ASD is ________________

A

relative pulmonary stenosis from increased pulmonary flow.

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5
Q

KNOW: cyanosis may be related to ___________ and ________

Is sometimes related to _________

Is present in SOME ________

A

May be related to central apnea
May be related to pneumonia or pneumothorax
Is sometimes related to intracardiac shunting
Is present in some congenital heart defects.

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6
Q

frequency of pediatric cardiology pt. diseases:

congenital heart disease:
acquired heart disease:
cardiac arrhythmias

A

Congenital Heart Disease 80-90%
Acquired Heart Disease 5-10%
Cardiac Arrhythmias 5%

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7
Q

what is the incidence of congenital heart disease?

A

For every 1000 live births, 5 to 8 are born with congenital heart disease.

Over 85% of these infants born in developed countries are expected to reach adulthood if they receive appropriate therapy

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8
Q

etiology of congenital heart disease:

genetic %? environmental %? multifactorial %?

A

Genetic- chromosomal or monogenic defect (10%)
Environmental- drugs, chemicals, viruses, maternal disease (3%)
Multifactorial- combination of genetic and environmental factors (87%)

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9
Q

KNOW: Post natal circulation.

At birth, what happens to systemic resistance, pulmonary resistance?

A 
- systemic resistance increases
		(clamping of umbilical cord)
		- pulmonary resistance decreases 	
		(lung expansion)
		- pulmonary vascular resistance
		- ½ systemic 24 h
		- adult levels 2-6 wk (may be up to 12 weeks)
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10
Q

post natal circulation. what type of circulation? when is the ductus arteriosus and ductus venosus closed? when is foramen ovale closed?

A

Series circulation
Oxygenation from lungs
Closure of ductus arteriosus and ductus venosus, days
Closure of foramen ovale, weeks to months

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11
Q

VSD: changes.

Newborn: physical exam:
EKG/CXR, ECHO

2wk-2mo: physical exam, EKG/CXR, ECHO

1-2yr: physical exam, EKG/CXR, ECHO

A

New born:
-physical exam: acyanotic, no murmur, asymptomatic
-EKG/CXR: CCW loop AVC, normal
ECHO: large VSD, no hypertrophy

2wk-2mo:
PE: acyanotic, systolic & diasotilc murmur
EKG/CXR: LVH, cadiomegaly, increased pulm. flow
ECHO: large VSD, LVH

1-2yr:
PE: CYANOTIC, faint murmur, decreased exercise tol. ,

EKG/CXR: RVH, SI. cardiomeg., decreased pulm flow

ECHO: large VSD, RVH

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12
Q

A heart murmur is _________?

A

A heart murmur is an extra sound, heard as blood flows through the heart or blood vessels

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13
Q

Physiologic Murmurs are heard in _________hearts.

A

normal

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14
Q

Pathologic Murmurs are heard in abnormal hearts, from __________

A

turbulence as blood flows through abnormal structures (holes in the heart, thickened valves, narrowed vessels).

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15
Q

which type of murmurs are always pathologic

A

diastolic

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16
Q

what are 7 characteristics of innocent murmurs?

A 
General characteristics: 
always associated with normal heart sounds
always in systole. NEVER in diastole
usually brief
usually localized to left sternal border
usually grade 1-3/6
never associated with a thrill
often changes with position
17
Q

___________are associated with structural and/or functional cardiac abnormalities

A

pathologic murmurs

18
Q

what is the diagnostic approach to pathologic murmurs?

A

Diagnostic approach:
Location of murmur (valve anatomy)
Characteristics, duration, and timing of murmur (physiology)
“relative stenosis”

19
Q

which murmurs are head in systole?

A

systole: AV valves: regurgitation; Semilunar valves: stenosis

20
Q

which murmurs are heard in diastole?

A

diastole. AV valves: stenosis; semilunar valves: regurgitation

21
Q

Murmurs of _________ stenosis occur when abnormally large amounts of blood flow pass across a structurally normal (non-stenotic) valve.
ASD: relative PS and TS
VSD, AVC: relative MS

A

Murmurs of “relative” stenosis occur when abnormally large amounts of blood flow pass across a structurally normal (non-stenotic) valve.
ASD: relative PS and TS
VSD, AVC: relative MS

22
Q

what is the most common congenital heart disease?

A

VSD

23
Q

Is VSD initially a cyanotic or acyanotic murmur?

A

acyanotic

24
Q

which congenital defect is associated with a machine-like murmur?

A

PDA

25
Q

define cyanosis

A

Cyanosis – “a bluish discoloration of the skin and mucous membranes”

26
Q

at which concentration of desaturated Hgb is cyanosis seen?

A

Typically observed when there the concentration of desaturated Hgb > 4 gm/dl.

27
Q

when will babies turn blue?

A

What is blue?
Babies will appear cyanotic when they have at least 4 gm/dl of desaturated hemoglobin. Since levels of Hgb vary widely, cannot use colour alone.

28
Q

what are four acyanotic congenital heart defects?

A

VSD, ASD, PDA, coarction of aorta w/out PDA.

29
Q

what is the cardiac cause of cyanosis?

A

Cardiac: perfusion of systemic circulation with desaturated (mixed) blood. Result of intracardiac shunting

30
Q

what are some non-cardiac causes of cyanosis?

A

Peripheral vasoconstriction

Desaturation of pulmonary venous blood (hypoventilation, ventilation-perfusion abnormalities: pneumonia, pneumothorax

31
Q

how do you test for cyanosis?

A

100% O2 test.

32
Q

fyi card.

A

Administration of 100% FiO2 by hood or ETT.
pO2 < 100 suggests the possibility of cyanotic congenital heart disease.
Exceptions:
Low pO2’s are frequently present with severe lung disease.

33
Q

what are 6 cyanotic congenital heart defects?

A
  1. hypoplastic left heart syndrome
  2. I- truncus arteriosus - 1 trunk
  3. II- transposition of great vessels - 2 vessels- want a PDA or ASD to keep baby alive
  4. III - triscupid atresia - associated with ASD
  5. IV - tetralogy of fallot -
  6. total anomalous pulmonary venous return - pulmonary vein empties oxygenated blood into right atirum

cardio physiology (3 decks)

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