Pediatric CHD, part 1

Question 1

How do neonates and small children adjust cardiac output

Answer 1

They rely on changes in heart rate to adjust cardiac output, as they cannot increase stroke volume

Question 2

The ductus arteriosus is functionally closed by

Answer 2

15 hours of life

Question 3

The foramen ovale is usually funcitonally closed by

Answer 3

3 months of age

Question 4

Usually, innocent flow murmurs are

Answer 4

of low intensity
do not raidate
brief
most often systolic

Question 5

Most common benign murmur in children 2-6 y

Answer 5

Still’s vibratory murmur
early systolic
vibratory musical quality

Question 6

List cyanotic congenital heart diseases (CHD)

Answer 6

(1) Truncus arteriosus
(2) Transposition of Great Arteries
(3) Tricuspid atresia / Ebstein Anomaly
(4) Tetralogy of Fallot
(5) TAPVR

Question 7

When will cyanosis be clinically apparent

Answer 7

When deoxyhemoglobin is 3 to 5 mg/dL

Question 8

Noncardiac causes of persistent fetal circulation

Answer 8

Meconium aspiration
Pneumonia
Sepsis
Pulmonary hypertension

Question 9

This produces cyanosis in the period immediately after birth

Answer 9

Transposition of Great Arteries (TGA)
Compared to other congenital heart defects, extracardiac anomalies occur less often in babies with TGA

Question 10

Most common cyanotic congenital heart disease

Answer 10

Tetralogy of Fallot
- large VSD
- RVOT Obstruction*
- overriding aorta
- RVH

*The intensity of cynosis in TOF depends on the amount of obstruction of RVOT

Question 11

Most common congenital heart disease in general

Answer 11

VSD

Question 12

What occurs in TAPVR?

Answer 12

The pulmonary veins empty into the right atrium instead of returning blood from the lungs into the left atrium

Question 13

Most common type of TAPVR

Answer 13

Supracardac (50%), where the common pulmnoary veins is attached to the SVC

Question 14

Remarks on neonates with cynaosis secondary to congenital heart disease

Answer 14

They rarely have respiratory symptoms other than tachypnea

Question 15

Hyperoxia test

Answer 15

100% O2 for 20 minutes, expect an inability to increase PaO2 by >20 mm Hg in CHD

Question 16

Cyanotic CHD with increased pulmonary vascular markings

Answer 16

TGA
TAPVR
Truncus Arteriosus

Question 17

Boot-shaped heart

Answer 17

TOF

Question 18

Egg-shaped heart

Answer 18

TGA

Question 19

Snowman sign

Answer 19

TAPVR

Question 20

Superior QRS axis

Answer 20

Tricuspid atresia
Also with RAH, LAH, LVH

Question 21

With biventricular hypertrophy

Answer 21

Trucnus arteriosus