Peds cardiology

Question 1

what is the most common congential heart defect?

Answer 1

ventricular septal defect

Question 2

murmur associated with ventricular septal defect

Answer 2

holosystolic

Question 3

large ventricular septal defect present with

Answer 3

• failure to thrive
• tachypnea
• hepatomegaly
• GERD

Question 4

what is the most common heart defect in Trisomy 21 (down syndrome)

Answer 4

ventricular septal defect

Question 5

ventricular septal defect is what type of shunt

Answer 5

L to R shunt

Question 6

medication based treatment of ventricular septal defect

Answer 6

• diuretic
• ACE inhibitor

Question 7

what is the most common type of atrial septal defect

Answer 7

secundum ASD

• failure of septum primum and septum secundum to overlap

Question 8

atrial septal defect is what type of shunt? What changes are made to the heart because of it?

Answer 8

• L to R shunt
• enlarged RA, increased pulmonary flow

Question 9

symptoms associated with atrial septal defect

Answer 9

• usually asymptomatic, may have fatigue, palpitations, or exercise intolerance

Question 10

what size of atrial septal defect usually close on thier own

Answer 10

< 8 mm

Question 11

septation of the atrioventricular canal usually occurs when? How?

Answer 11

end of 4th week

• superior and inferior cushions grow toward each other and eventually fuse seperating AV canal into a right and left channel

Question 12

what is a complete atrioventricular septal defect

Answer 12

• large VSD and ASD
• common AV valve

Question 13

what type of shunt is atrioventricular septal defect

Answer 13

L-R shunt

Question 14

complete atrioventricular septal defect is repaired in infancy to prevent what

Answer 14

pulmonary vascular obstructive disease

Question 15

What is a partial atrioventricular septal defect

Answer 15

• Large ASD, no VSD
• two seperate AV valves

Question 16

repair of partial atrioventricular septal defect is usually delayed until

Answer 16

18-24 months old

Question 17

patent ductus arteriosus is what type of shunt

Answer 17

• L-R shunt (aorta to pulmonary artery)

Question 18

medical treatment of patent ductus arteriosus

Answer 18

• indomethacin
• ibuprofen

Question 19

surgical treatment of patent ductus arteriosus for premies

Answer 19

left thoracotomy: clip

Question 20

surgical treatment of patent ductus arteriosus for neonates, infants

Answer 20

left thoracotomy, ligate

Question 21

surgical treatment of patent ductus arteriosus for toddlers and older

Answer 21

left thoracotomy: divide and over sew

Question 22

catheter based treatment of patent ductus arteriosus

Answer 22

coil closure

Question 23

what is still’s murmur

Answer 23

• innocent murmur
• vibratory systolic LSB
• decreases with expiration/standing

Question 24

physiologic peripheral pulmonic stenosis

Answer 24

• innocent murmur
• soft, harsh systolic ejection murmur
• usually disappears by 12 months

Question 25

the 5T's that causes cyanotic congenital heart defect

Answer 25

* Truncus arteriosus * Transposition * Tricuspid Atresia * Tetralogy of Fallot * TAPVR: total anomalous pulmonary venous return

Question 26

cyanotic CHD are due to R to L shunt. Name the 2 broad categories

Answer 26

* intracardiac defects and obstruction to pulmonary flow * mixing fo oxygenated and deoxygenated blood * admixture of pulmonary and system venous return * single chamber recieves total systemic and pulmonary venous return

Question 27

Name the three CHD that fall into the intracardiac defects and obstruction to pulmonary flow catagory

Answer 27

1. tetralogy of fallot 2. tricuspid atresia 3. pulmonary atresia

Question 28

tetralogy of fallot presents with what 4 abnormalities

Answer 28

* right ventricular outflow tract obstruction * VSD * overriding aorta * right ventricular hypertrophy

Question 29

tet spell hyper-cyanotic spell seen in tetralogy of fallot is precipitated by what 3 factors

Answer 29

1. dehydration - decreased heart volume 2. anesthesia - vasodilation 3. crying

Question 30

tet spell hyper-cyanotic spell seen in tetralogy of fallot is relieved by

Answer 30

1. squatting (baby increases SVR to force more blood flow through pulm artery) 2. volume resuscitation 3. administer vasoconstrictors

Question 31

truncus arteriosus

Answer 31

* a single blood vessel (truncus arteriosus) comes out of the right and left ventricles, instead of the normal two vessels (pulmonary artery and aorta * have large VSD

Question 32

babies with truncus arteriosus commonly have what gene mutation

Answer 32

22q11 deletion (DiGeorge)

Question 33

repair for truncus arteriosus

Answer 33

* VSD closure * RV-PA conduit * usually operate in first two weeks of life

Question 34

if baby is blue, what medication should be given

Answer 34

prostaglandins

Question 35

Transposition of great vessels

Answer 35

* cyanotic * the aorta and the pulmonary artery are switched

Question 36

treatment of Transposition of great vessels

Answer 36

1. prostaglandins to keep ductus open 2. BAS: balloon atrial septostomy 3. arterial switch operation

Question 37

Total Anomalous Pulmonary Venous Return: supracardiac

Answer 37

pulmonary vein to Brachiocephalic vein (25-50% can be obstructed)

Question 38

Total Anomalous Pulmonary Venous Return

Answer 38

child’s pulmonary veins don’t connect normally to the left atrium. Instead they’re re-directed to the right atrium by way of an abnormal (anomalous) connection

Question 39

Total Anomalous Pulmonary Venous Return: cardiac

Answer 39

* pulmonary vein to coronary sinus

Question 40

Total anomalous pulmonary venous connection: infracardiac

Answer 40

* pulmonary vein drains via descending vein into liver * usually obstructed * presents: very sick with wet lungs, cyanotic, pulmonary hypertension * emergency/urgent repair

Question 41

unexplained HTN in children could be a result of

Answer 41

coarctation of aorta

Question 42

coarctation of aorta

Answer 42

is a narrowing of the aorta, the large blood vessel that branches off your heart and delivers oxygen-rich blood to your body. When this occurs, your heart must pump harder to force blood through the narrow part of your aorta.

Question 43

coarctation of aorta is associated with what genetic condition

Answer 43

turners syndrome

Question 44

CXR findings with coarctation of aorta

Answer 44

* cardiomegaly * rib-notching- takes several years to develop

Question 45

gold standard to diagnosis coarctation of aorta

Answer 45

CT-angio or MRA

Question 46

list acyantoic congential heart defects

Answer 46

1. VSD 2. ASD 3. atrio-ventricular canal 4. patent ductus arteriosis 5. coarctation of aorta