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SU 17: Wine Tasting > Peds Cardiology > Flashcards

Flashcards in Peds Cardiology Deck (52):

What is the overall incidence of congenital heart disease/defects (CHD)?

0.3-1.2% of live births


What are the 3 most common CHD?

1. Bicuspid aortic valve
2. Ventricular Septal Defect (VSD)
3. Atrial Septal Defect (VSD)


Fetal Circulation:

The RV delivers blood to the Both the ____ and _____ circulation through the _____ _____.

The RV delivers blood to the Both the Pulmonary and Systemic circulation through the Dutus Arteriosus.


Fetal Circulation:

The LV delivers blood to the _____ and _____ circulation.

The LV delivers blood to the Systemic and Placental circulation.


Fetal Circulation:

What is the P02 and O2 Saturation of blood

PO2: 32-35mmHg

O2 Saturation of 80%


Fetal circulation has a higher PVR or SVR?



Transitional circulation (shortly after baby is born):

What happens to close the Foramen Ovale?

When the umbilical cord is clamped, the SVR rises, this causes L atrial pressure to rise and become greater than R atrial pressure. This closes the Foramen Ovale.

In fetal circulation, the FO shunts blood from RA to LA.


Transitional circulation (shortly after baby is born):

A Foramen Ovale that remains patent lends itself to risk of what specific complication?

-Paradoxical embolism (embolism goes straight to brain instead of lungs)


Functional closure of the Foramen Ovale happens:

Anatomic closure happens:

Adult Remnant:

Functional closure: is when the LAP>RAP with clamping of cord and increase in SVR

Anatomic closure: 3 days (according to apex); 1-3 months (per Bernstein's slides)

Adult Remnant: Fossa Ovalis (which remains probe-patent in ~30% of adults)


Transitional circulation (shortly after baby is born):

What is the purpose of the Ductus Arteriosus?

What happens to cause this structure to close?

-Shunts blood from the pulmonary trunk to the aorta

-SVR>PVR (increased PaO2 and decreased prostaglandins form placenta) influence closure.


Transitional circulation (shortly after baby is born):

When is the Functional Closure of the Ductus Arteriosus?

When is the Anatomical Closure of the Ductus Arteriosus?

What is the adult Remnant?

-Functional closure: SVR>PVR (Shortly after birth when the cord is clamped and the baby breathes)

Anatomical Closure: Several weeks via fibrosis (apex) 3 mo- 1 year (per Bernstein's slides)

Adult remnant: Ligamentum arteriosum

*Key Point* The ligament arteriosum can tear with rapid deceleration traumas and can range from a partial tear to a complete aortic dissection. (common with MVAs)


What Medicines can be used to Keep the Ductus Arteriosus open?

Prostaglandin E1 (PGE-1)
-example: Alprostadil (Prostaglandin) Vasodilator


What Medicine can be used to Close the Ductus Arteriosus?

-Indomethacin (Prostaglandin synthase inhibitor)


Transitional circulation (shortly after baby is born):

What is the purpose of the Ductus Venosus?

Allows umbilical blood to bypass the fetal liver.


Transitional circulation (shortly after baby is born):

When does functional and anatomic closure of the Ductus Venosus happen?

Adult Remnant:

-Functional and anatomic closure: Umbilical cord clamping

-Adult remnant: Ligamentum Venosum


T/F: The Foramen Ovale, Ductus Artriosus, and Ductus Venosus can remain patent?


The Ductus Venosum cannot be reopened, nor is there any physiological advantage to be gained from reopening it.


Signs of patend Ductus Anteriosus:

-Hyperactive precordium
-bounding pulses with a wide pulse pressure


Blood Volume (Dr. Bernstein's slides):

< 3 months:
3-12 months:
>12 months:

Blood Volume (Dr. Bernstein's slides):

Premature: 100-120ml/kg
< 3 months: 90 ml/kg
3-12 months: 80 ml/kg
>12 months: 70 ml/kg

Per Apex:
Premature: 90-100ml/kg
Term Neonate (up to 28 days old): 80-90 ml/kg
Infant (over 28 days): 75-80 ml/kg
>12 months: 70-75 ml/kg


Fetal and post natal myocardium is structurally and functionally immature with a limited ability to increase CO, compared to an older child. How does an infant increase their CO?

In order to increase CO, HR must increase.

FYI: Increases in preload cause little or no change in CO.


T/F: Autonomic innervation is complete at birth.


Parasympathetic innervation is fully functional at birth only. Infants are parasympathetic dominant and have very little SNS innervation. During stress, Bradycardia instead of tachycardia will occur.


What does not change in the newborn?

a. Slower HR
b. Stroke Volume
c. Higher blood pressure
d. cardiac output

b. stroke volume


The hallmark of intravascular fluid depletion in neonates and infants is: _________?

a. hypotension
b. hypertension
c. hypotension without tachycardia
d. hypotension with tachycardia

c. hypotension without tachycardia


A concern for paradoxical air embolism may occur in the neonate because of: _____?

a. mitral stenosis
b. patent foramen ovale
c. rate regulated cardiac output
d. changes in bp

b. patent foramen ovale. (embolism that travels directly to the brain, bypasses the lungs d/t R to L shunt)

paradoxical embolism (not specifically air) can occur with tetrology of fallot


Hypotension is defined as

1 year:
older than 1 year:

New born: SBP <60 mmHg
1 year: SBP <70
older than 1 year SBP less than: 70+ (age in yrs x 2)

for a 3 year old: 70+ (3 x 2)= 76 mmHg
SBP less than 76 = hypotension in a 3 year old.


Septal defects:

When does cyanosis occur?

only if Pulmonary HTN is present


What causes systolic and diastolic murmurs of atrial septal defects (ASD)?

Systolic murmur is caused by increased flow across the pulmonary valve (NOT the ASD)

Diastolic murmur is caused by increased flow across the triscupid valve and this suggests high flow Qp:Qs 2:1


Eisenmenger syndrome:

Is considered a late complication of untreated ASD. As R atrial pressure rises, the shunt reverses (becomes R to L). Leading to development of pulmonary HTN, hypoxemia and cyanosis


Is endocarditis prophylaxis required for ASD or VSD? (Antibiotic prophylaxis)

No, not unless an ASD or VSD repair was performed within the last 6 months.


T/F: VSD is more common than ASD?


VSD = 25% of all CHD
ASD = 10% of all CHD


ASVD is more commonly seen with which chromosomal abnormality?

Down's syndrome: Trisomy 21
seen in 20-25% of cases.


Coartation is:

Narrowing of the arota at varying points anywhere from the transverse arch to the iliac bifurication.

-98% are juxtaductal (beside the ductus arteriosus)

-male to female: 3:1


What other heart anomaly is coarctation associated with?

Bicuspid aortic valve, seen in >70% of coarctation cases.


What chromosomal syndrome is coarctation seen in?

Turner Syndrome: A chromosomal disorder in which a female is born with only one X chromosome

Also called: gonadal dysgenesis

Symptoms include short stature, webbed neck, delayed puberty, infertility, heart defects, and certain learning disabilities.
Treatment involves hormone therapy. Fertility treatment may be necessary for women who want to become pregnant.


Signs/Symptoms of coarctation:

-diminished or absent femoral pulses

-90% have systolic hypertension of the upper extremities

-pulse discrepancy between R and L arms. (measure BP on R arm)

-Higher BP in upper vs lower extremities, sometimes with hypoperfusion to the extremities.

-systolic ejection murmur

-cardiomegaly, rib notching on CXR.


Severe Coarctation requires reopening or maintaining opening of which fetal circulatory shunt?

The Ductus Arteriosum with PGE-1.


Endocarditis (antibiotic) prophylaxis is required for what CHD? (it's a long list)

It's probably easier to list who DOES NOT need prophylaxis.

-Prosthetic valves
-previous infective enocarditis
-cardiac transplantation recipients who develop cardiac valvulopathy
-unrepaired cyanotic CHD including palliative shunts and conduits.
-completely repaired CHD with prosthetic material or device, during the 1st 6 months after procedure (ASD or VSDs)
-CHD with residual defects a the site or adjacent to the site of a prosthetic patch or device.

-mild or simple CHD does not require Endocarditis Prophylaxis.


Kawasaki disease:

-mucosutaneousl lymph node syndrom
-coronary artery dilation
-aneurysm formation


VACTERL stands for:

V-vertebral and tracheal anomalies (makes airway and regional mgnt difficult)

A- anal atresia or imperforate anus

C- cardiovascular diseases (Ductal dependent lesions)

T- trachesoesophageal abnormalities

R- renal issues

L- limb defects (difficult vascular access.


An appropriate BP for a neonate should be:

a. 110/60
b. 100/70
c. 95/65
d. 65/40

d. 65/40

For neonates: MAP is more important and should be around their post conceptual age. 50 weeks

SBP should not be less than 60.


Does the premature infant's heart exhibit greater or lesser sensitivity to catecholamines?


Parasympathetic dominant, and already near maximal level of beta-adrenergic stimulation.


Patent ductus Arteriosus monitoring:

2 pulse oximeters: one on R hand and one on lower extremity during test clamp.


Tetrology of fallot is associated with what conditions/syndromes?


Trisomy 21 (Down's)


Dx of Tracheoesophogeal fistula is made by:

failure to pass a catheter into the stomach and confirmed by a visualization of the catheter coiled in the blind pouch.


The most common type of T-E Fistula is:

a. Type II
b. Type IIIA
c. Type IIIB
d. Type IIIC

c. Type IIIB


The peak inspiratory pressure (PIP) for a patient with Congenital Diaphragmatic Hernia should be:



Which is NOT a manifestation of CDH?

a. scaphoid abdomin
b. decreased breath sounds
c. arterial hypoxemia
d. lab tests

d. lab tests


CDH is more common on which side?

Left side


A major cardiac syndrome caused by CDH is:

Hypoplastic Left Heart Syndrome


A 12 lead EKG of a new born reveals upright T waves in all chest leads, is this normal?



How does the QRS axis appear at birth?

Due to the predominance of the RV during intrauterine development, the QRS axis is R sided at birth, it shifts L ward by about 1 month of age


How does the normal CO of an infant compare to that of an adult?

A healthy full term infant has a CO that is about 2-3 times that of an adult


The definitive treatment of Scholine-induced HyperKalemia is:

-IV calcium (10mg/kg Calcium chloride or 30mg/kg calcium gluconate)

-Glucose and insulin

-Defibrillation (as indicated)

-Hyperventilation to reduce K