1229 Exam 8: Congenital Heart

Question 1

Fetal Circulation

Answer 1

Pressure higher on the left side of the heart, lower on the right
Foramen ovale- pressure are higher on the RIGHT side of the heart, blood will shunt from right to left bc does not need to go to fetal lungs, go through ductus arteriosis which connects for blood across to the aorta and out to the body
when capillary beds expand and blood rushes into there is a pressure gradient change occurs and pressure becomes lower on right side and higher on left side, pressure changes are what cause fetal shunts to close
Can tell if has interrupted electrical activity by irregular heart beat by checking radial and apical pulse, murmur-backflow of blood

Question 2

Congenital Heart Defects

Answer 2

a lot do not know why has heart defect
Can know child has defect before born by ultrasound
Down syndrome usually have heart defects, Mothers who receive Rubella in 1st trimester baby can be born w/ heart defect, often blind or deaf
Children with parents who have congenital heart defect are more likely to have one as well
80% of cases no clue as to cause of defect
often not diagnosed until adulthood

Question 3

Terms

Answer 3

asdfasdf

Question 4

Atrial Septal Defect (ASD)

Answer 4

Pressure is lower in atria than in ventricles
Blood shunt left to right and go back into the lungs
congested lung sounds, may have atrial arrhythmias, may have murmur
RA and RV may enlarge
repair during cath
If too big to close in cath lab they have to open the heart and close with a Dacron patch while on bypass-true open heart surgery

Question 5

Ventricular Septal Defect (VSD)

Answer 5

Blood flows back into RV and into pulmonary artery
RV hypertrophy
irregular HR, irregular pulse, murmur, CHF, may have arrhythmias
Patch or suture while on CP bypass

Question 6

Atrioventricular Canal Defect (Endocardial Cushion Defect)

Answer 6

can occur anywhere along the wall between right and left atrium and ventricles
generally left to right blood flow w/ pulmonary vascular engorgement
Usually left to right shunt- oxygenated blood back into RV
CHF, murmur, cyanosis w/ crying
Grafting, repair or replacement of valves
Heart block, CHF, Mitral regurgitation, dysrhythmias, pulmonary HTN after surgery

Question 7

Patent Ductus

Answer 7

sometimes fetal shunts do not automatically close, not always a bad thing
increased blood flow into the pulmonary artery, increase work on left side of heart
Tx includes Indomethacin-to close patent ductus w/o any invasive procedure, repair in cath lab, surgery- clamp on ductus w/ microscopic procedure

Question 8

Obstructive defects include:

Answer 8

Coarctation of the Aorta
Aortic Stenosis
Pulmonic Stenosis

Question 9

Coarctation of the Aorta

Answer 9

narrowing within the aorta that increased pressure in the upper extremities and decreased pressure to the lower extremities
If no collateral circulation, admitted ICU near death
Clinical manifestations: may have high BP, bounding pulses in arms, weak or absent femoral pulses, cool lower extremities, signs of CHF, older children may experience dizziness, headache, fainting, epistaxis from hypertension
Pts at risk for hypertension, ruptured aorta, aortic aneurysm and stroke
Tx: surgery to resect and anastomosis, balloon angioplasty can be performed as a primary intervention in older infants and children, stents may be placed in older children

Question 10

Aortic Stenosis

Answer 10

narrowing of the aortic valve, resistance of blood flow in the LV, decreased cardiac output, left ventricular hypertrophy, pulmonary congestion
Decreased cardiac output, decreased BP, tachycardia, faint pulses, exercise intolerance, murmur, chest pain and dizziness when standing for a long period
Tx: angioplasty or surgery

Question 11

Pulmonic Stenosis

Answer 11

narrowing at the entrance of the pulmonary artery
Right ventricle hypertrophy, decreased pulmonary blood flow, may have patent ductus
Can be asymptomatic, some cyanosis, if severe will be cyanotic with murmur and cardiomegaly
Tx: angioplasty, surgery for pulmonary valvotomy on bypass

Question 12

Decreased pulmonary blood flow defects:

Answer 12

Tetralogy of Fallot

Tricuspid Atresia

Question 13

Tetralogy of Fallot

Answer 13

VSD, pulmonic stenosis, overriding aorta, RV hypertrophy
Shunting of blood depends on resistance, decrease oxygenated blood to they body, probably cyanotic at birth, murmur, hypoxia
Tx: surgery in the first year of birth, Palliative shunt to increase pulmonary blood flow and increase oxygen saturation, Complete repair is indicated when increased cyanosis and development of hyper cyanotic spells

Question 14

Tricuspid Atresia

Answer 14

Failure of tricuspid valve to develop, no communication between RA & RV, RV very underdeveloped at birth
Blood flow from ASD or patent foramen and through VSD to lungs
Mixing of unoxygenated and oxygenated blood
Newborn-cyanosis, prostaglandin to keep ductus open
Older Child-chronic hypoxemia w/ clubbing, may have endocarditis, brain abscess, stroke
Tx: angioplasty, surgery, can not correct the abnormal anatomy

Question 15

Transposition of the Great Vessels (or Arteries)

Answer 15

Pulmonary artery leaves the LV, Aorta leaves the RV. Must have another defect so oxygenated and unoxygenated blood can mix, usually foramen ovale
Very cyanotic at birth, CHF, cardiomegaly usually evident few weeks after birth
Tx: prostaglandin to keep ductus open, balloon setostomy. Surgery to switch vessels

Question 16

Total Anomalous Pulmonary Venous Connection

Answer 16

Rare defect, failure of pulmonary veins to join the left atrium
Results in mixed blood being returned to right atrium and shunted from R to L by ASD
Most infants develop cyanosis early in life, degree of cyanosis is related to amt of pulmonary blood flow, signs of CHF, murmur, irregular heart beat, congested lung sounds, without intervention cardiac failure will progress to death
Tx: corrective repair in early life

Question 17

Truncus Arteriosus

Answer 17

One vessel that overrides both ventricles, no separate pulmonary artery and aorta