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N216 A/B > [216B] Congenital Heart Defects > Flashcards

[216B] Congenital Heart Defects Flashcards

1
Q

What’s an echocardiogram?

A

Ultrasound of the heart.

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2
Q

What are 3 anatomical structures present in fetal circulation that should not be present after birth?

A
  1. Ductus venosus.
  2. Foramen ovale.
  3. Ductus arteriosus.
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3
Q

Why do fetuses have increased pulmonary resistance?

A

They still have fluid in their lungs.

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4
Q

What physiological changes would we expect to see with the heart muscle after the transition to postnatal circulation? Why?

A

RV hypertrophy: must overcome pressure to pump blood into the lungs.

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5
Q

Which notable genetic condition is associated with CHD?

A

Trisomy 21 (Down Syndrome).

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6
Q

What is the size of the ASD determined by?

A

Volume of shunting

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7
Q

What are the 3 types of ASDs and their locations?

A
  1. Sinus venosus (junction of the SVC + RA)
  2. Secundum (mid septum)
  3. Primum (low septum at the “crux”)
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8
Q

What’s the average adult’s CO?

A

4900 mL/min.

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9
Q

What is the tx for HF & FTT?

A
  • Fluid restriction
  • Diuretics
  • ACE inhibitors
  • O2
  • Optimize nutrition (hypercaloric tube feeds)
  • Coil occlude in catheter (NOT for sinus venosus)
  • Surgical closure
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10
Q

What range would we expect an infant’s SV to fall into?

A

5-13 mL/beat.

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11
Q

Would we expect an infant to have a higher or lower HR compared to an adult?

A

Higher.

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12
Q

If there is a left to right shunt, that means there’s an increased ____ blood flow from re-circulation of ____ blood

A

pulmonary, oxygenated

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13
Q

What’s the equation for cardiac output?

A

CO= SV x HR

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14
Q

List 5 factors that affect CO (besides the ones in the equation).

A
  1. Body size/body surface area (BSA).
  2. Metabolic needs of tissues.
  3. Preload.
  4. Afterload.
  5. Contractility.
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15
Q

Would you be concerned if you heard 2 S2 heart sounds? Why might we see this?

A

It can be normal: the pulmonic valve may close slower than the aortic valve.

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16
Q

Can systolic or diastolic murmurs be benign? When would we classify them as such?

A

Only systolic - when the murmur disappears with position/respirations.
Diastolic murmurs are always concerning!

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17
Q

Patent ductus arteriosus (PDA) occurs in 2 phases:

A
  1. Functional closure (continuous contraction of the smooth muscle wall in the first 12h after birth).
  2. Cessation of PGE2 in the fetal period.
18
Q

What is the tx if the ASD is restrictive?

A

None

19
Q

Average CO for an infant?

A

~600 mL/min

20
Q

Which 2 anatomical structures does a PDA allow blood to flow between?

A

Aorta > pulmonary arteries.

21
Q

In a PDA, there is a ____ to ____ shunt.

A

Left to right.

22
Q

List 3 factors that affect the amount of shunting in a PDA.

A
  1. PDA size & length.
  2. Pressure gradients between aorta (higher) and pulmonary arteries (lower).
  3. Changing vascular resistance from the transition to postnatal period (increasing SVR, decreasing PVR).
23
Q

A PDA increases the _____ ______ [heart chamber] preload & output.

A

left ventricle.

24
Q

List 6 s&s of a PDA.

A
  1. Pulmonary HTN.
  2. CHF.
  3. Increased work of breathing.
  4. Continuous murmur.
  5. Palpable thrill in LUSB (left upper sternal border) - d/t high LV output.
  6. Apneas in premature infants - d/t immature myelination.
25
Q

List 4 tx for PDAs.

A
  1. NSAIDs PO (ex: Indomethacin) - inhib prostaglandin synthesis causing muscle contraction.
  2. Prostaglandins IV (ex: Alprostadil) - life-saving in some defects until they can be repaired.
  3. Device/coils closure.
  4. Surgical ligation.
26
Q

What are 3 indications to close a VSD for infants?

A
  • Large shunt
  • CHF
  • FTT
27
Q

What is an indication to close a VSD for children + adolescents?

A
  • Reversible pulmonary vascular resistance
  • Qp:Qs > 2:1
  • Aortic valve involvement
28
Q

Define a ventricular septal defect (VSD)

A

Direct communication between the left + right ventricles

29
Q

During what age is spontaneous closure of VSD most common?

A

First year

30
Q

Is there a genetic link for VSDs?

A

No

31
Q

What should be the tx for an adolescent with a VSD + Eisenmenger’s syndrome?

A

Heart-lung transplant

32
Q

Define an atrioventricular septal defect (AVSD)

A

Lesion that affects septum + AV valves

33
Q

40-50% of children with ____ Syndrome are affected by AVSD

A

Down’s

34
Q

What are 3 physical exam findings of AVSDs?

A
  • Increased pulmonary blood flow (ie. tachypnea, bad g&d)
  • Systolic ejection murmur in LUSB or holosystolic ejection murmur in MV
  • Pulmonary HTN
35
Q

What are 2 objectives of a partial AVSD repair?

A
  • Close ASD

- Restoration of MV cleft

36
Q

What are 3 objectives of a complete AVSD repair?

A
  • Close interatrial + intraventricular holes
  • Construct 2 separate AV valves
  • Repair valve clefts
37
Q

What is the preferred technique for complete AVSD repairs?

A

Two-patch

38
Q

What are 3 drug classes for tx of AVSDs? Explain why

A
  • Diuretics (decrease pulmonary edema)
  • ACE-I (decrease BP + fluid)
  • PDE5 + O2 (stop pulmonary HTN)
39
Q

What are the 4 structural lesions of the Tetralogy of Fallot (TOF)?

A
  • Large unrestrictive VSD
  • Overriding aorta
  • RV outflow tract obstruction
    (RVOT) PS (Pulmonary Stenosis)
  • RV hypertrophy
40
Q

What are 4 physical exam findings of TOF?

A
  • Cyanosis
  • Pink tet
  • Loud systolic ejection murmur
  • Single S2 sound (no pulm. valve)
41
Q

Describe how tet spells (hypercyanotic) occur

A

Increased activity or irritability –> increased O2 demand –> SOB –> cyanosis

42
Q

What are the 7 tx for TOF? Explain them

A
  • Comfort kid + knees to chest (decrease PVR)
  • IV bolus of colloid (increase vasc volume)
  • IV morphine (relieve pain)
  • Esmolol/propanol (BB to decrease HR)
  • Pheylephrine (vasoconstrict PV)
  • Sodium bicarb (acidosis)
  • Intubation

N216 A/B (26 decks)

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