26 Cardiac Flashcards
what kind of shunt causes cyanosis?
right to left
children squat to do what to SVR in what kind of shunt?
increase SVR, decrease R to L shunt
what problems do you get for long term cyanosis from R to L shunt?
polycythemia, strokes, brain abscess, endocarditis
what is eisenmenger’s syndrome? what does it mean when you have it? is it irreversible?
shift from L to R shunt to R to L shunt. sign of increasing pulm vascular resistant (PVR) and pulmonary HTN. not irreversible.
what kind of shunt causes CHF?
L to R shunt
how do L to R shunts manifest? how about in children?
L to R shunt causes CHF. CHF manifests as failure to thrive, tachycardia, tachypnea, hepatomegaly. in children, hepatomegaly is first sign of CHF
what are the causes of L to R shunt?
VSD, ASD, PDA
what are the causes of R to L shunt?
tetraology of fallot
how to R to L shunts manifest?
cyanosis
what is ductus arteriosus?
connection between descending aorta and L PA; blood is shunted away from lungs in utero.
what is ductus venosum?
connection between portal vein and IVC; blood shunted away from liver in utero
how many umbilical arteries?
2
how many umbilical veins?
1
draw a diagram of fetal circulation.
http://cl.ly/T5ly
what is the most common heart defect?
VSD (ventricular septal defect)
what kind of shunt occurs in VSD?
L to R
what percent of VSDs close spontaneously? by when?
usu by 6 mo, 80% close
when do large VSDs cause symptoms? why?
after 4-6 weeks of life, b/c PVR dec then shunt inc
do VSDs cause CHF or cyanosis?
CHF (tachypnea, tachycardia), and failure to thrive
what is the rx for VSD causing CHF?
diuretics and digoxin
what is the timing of repair for large VSDs and medium VSDs? what is the definition for large and medium?
large VSD (shunt >2.5): 1yo medium (shunt 2-2.5): 5yo
what is the most common reason for earlier repair of VSD?
failure to thrive
what kind of shunt occurs in ASD?
L to R
where are ASDs located? what percent of the time?
ostium secundum (most common, 80%), centrally located. ostium primum (or atrioventricular canal defects or endocardial cushion defects)
what other problems occur with ASD in ostium primum?
can have MV and TV problems, frequent in down’s syndrome
when are ASDs symptomatic? what are si/sx?
shunt >2. CHF (SOB, recurrent infections)
what happens to pts with ASD in adulthood?
paradoxical emboli
what is medical rx of ASD?
diuretics and digoxin
what is the usual timing of repair for ASD?
1-2 yo.
if pt has canal defects, 3-4 months old
what are the 4 parts of tetralogy of fallot?
VSD, pulmonic stenosis, overriding aorta, RV hypertrophy (mnemonic VORP)
what kind of shunt is tetralogy of fallot?
R to L
what is the most common congenital heart defect that results in cyanosis?
tetralogy of fallot
what is the treatment for tetralogy of fallot?
beta blocker
when do you repair tetralogy?
3-6 month old
