26 Cardiac

Question 1

what kind of shunt causes cyanosis?

Answer 1

right to left

Question 2

children squat to do what to SVR in what kind of shunt?

Answer 2

increase SVR, decrease R to L shunt

Question 3

what problems do you get for long term cyanosis from R to L shunt?

Answer 3

polycythemia, strokes, brain abscess, endocarditis

Question 4

what is eisenmenger’s syndrome? what does it mean when you have it? is it irreversible?

Answer 4

shift from L to R shunt to R to L shunt. sign of increasing pulm vascular resistant (PVR) and pulmonary HTN. not irreversible.

Question 5

what kind of shunt causes CHF?

Answer 5

L to R shunt

Question 6

how do L to R shunts manifest? how about in children?

Answer 6

L to R shunt causes CHF. CHF manifests as failure to thrive, tachycardia, tachypnea, hepatomegaly. in children, hepatomegaly is first sign of CHF

Question 7

what are the causes of L to R shunt?

Answer 7

VSD, ASD, PDA

Question 8

what are the causes of R to L shunt?

Answer 8

tetraology of fallot

Question 9

how to R to L shunts manifest?

Answer 9

cyanosis

Question 10

what is ductus arteriosus?

Answer 10

connection between descending aorta and L PA; blood is shunted away from lungs in utero.

Question 11

what is ductus venosum?

Answer 11

connection between portal vein and IVC; blood shunted away from liver in utero

Question 12

how many umbilical arteries?

Answer 12

2

Question 13

how many umbilical veins?

Answer 13

1

Question 14

draw a diagram of fetal circulation.

Answer 14

http://cl.ly/T5ly

Question 15

what is the most common heart defect?

Answer 15

VSD (ventricular septal defect)

Question 16

what kind of shunt occurs in VSD?

Answer 16

L to R

Question 17

what percent of VSDs close spontaneously? by when?

Answer 17

usu by 6 mo, 80% close

Question 18

when do large VSDs cause symptoms? why?

Answer 18

after 4-6 weeks of life, b/c PVR dec then shunt inc

Question 19

do VSDs cause CHF or cyanosis?

Answer 19

CHF (tachypnea, tachycardia), and failure to thrive

Question 20

what is the rx for VSD causing CHF?

Answer 20

diuretics and digoxin

Question 21

what is the timing of repair for large VSDs and medium VSDs? what is the definition for large and medium?

Answer 21

large VSD (shunt >2.5): 1yo
medium (shunt 2-2.5): 5yo

Question 22

what is the most common reason for earlier repair of VSD?

Answer 22

failure to thrive

Question 23

what kind of shunt occurs in ASD?

Answer 23

L to R

Question 24

where are ASDs located? what percent of the time?

Answer 24

ostium secundum (most common, 80%), centrally located.  
ostium primum (or atrioventricular canal defects or endocardial cushion defects)

Question 25

what other problems occur with ASD in ostium primum?

Answer 25

can have MV and TV problems, frequent in down’s syndrome

Question 26

when are ASDs symptomatic? what are si/sx?

Answer 26

shunt >2. CHF (SOB, recurrent infections)

Question 27

what happens to pts with ASD in adulthood?

Answer 27

paradoxical emboli

Question 28

what is medical rx of ASD?

Answer 28

diuretics and digoxin

Question 29

what is the usual timing of repair for ASD?

Answer 29

1-2 yo.

if pt has canal defects, 3-4 months old

Question 30

what are the 4 parts of tetralogy of fallot?

Answer 30

VSD, pulmonic stenosis, overriding aorta, RV hypertrophy (mnemonic VORP)

Question 31

what kind of shunt is tetralogy of fallot?

Answer 31

R to L

Question 32

what is the most common congenital heart defect that results in cyanosis?

Answer 32

tetralogy of fallot

Question 33

what is the treatment for tetralogy of fallot?

Answer 33

beta blocker

Question 34

when do you repair tetralogy?

Answer 34

3-6 month old