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CSI Exam 5 > Blue Baby and CHD > Flashcards

Blue Baby and CHD Flashcards

1
Q

Hypoplastic Left Heart Syndrome S/S

A

as PDA closes… Hypoxia, acidosis, CV collapse

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2
Q

Tx order for hypoxic, acidotic 2-10d old baby

A

O2, intubate, Dextrose, PGE, Gentamicin/Ampicillin

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3
Q

Intraembryonic blood vessels noted at day

A

20

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4
Q

the median heart tube is completely day

A

Days 21 – 23

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5
Q

heart starts beating on day

A

22

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6
Q

fetal circulation begins on day

A

Days 27-29

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7
Q

ductus venosus shunts blood from

A

umbilical vein -> Inferior Vena Cava allowing oxygenated blood to bypasses the liver

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8
Q

foramen ovale shunts blood from

A

Right atrium -> Left atrium allowing blood to bypass the lungs

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9
Q

Ductus arteriosis shunts blood from

A

Pulmonary artery -> Aorta allowing blood to bypass the lungs

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10
Q

First treatment for a BLUE baby?

A

Oxygen

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11
Q

Gestational Diabetes increases the risk for

A

Congenital heart defects by 2X

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12
Q

Umbilical vein PaO2 is 30-35 mmHg.

Fetus 70-80% saturated at this PaO2, why?

A

fetal Hgb functions to deliver O2 at a low O2 concentration

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13
Q

Fetal Hgb transitions at

A

~6months

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14
Q

Upon first breath, pulmonary pressure

A

Decreases, blood shifts from left to right

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15
Q

Upon first breath, systemic pressure

A

Increases, blood shifts from left to right

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16
Q

Foramen Ovale closes

A

functionally upon first breath, closed by 3 months

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17
Q

Ductus Arteriosus closes

A

2-3 days post birth, unless CHD is present

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18
Q

What may cause the Ductus Arteriosus to remain open past 2-3days

A

low O2 tension (hypoxia), PGE

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19
Q

In the fetus, the normal direction of the shunted blood is

A

Right side -> Left (bypass fetal lung)

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20
Q

What function does the PDA provide after birth in a baby w/ cyanotic CHD?

A

Provide a source of pulmonary blood flow

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21
Q

In the neonate, the normal direction of the shunted blood is

A

reverses, Left -> Right

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22
Q

Pulmonary resistance should drop by _______ in infants

A

6 weeks

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23
Q

What type of CHD’s present later (closer to 6 weeks)?

A

LEFT-TO-RIGHT shunts (ASD, VSD, PDA)

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24
Q

What S/S would you find in an infant with Persistent Pulmonary HTN?

A

Difficulty transitioning, differential pulse Ox sat > 10% (O2 sat in UE is normal, LE is low)

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25
If you have a hole in the heart, what effects shunt flow?
Pressure
26
Main cause of CHD
No specific cause/Multifactorial
27
Maternal Gestational diabetes is associated with what CHD?
Transposition of vessels, VSD, Coarctation
28
Lupus is associated with what what CHD?
Complete heart block
29
Maternal Rubella infection w/in 1st 7 weeks is associated with what CHD?
PDA, septal defects, pulmonary a. stenosis
30
FAS (Maternal EtOH use) is associated with what CHD?
50% chance of CHD | ToF; L-to-R shunt
31
Down Syndrome is associated with what CHD?
AV canal, VSD | ASD, AV septal defect
32
Turner Syndrome is associated with what CHD?
Coarctation of the aorta | bicuspid aortic valve
33
Trisomy 13 or 18 is associated with what CHD?
VSD, PDA
34
Differential cyanosis CHD causes
PDA with R>L shunt | CoA with PDA after constriction
35
Differential pulses
CoA
36
Single S2 on heart auscultation
one semilunar valve (truncus)
37
Fixed split S2 on heart auscultation
ASD
38
Continuous murmur is associated with what CHD?
PDA
39
Holosystolic murmur is associated with what CHD?
VSD
40
What type of CHDs would present as cyanotic w/in hours/days of birth
R->L (deoxygenated blood into circulation)
41
L->R shunt CHDs typically present?
Later, pulmonary pressure must drop enough (~6wks) to allow blood flow from L to R
42
PDA/VSD present as
Infant w/ heart failure, murmur, and poor growth; Left heart enlargement; P & F to lungs
43
ASD presents as
Child w/ murmur or exercise intolerance | Right heart enlargement; F to lungs
44
Eisenmenger Syndrome
Long standing L->R shunt causing irreversible pulmonary vascular disease
45
R-to-L shunt w/ increased BF:
Truncus arteriosus, TAPVR, TGA
46
R-to-L shunt w/ decreased BF:
ToF, Tricuspid atresia, Ebstein's anomaly
47
CXR w/ very dark lung fields
decreased PBF: ToF, Tricuspid atresia, Ebstein's
48
CXR w/ increased vasculature marking & light lung fields
increased PBF: truncus arterioles, TAPVR, TGA
49
CXR of ToF
boot-shaped
50
ToF Sx are dependent on
degree of pulmonary stenosis
51
Signs of ToF
PROV: pulmonary stenosis, RVH, Overriding aorta, VSD
52
TGA physiology & findings
2 parallel circuits, w/ at least 2 shunts (R->L & L->R)
53
Shunts in TGA
ASD, PFO | VSD, PDA
54
TGA presents when
early, w/in hours typically
55
TGA CXR finding
"egg on a string" narrow mediastinum
56
Male:Female 3:1 in what CHD
TGA
57
In TAPVR, the most common site for pulmonary veins to drains is?
SVC > RA = IVC
58
Male:Female 4:1 in what CHD
TAPVR
59
TAPVR typically have what shunts
100% ASD R->L shunt
60
TAPVR CXR finding
Cardiomegaly "snowman Sign"
61
TAPVR w/ pulmonary venous obstruction
cyanotic early (w/in 6hr) bc very little oxygenated blood is entering circulation
62
Would PGE help resolve a TAPVR w/ pulmonary venous obstruction
NO, this increases pulmonary blood flow
63
Tricuspid atresia involves what shunt
VSD
64
Tricuspid atresia presents
Early
65
Ebstein's Anomaly CXR
balloon-shaped heart (enlarged RA + ARV)
66
Shunt with Ebstein's Anomaly
ASD, may have slight improvement over next few days as pulmonary resistance drops
67
Severe HLHS or CoA are
ductal dependent (PDA)
68
Norwood procedure for HLHS
(DAY 5) creates aorta from RV, closes PDA & opens shunt from aorta to pulmonary a.
69
Bidirectional Glenn for HLHS
(5MO) get rid of BT shunt, SVC hooks to pulmonary a
70
Fontan Circuit for HLHS
IVC connected to pulmonary a (deoxygenated blood bypasses heart & directly enters lungs)

CSI Exam 5 (4 decks)

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