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Pediatrics > Cardiac Congenital Defects > Flashcards

Cardiac Congenital Defects Flashcards

1
Q

What maternal conditIons should a pre-natal echo be performed?

A

diabetes, collagen vascular dx, drug or teratogen exposure in 1st trimester, in utero infection (TORCH)

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2
Q

What family conditions should a pre-natal echo be performed?

A

hx of congenital heart dx/ genetic anomalies

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3
Q

How likely is it for a women to have another baby with CHD?

A

5-10%

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4
Q

What is the flow of fetal circulation?

A

from the placenta to the ductus venosus to the IVC into the right atrium through the foramen ovale. To the left atrium-> left ventricle-> aorta.
In in the right ventricle to the ductus arterious to the descending aorta -> placenta

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5
Q

What changes occur after birth?

A

decreased PVR
Increased SVR
Left side becomes dominant

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6
Q

What hole is the first to close?

A

Foramen ovale (1st hr)

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7
Q

How long does it take the ductus arteriosus to close?

A

10-15 hrs in term infant and fully in 2-3wks

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8
Q

Changes after birth occur for how long?

A

6-8wks

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9
Q

Ayanotic diseases?

A

ASD, VSD, PDA, Coarctation of Aorta

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10
Q

Cyanotic diseases?

A

Tetrology of Fallot, TGA, HLHS

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11
Q

Diseases that causes increased pulmonary blood flow?

A

ASD, VSD, PDA

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12
Q

Diseases that causes obstruction of blood flow?

A

Coarctation of Aorta

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13
Q

Diseases that causes decreased pulmonary blood flow?

A

Tertrology of Fallot

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14
Q

Diseases that cause mixed blood flow?

A

TGA and HLHS

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15
Q

What are 5 symptoms of Acyanotic congenital defects?

A 
Fatigue
Murmur
Risk of Endocarditis
CHF
Growth Retardation
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16
Q

What is ASD?

A

a hole in the heart between the atria’s

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17
Q

Which shunt is seen in ASD?

A

L->R

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18
Q

Which arrhythmia’s is seen in ASD?

A

A fib and A flutter

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19
Q

In ASD which dysfunction can result over time?

A

RV

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20
Q

What is the difference between ASD and PFO?

A

PFO is normal in utero and closes within the first few hours of life. ASD is failure of the septal tissue to form, a greater risk of blood clots

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21
Q

What percentage of children with CHD have ASD?

A

30-50% F:M 2:1

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22
Q

How is ASD diagnosed?

A

widely split and fixed S2

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23
Q

What is seen on CXR for ASD?

A

often normal, cardiomegaly

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24
Q

What is seen on EKG for ASD?

A

RVH, RAD

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25
Q

What are the signs/symptoms of ASD?

A

usually asymptomatic-unless untreated
Dyspnea on exertion
child Heart failure is rare

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26
Q

What does HOLES stand for in ASD?

A 
H-heart failure & lung HTN
O-often experience lung infections
L-low growth rate
E- extra heart sound
S- stroke
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27
Q

What is the treatment for ASD?

A

spontaneous closure
catheter placed occlusion device
surgical closure

28
Q

What is a post surgical risk for ASD?

A

Postpericardiotomy syndrome

29
Q

What is VSD?

A

A hole in the ventricles

30
Q

When do VSD present?

A

may not have many symptoms until 4-6wks of age

31
Q

What may delay decrease in PVR?

A

Down’s syndrome, respiratory viruses, and meconium aspiration

32
Q

What can worsen VSD?

A

oxygen therapy

33
Q

What is the most common VSD?

A

perimembranous (70%)

34
Q

How is VSD diagnosis?

A

Holosystolic murmur
Diastolic flow rumble
Increased precordial activity

35
Q

What is seen on a EKG for VSD?

A

RVH +/- LVH

36
Q

CXR for VSD?

A

Cardiomegaly or increased pulmonary vascular markings

37
Q

What can VSD cause?

A

Eisenmenger syndrome

38
Q

Med Txt for VSD?

A

Diuretics and ACE Inhibitors for CHF symptoms

Optimize caloric intake- for tachypnneic and PO intolerance

39
Q

Surgical Txt for VSD?

A

Pulmonary artery banding- palliative

Surgical Patch repair

40
Q

What drug is commonly used to keep a ductus arteriosus open?

A

Prostaglandins PGE-1

41
Q

What are PGE1 risks?

A

apnea, hypotension, fever

42
Q

What vitals should be monitor when PGE1 are admin?

A

pre and post ductal O2 stats

43
Q

What is patent ductus arteriosus?

A

connection between pulmonary artery and aorta

44
Q

When does the patent ductus arteriosus usually close?

A

on DOL 1

45
Q

Symptoms of PDA?

A

wide pulse pressure

symptoms of CHF and pulmonary HTN

46
Q

What are risk of PDA?

A

risk of FTT or NEC or TPN

47
Q

Diagnosis of PDA?

A

Continuous “machine-like” murmur

48
Q

Findings on PDA EKG?

A

LV or atrial enlargement

49
Q

Findings on CXR for PDA?

A

normal or increased pulmonary vascular markings

50
Q

Treatment for patent ductus arteriosus?

A

surgical ligation- thoractomy
catheterization device closure- amplatzer or coiling
Indomethacin (if caught early)

51
Q

What should be monitored in Indomethacin admin?

A

kidney function and bleeding risk

52
Q

What is a big surgical risk in PDA?

A

Vocal cord paralysis/paresis

53
Q

What is coarctation of the Aorta?

A

Thoracic aorta narrowing commonly juxtaductal

54
Q

What is the biggest associated condition of coarctation?

A

Bicuspid Aortic Valve (60%)

55
Q

Diagnosis of coarctation in infancy?

A

heart failure after PDA closes

56
Q

Diagnosis of coarctation in older children?

A

HTN, decreased femoral pulses

57
Q

Heart sound heard in coarctation?

A

occasional murmur or click

58
Q

Signs and symptoms of coarctation?

A

poor feeding and weight gain
higher BP in UE vs. LE
Decreased femoral pulses

59
Q

What is the SEM best heard?

A

@ site of obstruction, on the scapular area on the back

60
Q

CXR for coarctation?

A

rib notching and “3” sign

61
Q

EKG for coarctation?

A

normal

62
Q

Med txt for coarctation?

A

PGE-1

63
Q

Interventional txt for coarctation?

A

ballon aortoplasty

transcatheter stent placement (older pt)

64
Q

Surgical txt for coarctation?

A

extended end-to-end repair
Left subclavian flap repair
Subclavian translocation
Synthetic patch angioplasty

65
Q

What are postoperative concerns in coarctation?

A

systemic hypertension often encountered

post-coarctectomy syndrome

66
Q

T/F re-coarctation is common

A

TRUE, typically mild

Pediatrics (7 decks)

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