Cardiac Disease Of The Newborn

Question 1

3 important shunts in the newborn

Answer 1

PFO
Aterial ductus
Venous ductus liver

Question 2

What changes take place at birth and the timing

Cardiac

Answer 2

Breathing
Pulmonary vascular resistance PVR decreases (drops 4-8/52)/ more with oxygen decreases resistance
Systemic vascular resistance increases
Closure of shunts PFO, Ductus arteriosis , ductus venosis

Question 3

Syndromes association with congenital cardiac problems

Answer 3

Down’s syndrome AVSD
Turners Sx CoA/ bicuspid aorta
Velocardial Facial syndrome VSD, T of F/ Ca++ levels

Question 4

Congenital Cardiac disease how does it present

Answer 4

1 cyanosis OR

2 CCF tachyponea/ increased WOB
Poor feeding HMG, Tachycardia

Question 5

Incidence of Congenital heart disease

Answer 5

6-8/1000

Question 6

VSD features

Answer 6

Commonest type of CHD
VSD many different points and this effects outcome
Eg high assoc with valvular disease and rarely close
Peri membranous rarely close

VSD presents about 6/52 Left to right shunt
Murmur not present at birth the pressures are the same no mumrmur
As time goes on the PVR decreases and the pressure gradient increases across the right and left ventricle and therefore you get murmur
don’t give O2 as this decreases the PVR and makes the murmur worse
long term untreated VSD pulmonary a damage
If CCF treat with diuretics

Question 7

CoA of aorta

Answer 7

Presentation varies greatly
Poor feeding
Poor weight gain
Metabolic collapse
Decrease femoral pulses BP can be different in the upper and lower limbs
Ductus closes 3-7 days and that shows the CoA symptoms
TREAT PROSTIN reopens the ductus

Question 8

Tetralogy of Fallot

Answer 8

Cyanotic heart disease 
2 things 
1 large VSD right to left shunt 
2 tight/narrowing of right vent outflow/pulmonary a stenosis and all the blood mixes and goes into the aorta 
Cyanosis 
If they do have increased Pulmonary flow  CCF and increased WOB
Tet spells 
Murmurs

Question 9

Aortic stenosis

Answer 9

Too little systemic blood flow
Treat with PROSTIN keeps the ductus open and this helps flow
Otherwise catheter
Surgery

Question 10

Transposition of the great vessels TGA

Answer 10

Aorta comes out of the right ventricle
Pulmonary a comes out of the left V
End up with parallel circulation 
CYANOSIS at birth
USS 18-20/52 may pick up
TREAT make the PDA larger

Question 11

Murmurs that would concern

Answer 11

Loud 
Diastolic 
Continuous 
Associate with other abnormalities eg cyanosis FTT poor feeding 
HMG

Question 12

CXR changes in CHD

Answer 12

Increased Pul blood flow
Large heart size
Abnormal cardiac contour

Question 13

Blood test are helpful in CHD

Answer 13

ABG
Ca++ LOW in VCFS
Genetic Down’s syndrome, Turners VCFD

Question 14

Management principals
LARGE VSD
Cyanosis

Answer 14

Large VSD too much blood flow to lungs wet lungs Diurectics
Avoid Oxygen and may need pulmonary a banding ( prevents the increased pressure that damages the pulmonary a
Cyanosis too little blood flow to lungs PROSTIN PGE1
Catheter
Surgery

Question 15

Arrhythmias in new born

Answer 15

SVT
Atrial Flutter
Complete heart block 
Prolonged QT 
VT

Question 16

SVT

Answer 16

Accessory short circuit leads to increased rate
Treat a gal maneuvers iced cold water
2 adenosine AV node blocked - SR
3 often further episodes
4 long term 2/3 resolve by 12/12 age
5 cease anti arrhythmia meds 6/23
6 1/3 will need ablation of the accessory pathway

Question 17

Long QT

Answer 17

1/2500
Inherited autosomal dominant 
Abnormal K+/Na+ channels
Risk of VF/VT
10% SIDS 

If parents have prolonged qt ECG and if neonatal QT b blocker

Question 18

Innocent murmur features

Answer 18

Murmur found in a very normal child completely normal examination 
Systolic murmur 
Ejection murmur 
Musical 
Grade 2-3/6
Changes with body position sitting /standing may go away
Varies with review 
Augmented by illness 

Ix. May do nothing
ECG don’t forget paed population different standards RHS dominant
CXR ?CCF
ECHO needs a paed cardiologist doing it

Question 19

Clues of a congenital heart murmur /problem

Answer 19

Appearance of the child eg Down’s syndrome other facial changes
FTT
Cyanosis ( pO2 <85%) periph vs central ( look in the mouth)
Symptoms of CCF. Tachyponea/ poor feeding/ poor exercise tolerance
Clubbing ( late sign) BP ( CoA of A)
Pulses UL/LL. Hepatomegally

Question 20

Commonest lesions CHD

Answer 20

VSD
Persistent Ductus Arteriosis 
ASD
Pulmonary valve stenosis 
Aortic stenosis 
CoA of Aorta 
Tetralogy of fallout Cyanotic 
Transposition of the great vessels. Cyanotic

Question 21

Long term consequences of Cyanotic heart disease

Answer 21

Hypoxia
Myocardial dysfunction
Increased risk of thromobisis infection embolus
Neurological effects CVA/ plagia/ abscess

Question 22

ANC 18-20 week uss normal does not rule out significant congenital heart disease

Answer 22

It will pick about 35-40% but some are normal
Eg ASD and patent ductus arteriosis so wont be commented on
Don’t be lulled into a false sense of security

Question 23

Prophlaxisis antibiotics

What is and what lesions do you use if for

Answer 23

1 cyanotic heart disease
2 6/12 post cardiac surgery
3 prosthetic valves
4 Rh heart disease

Big thing is to have regular dental check ups avoid dental caries

Question 24

General care of CHD

Answer 24

1 growth/nutrition 
2 CVS risk factors 
3 exercise 
4 antibiotic prophlaxisis 
5 dental care 
6 general infections 
7 immunizations 
8 psychological well-being  support the families /stressors