Cardiac malformation and pericardial disorders Flashcards
What is the leading cause of death in the first year of life
Congenital heart defect
What disease will you see a blue sclera
osteogenesis imperfecta
Where is the ductus arteriosus
Junction at the bifurcation of pulmonary arteries and less curve of aortic arch
Which part of the heart provides 65% of CO in fetal development
RV
When does the Ductus arteriosus close and why
at birth (hours to days) from decreased prostaglandins
What occurs to pulmonary pressure with PDA
Increases
What will cause a PDA
Decreased respiratory drive in neonates
increased prostaglandins to failure of closure
What increases the risk for a PDA
maternal rubella
What exam findings will you see with a PDA
diastolic murmur heard best under L. clavicle
LV enlargement
May progress to HF
When does the heart begin to develop
around 3 weeks
When does the heart begin to beat
day 28
How are ASDs classified
size and symptoms
**especially when talking about kids
What is an ASD
Defect in the atrial septum that allows for left to right blood flow
**leads to increased right side filling and eventually dilated RA
What is the most common type of ASD
ostium secundum
What are the different types of ASD
Ostium secundum
ostium primum
sinus venosus
What type of ASD may be associated with mitral valve defects and involve the ventricular septum / subaortic abnormality
Ostium primum
What is the most common cardiac malformation associated with Down syndrome
ASD
*also have looser ligaments
What type of murmur will occur with ASD
Pulmonary outflow murmur
split S2
Why is a PFO different from and ASD
PFO is not missing any tissue
What study can be done to test for a PFO
Bubble study
**will see R->L shunting
When do PFOs typically close
within the first week of life
What is the typical size of a PFO
3.4mm
What is a paradoxical embolism
Venous to arterial emboli
When will a paradoxical embolism occur
If RA pressure is greater than LA
Where are VSDs most common
perimembranous area of the septum
What will you hear when listening to to a VSD
Holosystolic or palpable murmur
What may occur in an infant with a large VSD
failure to thrive
What determines which way the blood shunts in a VSD
pressure in the heart
What is tetralogy of fallot characterized by
large VSD
pulmonary stenosis
Overriding aorta that straddles VSD
RV hypertrophy
What is the most common cause of cyanosis in neonates
tetralogy of fallot
How is tetralogy of fallot treated
surgically within the first year of life
What genetic condition is tetralogy of fallot associated with
DiGeorge syndrome
What causes cyanosis in tetralogy of fallot
The direction of the shunting blood changes (R->L)
What are tet spells
increased obstruction of the RV outflow tract leading to cyanosis and deep rapid breathing
What PE findings will you see on an undiagnosed adult with tetralogy of fallot
clubbing
cyanosis
arrhythmia
arthroplasty
increased erythrocyte mass
What is coarctation of the aorta
Narrowing of the Aorta distal to the subclavian artery (near doctor arteriosus)
what occurs in the body with coarctation of the aorta
increased pressure proximal to the lesion and hypotension distal to it
What genetic disease is coarctation of the aorta associated with
turner syndrome
What causes coarctation of the aorta
fibrous ridge of tissue
What PE findings will you see with coarctation of aorta
systolic continuous murmur, heard best on back
decreased ability to exert themselves
What are patients with aorta coarctation at increased risk for
HF
hypertensive encephalopathy
aortic dissection
rupture
What is the job of the pericardium
anchor the heart within the mediastinum
what is the number one cause of pericarditis
viral (coxsackie)
How is pericarditis diagnosed
pericardial friction rub
ECG changes
Pericardial effusion
What ECG changes are seen with pericarditis
Diffuse ST elevation
no correlation with specific coronary
How will a patient with pericarditis present
sharp chest discomfort
no improvement with nitro
worse while laying down
What is pulsus paradoxus
exaggerated fall in blood pressure with inspiration (>10mmHg)
What may be seen on ECG with pericarditis
low voltage in severe cases or tamponade
What is Kussmals sign
Increase in JVD distention on inspiration
