Cardio 2 Flashcards
Tetralogy of Fallot
Primary defect in Tetralogy of Fallot:
Anterior deviation of the infundibular septum
Muscular septum that separates the aortic and pulmonary outflows:
Infundibular septum
Cite the 4 componentes of Tetralogy of Fallot:
Pulmonary stenosis; ventricular septal defect; dextroposition of the aorta; RV hypertrophy
Constitutes an extreme form of ToF:
Complete obstruction of RV outflow
Determinants of patient’s cyanosis and age of presentation: (2)
Degree of pulmonary outflow obstruction; ductus arteriosus patency
In ToF; Pulmonary valve usually mantains its three flaps T/F
False; usually bicuspid or unicuspid; ocasionally can be the only site of stenosis
In ToF; In the absence of pulmonary artery patency…
pulmonary flow may be provided by PDA or by “aortopulmonary collateral arteries”
In ToF; the aortic arch is right sided in ___ of cases.
20%; the aortic root is large and “overrides the VSD to varying degrees
In ToF; an aorta overriding the VSD by >50% can be classified as…
A form of double-outlet right ventricle; dynamics and method of repair are the same
In ToF; Systemic venous return to the right atrium and ventricle are diminished T/F
False; venous return is normal
In ToF; Pulmonary artery pressure is…
Either normal or lower than normal
In ToF; a mild to moderate RV outflow obstruction and a balanced shunt presents as…
An acyanotic or “pink” tetralogy of Fallot
In ToF; a severe RV outflow obstruction and important shunt presents as…
Severe cyanosis from birth and worsens with DA clossure
In ToF; Mild degrees of RV outflow obstruction develop cyanosis…
in the 1st few months of life
In ToF; Severe degrees of RV outflow obstruction develop cyanosis…
At birth; pulmonary bloodflow may depend solely on PDA
In ToF; Severe degrees of RV outflow obstruction may develop circulatory collapse if…
PDA begins to close in the 1st few hrs or days of life
In ToF; Older children with long-standing cyanosis who have not undergone surgery may present with… (3)
Dusky blue skin; gray sclerae with engorged blood vessels; finger clubbing
In ToF; Dyspneia occurs…
On exertion; the may play actively for a short time.
In ToF; Paroxismal hypercyanotic attaks (blue spells) are a problem during…
the first year of life
In ToF; Paroxismal hypercyanotic attacks (blue spells) symptoms: (5)
Infant becomes hyperpneic; restless; cyanosis increases; gasping and syncope may follow
In ToF; Paroxismal hypercyanotic attaks (blue spells) occur most frequently:
In the morning on initially awakening or after vigorous crying
In ToF; Paroxismal hypercyanotic attaks (blue spells) systolic murmur may…
Temporarily disappear or decrease in intensity as flow acros the RVOT “diminishes”
In ToF; Paroxismal hypercyanotic attaks (blue spells) may last…
From a few minutes to a few hours
In ToF; Paroxismal hypercyanotic attaks (blue spells) are followed by…
Weakness and sleep
In ToF; Paroxismal hypercyanotic attaks (blue spells); when severe; may lead to…
Unconsciousness; convulsions or hemiparesis
In ToF; Paroxismal hypercyanotic attaks (blue spells) can result in ___ hypoxemia and metabolic…
Severe; acidosis
In ToF; One procedure for blue spells consist of placing the infant on ___ in the ___ position.
The abdomen; knee-chest; also important to check for constrictive clothing
In ToF; Administration of O2 during a blue spell can reverse cyanosis T/F
False; intracardiac shunting is unaffected by inspired O2; O2 should be provided nonetheless
In ToF; Morphine should be administered via ___ to aid in calming the infant
Subcutaneous; not to exceed 0.2mg/kg
In ToF; Blood samples should be obtained during spells T/F
False; may cause further agitation and be counterproductive
In ToF; Rapid acidosis may develop if PaO2<40; prolonged or severe spells may need…
Rapid correction with IV BIC
In TOF; Refractory spells may need…
Intubation and anesthetic sedation
In ToF; Drugs that increase SVR (phenylephrine)…
Can improve RC outflow; decrease R-to-L shunt and improve symptoms
In ToF; __-Adrenergic blockade has also been used to abort spells
Beta; Propanolol 0.1mg/kg given slowly to a max of 0.2/kg
In ToF; Chronically SaO2<70 may lead to…
Growth and development delay
In ToF; Pulse; venous and arterial pressures are…
Normal
In ToF; The classical murmur is…
Systolic; loud; harsh; most intense at the left sternal border
In ToF; Typical AP Rx shows:
Narrow base; concavity of the L heart border ocupied by pulmonary art; “Normal heart size”; rounded right border
In ToF; The ECG shows:
Right axis deviation and RVH
In ToF; Prefered method of Dx:
2D echocardiography with doppler; also useful in determining PDA role in pulmonary flow
In ToF; During catheterization shows a SO2 of 75-85% in…
Moderately cyanotic patients; pink fallots can have normal SO2
In ToF; Most children undergo repair (some cases palliation) during…
The first months of life
In ToF; Polycythemia and dehydration can lead to…
Cerebral tromboses; usually in the cerebral veins or dural sinuses
In ToF; Heat failure is more common in pink fallots T/F
True; undeveloped mechanism to tolerate acute hypoxemia
In ToF; an concomitant atrioventricular septal defect is often associated with…
Down syndrome
In ToF; If radiographic appearance of pulmonary vasculature differs on the 2 sides…
Absence of a branch pulmonary artery should be suspected; most often to the left
In ToF; Can be associated with ___ syndrome
DiGeorge; CATCH 22 (Cardiac def; Abnormal facies; Thymic hypoplasia; Cleft palate; HypoCa; deletion of chrom 22
In ToF; therapy is aimed at…
providing immediate increase in pulmonary blood flow
In ToF; Normal body temp must be mantained due to…
increased o2 consumption during cold
In ToF; DA patency can be prolonged with…
Prostaglandin E; 0.01-0.2 mcg/kg/min; can cause apnea
In ToF; Acyanotic patiens can progress fairly quickly to cyanotic episodes T/F
True; they require careful observation
In ToF; Propanolol can be used if Cx is expected to be delayed T/F
True; 0.5-1mg/kg 6/6h; reduces frequency and severity of spells
In ToF; Infants with severe cyanosis have 2 Cx options:
Corrective open heart surgery; Palliative shunts (Blalock-Taussig shunt)
In ToF; infants with mild to moderate cyanosis can perform Cx electively at…
4-6mo if adequate growth and lack of spells
In ToF; Corrective Cx consist of…
Resecting obstructive muscle bundles and closure of VSD
In ToF; Blalock-Taussig shunt is performed to…
Augment pulmonary artery blood flow by systemic-to-pulmonary artery shunt
In ToF; Blalock-Taussig shunt consists of…
Conduit anastomosed side to side from the subclavian artery to the homolateral branch of the pulmonary artery
In ToF; Blalock-Taussig shunt complications: (5)
Chylothorax; diaphragmatic paralysis; Horner syndrome; pulm overcirculation and HF
In ToF; Blalock-Taussig shunt a ___ indicates functioning anastomosis.:
Continuous murmur over the lung fields; may not be heard until several days
In ToF; Blalock-Taussig shunt; rapid cyanosis may develop after the Cx if…
Thrombosis of the shunt; emergency Cx
