Cardio Flashcards
Cyanotic heart defects
The 5 T’s that have right-to-left shunts
Truncus arteriosus = ONE arterial vessel overriding ventricles
Transposition of the great vessels = TWO arteries switched
Tricuspid atresia (THREE)
Tetralogy of Fallot (FOUR)
Total anomalous pulmonary venous return = FIVE words
presents with severe cyanosis within the first few hours of life.
Transposition of great arteries
Noncyanotic heart defects—
The 3 D’s
VSD
ASD
PDA
Down syndrome heart defects
ASD
Endocardial cushion defects
Congenital rubella heart defect
PDA
Turner’s syndrome heart defect
Coarctation of the aorta
Coronary artery aneurysms associated disease
Kawasaki disease
Associated with maternal lithium use
Ebstein’s anomaly
Neonatal lupus is associated with this heart problem
Congenital heart block
Neonatal thyrotoxicosis effect
Heart failure
Heart diseases of newborn associated with maternal diabetes
TGA
Asymmetric septal hyper trophy
Suprvalvular aortic stenosis seen in
William’s disease
most common cause of congenital heart disease.
VSD
Small versus large VSD
Small
-harsh holosystolic murmur
Large
-frequent respiratory infections, dyspnea, FTT, and CHF
Surgical indications of VSD
- symptomatic patients who fail medical management
2. children
VSD ECG
ECG: LVH and may show both LVH and RVH with larger VSD
Heart defect that has a fixed, widely split S2
ASD
Examination reveals a right ventricular heave; a wide and fixed, split S2; and a systolic ejection murmur at the left upper sternal border (from ↑ flow across the pulmonary valve). There may also be a mid-diastolic rumble at the left lower sternal border.
ASD
ASD ECG ABD CXR findings
ECG may show RVH and right atrial enlargement. PR prolongation is common.
CXR reveals cardiomegaly and ↑ pulmonary vascular markings.
Failure of the ductus arteriosus to close in the first few days of life, leading to an acyanotic left-to-right shunt from the aorta to the pulmonary artery. Risk factors include maternal first-trimester rubella infection, prematurity, and female gender
Patent ductus arteriosus
In infants presenting in a shocklike state within the first few weeks of life, look for:
- Sepsis
- Inborn errors of metabolism
- Ductal-dependent congenital heart disease, usually left-sided lesions (as the ductus is closing)
- Congenital adrenal hyperplasia
Examination reveals a continuous “machinery murmur” at the second left intercostal space at the sternal border, a loud S2, wide pulse pressure, and bounding peripheral pulses.
patent Ductus arteriosus
Indomethacin is to ____ Pda
Come IN and CLOSE the door: give INdomethacin to CLOSE a PDA.
Constriction of a portion of the aorta, leading to ↑ flow proximal to and ↓ flow distal to the coarctation.
Coarctation of the aorta
Most common site of coarctation
Occurs just below the left subclavian artery in 98% of patients
More than two-thirds of patients have a bicuspid aortic valve.
Coarctation
Coarctation of the aorta
The condition is associated with Turner’s syndrome, berry aneurysms, and male gender.
Heart defects that require a patent PDA for survival
transposition of the great vessels
tetralogy of Fallot
hypoplastic left heart
Critical coarctation
Differential cyanosis may be seen with lower O₂ saturation in the left arm and lower extremities (postductal areas) as compared to the right arm (preductal area).
Coarctation of the aorta
CXR and ECG of coarctation
LVH on ECG
the “3” sign on CXR due to pre- and postdilatation of the coarctation segment with aortic wall indentation
“rib notching” due to collateral circulation through the intercostal arteries
Without a septal defect (ASD or VSD) and a PDA, it is incompatible with life
The most common cyanotic congenital heart lesion in the newborn
TGA
Examination reveals tachypnea, progressive hypoxemia, and extreme cyanosis. Some patients have signs of CHF, and a single loud S2 is often present. There may not be a murmur if no VSD is present. If a VSD is present, a systolic murmur may be heard at the left sternal border.
TGA
DiGeorge syndrome—
CATCH 22
Cardiac abnormalities (transposition)
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia
22q11 deletion
CXR may show a narrow heart base, absence of the main pulmonary artery segment, an “egg-shaped silhouette,” and ↑ pulmonary vascular markings
TGA
__________ is the most common cyanotic heart disease of newborns
__________ is the most common cyanotic heart disease of childhood
TGA
TOF
Tetralogy of Fallot components
Consists of pulmonary stenosis, overriding aorta, RVH, and VSD
Children often squat for relief during hypoxemic episodes called “tet spells,” which ↑ systemic vascular resistance.
TOF
CXR shows a “boot-shaped” heart with ↓ pulmonary vascular markings. Remember that a VSD may result in ↑ pulmonary vascular markings.
ECG shows right-axis deviation and RVH.
TOF
Treat hypercyanotic “tet spells” with
O₂, propranolol, phenylephrine, the knee-chest position, fluids, and morphine.
Infants with FTT will first fall off of the ______ curve, then the ______ curve, and finally the _______ curve.
Infants with FTT will first fall off of the weight curve, then the height curve, and finally the head circumference curve.
Order of sexual development in a female
Thelarche
Pubarche
Growth spurt
Menarche
Precocious puberty in males
In females
8
9
Delayed puberty boys
Girls
14
13
Pattern of sexual development in males
Gonadarche
Pubarche
Adrenarche
Growth spurt
