CARDIOTHORACIC - Congenital Heart Problems Flashcards
A baby presents with respiratory distress. He has stridor and episodes of difficulty breathing during which he takes a hyperextended position.
- Likely dx
- Dx
- Tx
- Vascular rings
=abnl formation of aorta and/or surrounding vessels, which completely encircle the trachea & esophagus
=usually 2/2 persistent double aortic arch after 2nd month of fetal life
=> sxs of pressure on tracheobronchial tree & esophagus
—>stridor & episodes of respiratory distress w/”crowing” respiration with hyperextended position 2/2 swallowing difficulty
*if only respiratory sxs present, think tracheomalacia - Dx:
Barium swallow: extrinsic compression from abnl vessel
Bronchoscopy: segmental tracheal compression (& rules out diffuse tracheomalacia) - Tx:
Surgery (divide smaller of two aortic arches)
How does one best diagnose morphologic cardiac anomalies (congenital or acquired)?
Echocardiogram
What features do all Left-to-Right Shunts share?
- murmur
- overloading of pulmonary circulation w/long-term damage
- volume/consequence of shunt differ at different locations
A one-year-old infant presents for a well child check up, He has had frequent colds, but has been otherwise healthy. The physician notes a faint systolic flow murmur and a fixed second heart sound.
- Likely diagnosis
- Dx
- Tx
- Atrial septal defect
- minor, low pressure, low-volume shunt
- typically not recognized before late infancy
- common history: frequent colds
- -> faint pulmonary flow systolic murmur and fixed second heart sound - Dx: Echocardiogram
- Tx: Closure (surgical vs cardiac cath)
Presentation of VSDs depending on size/location.
Do all VSDs need repair?
How should one go about dx/tx?
No.
Small restrictive VSDs low in the muscular septum produce a heart murmur but few sxs. Likely to close spontaneously by 2-3 years of life.
More typical VSDs high in membranous septum lead to early trouble.
First few months:
-failure to thrive
-loud pansystolic murmur best heard @LSB
-increased pulmonary vascular markings on CXR
Dx/Tx:
-Echo & surgical closure
A murmur is heard on the exam of a 1 day old premie. The murmur is continuous and machine-like. He also has bounding pulses.
- Likely diagnosis
- Dx
- Tx
- PDA
- symptomatic in first few days of life
- bounding peripheral pulses
- continuous “machinery-like” heart murmur - Dx: Echo
3. Tx: Indomethicin to close PDA -in premies who have not gone into CHF Surgical division or Coil embolization - in premies whose PDA does not close - in premies already in CHF - in full-term babies
What features do all Right-to-Left Shunts share?
- murmur
- diminished vascular markings in the lung
- cyanosis
A small 5yo boy comes in due to episodes where he turns bluish around the lips and fingers; he squats to relieve these episodes. He is found to have a systolic ejection murmur in the 3rd left intercostal space. On CXR he has a small heart and diminished pulmonary markings. His EKG shows signs of RV hypertrophy.
- Likely diagnosis
- Dx
- Tx
- Tetrology of Fallot
- most common cyanotic anomaly
- crippling but allows children to grow up past infancy (cyanotic 5-6yo typically in questions)
- ->small for age
- ->bluish hue to lips/fingertips
- ->clubbing
- ->spells of cyanosis relieved by squatting
- ->systolic ejection murmur in left 3rd intercostal space - Dx
CXR: small heart & diminished pulmonary markings
EKG: signs of RV hypertrophy
Echo: diagnostic - Tx:
Surgical repair
A 2-day-old newborn has developed cyanosis, respiratory distress, and difficulty feeding. A loud machine-like murmur was heard on day 1, but is now must fainter.
- Likely diagnosis
- Dx
- Tx
- Transposition of the great vessels
- -> severe trouble early on
- kept alive by ASD, VSD or PDA (or combo)
- die soon if not corrected
- 1-2 day old child with cyanosis & in trouble
- risk factor: diabetic mother - Dx: Echo
- Tx:
Prostaglandins to keep PDA open
Surgical repair (complex!)
