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2023 RC Blue's Clues > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Cyanotic heart lesions

A

Cyanotic heart disease (5 T’s & H)
ToF
TGA
Truncus arteriosus
TAPVR
Tricuspid atresia & Ebstein’s
Hypoplastic left heart (any LV outflow tract obstruction can result in duct dependent lesion)

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2
Q

Acyanotic heart lesions

A

VSD
ASD
PDA
coarctation

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3
Q

test to distinguish cyanotic from acyanotic heart lesions

A

hyperoxia test

If the PaO2 rises above 150 mm Hg during 100% oxygen administration, an intracardiac right-to-left shunt can usually be excluded

pre ductal ABG. (right radial)

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4
Q

cyanosis with left axis deviation

A

tricuspid atresia

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5
Q

Late complications fontan surgery

A

stenosis of the superior or inferior vena cava anastomosis
vena cava or pulmonary artery thromboembolism
protein-losing enteropathy
plastic bronchitis
immune deficiency
supraventricular arrhythmias (atrial flutter. paroxysmal atrial tachycardia)
hepatic cirrhosis (and possibly hepatic carcinoma) as a result of persistently elevated central venous pressures

Oral budesonide or sildenafil has been used with varying success to treat protein-losing enteropathy associated with the Fontan procedure. Thoracic duct ligation or embolization has been used to treat plastic bronchitis. LV dysfunction may be a late occurrence, usually not until adolescence or young adulthood. Heart transplantation is a successful treatment option for pediatric patients with “failed” Fontan circuits

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6
Q

Orthostatic hypotension

A

orthostatic hypotension (OH) is defined as a sustained DROP in the systolic BP by >20 mm Hg or diastolic BP >10 mm Hg in the 1st 3 min of upright tilt.

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7
Q

most common CHD in DiGeorge

A

ToF is most common

could also have interrupted aortic arch, truncus arteriosus, VSD, pulm atresia, vascular rings (chonal truncal outflow track anomalies!!)

if you see truncus, think digeorge

autosomal dominant

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8
Q

Trisomy 21 CHD

A

of all AVSDs 50% have T21

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9
Q

Marfan CHD

A

dilated aortic root + aorta
mitral valve prolapse

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10
Q

Ehlers danlos CHD

A

dilated aorta
mitral valve prolapse

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11
Q

williams CHD

A

supravalvular AS/PS (normal valves but tight above valve)
PPS (small branch pulm arteries)

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12
Q

Noonans CHD

A

PS
hypertrophic CM

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13
Q

Turner CHD

A

bicuspid AV (the most common)
aortic stenosis
coarc aorta

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14
Q

Alagille CHD

A

PS
PPS

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15
Q

Maternal diabetes CHD

A

HOCM
PDA
VSD

worse if the mom had diabetes at the beginning of pregnancy!
HOCM occurs if poor sugar control. can improve when baby has normal sugar

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16
Q

maternal rubella CHD

A

pulmonary stenosis
PDA

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17
Q

FASD CHD

A

VSD
PDA
ASD

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18
Q

maternal lupus CHD

A

can lead to heart block, cardiomyopathy, or valve regurgitation (monitor pregnancies if mom has lupus, monitor until 26 weeks)

neonatal lupus: cardiac, skin, liver, heme problems

if normal at birth, no ongoing screening for the child

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19
Q

difficult delivery with shoulder dystocia and meconium aspiration. baby now cyanotic. what CHD?

A

PPHN
R to L shunt through PDA due to pulm hypertension

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20
Q

Tetrology of Fallot 4 lesions

A
  1. VSD
  2. Overriding Aorta
  3. Right ventricular outflow tract obstruction (ex. pulmonary valve stenosis)
  4. RV hypertrophy

degree of stenosis depends on degree of RVOTO

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21
Q

CXR in ToF

A

Boot shaped heart
d/t RVH - turns up the apex of heart
pulmonary artery is hypoplastic so dont get a typical PA shadow
decreased pulm vascular markings

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22
Q

Physical exam of ToF

A

normal S1
Single S2
SEM at ULSB (differentiates this from TGA) - pulm stenosis murmur

23
Q

ECG changes in ToF

A

RVH
Right axis deviation
upright T wave in V1

24
Q

Tet Spells

A

increased shunting R–> L

25
Q

toF ECG post repair

A

RBBB in V1

26
Q

TGA

A

parralel circulation
needs to have mixing
- PFO
- ASD and/or PDA
- occassionally VSD

universally cyanotic (typically 70s at birth)
- degree of cyanosis depends on ability to mix

27
Q

TGA murmur/exam

A

NO MURMUR IN TGA - no turbulence (valves are normal, normal shunts) *distinguishes from ToF

Normal S1, single loud S2 - can’t hear due to altered anatomy and pressures aren’t as varied with respirations

28
Q

TGA xray

A

egg on a string

mediastinum is narrow because aorta/PA are overlying on top of each other so looks tall and narrow

29
Q

TGA management

A

KEEP PDA OPEN - start prostaglandin

Needs a shunt to improve mixing
- balloon atrial septostomy if no ASD or small ASD

30
Q

TGA vs. ToF

A

TGA
- most common immediate cyanosis at birth
- NO murmur
- CXR egg on string with normal or increased pulm markings
- usually no syndrome

ToF
- stenosis progresses over time so may not be as cyanotic at birth
- LOUD SEM murmur
- CXR decreased pulm markings and boot shapped
- most common cardiac cause of cyanosis overall (But may not be at birth)

31
Q

Tricuspid atresia

A

think about single ventricle physiology because the RV does not form since the tricuspid is closed

all blood goes through LV

need shunts to get blood from RA to left heart

cyanotic lesion

typically has LV heave, single S2, and holosystolic murmur at LSB

32
Q

Ebsteins anomaly

A

tricuspid valve leaflet not formed properly - think of as tricuspid regurgitation CHD

spectrum of disease

if severe, RV and RA are essentially one, RA enlarges, lots of blood can go through the ASD, less blood goes through pulmonary vessels (Cyanosis)

can get massively enlarged hearts (may not even survive fetal life because the heart prevents lungs from forming)

33
Q

Ebstein’s anomaly murmur

A

loud, regurgitant murmur at llsb

34
Q

LSB

A
35
Q
A

Pericarditis: Diffuse ST Elevation and PR depression

36
Q
A

Hyperkalemia: Tall Peaked T Waves

37
Q
A

2nd Degree Heart Block (Wenckebach)

38
Q
A

Pericarditis: Diffuse ST Elevation and PR depression

39
Q
A

1st Degree HB

40
Q
A

2nd Degree HB (Wenckebach)

41
Q
A

Complete Heart Block

42
Q
A

Atrial Flutter

43
Q
A

Left Bundle Branch Block

44
Q
A

LVH with strain

45
Q
A

Long QT

46
Q
A

SVT (Narrow Complex VT)

47
Q
A

Premature Atrial Contractions

48
Q
A

Monomorphic VT

49
Q
A

Premature Ventricular Contractions

50
Q
A

Right Bundle Branch Block

51
Q
A

Torsades de Pointe

52
Q
A

Wide Complex VT

53
Q
A

Wide Complex VT

2023 RC Blue's Clues (20 decks)

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