CHD Flashcards by Christine Deihl

A neonate is suspected of having VSD. What should be done to confirm or rule out this condition?
A. Perform capnography to monitor the PetCO2 level
B. Perform a Vd/Vt calculation
C. Check the PvO2 value from the pulmonary artery
D. Check the PvO2 value from the right atrium and right ventricle

D. Check the PvO2 from the right atrium & right ventricle

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This condition is characterized by constriction in the lumen of the aorta, the most common location is near the ductus arteriousus at the junction of the transverse aortic arch & descending aorta?

Coarctation of the aorta

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The most common cyanotic anomaly, characterized by 4 characteristics: VSD, pulmonary valve stenosis, positioning of aorta directly above or overriding the VSD, Rt ventricular hypertrophy

Tetralogy of Fallot

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In this condition, you have a “blue baby” and you see two separate & parallel circulations but survival depends on mixing blood between two systems

Transposition of great arteries

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In this condition, you have a baby normally born pink who then becomes blue, you may see TET or severe cyanosis; the baby may experience prolonged crying, hyperpnea, & most often seen in boys then girls.

Tetralogy of Fallot

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On an xray you will see switched vessels, may be seen as egg shaped or egg on side, cardiomegaly & pulmonary vascular enlargement may be seen

Transposition of great arteries

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May produce boot shaped heart on xray caused by narrow mediastinum & sustained increase in PVR, ventricular overfill & hypertrophy

Tetralogy of Fallot

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Characterized by a common artery (or truncus) originating from both ventricles and overriding a VSD?

Truncus arteriosus

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T or F: in a truncus arteriosus Pulmonary blood pressure reamins higher than systemic BP

F: Pulmonary bp usually is equal to systemic BP

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This condition is characterized by reversed position of aorta & pulmonary arteries. The aorta originates from the right ventricle and pumps unoxygenated blood to body; the pulmonary artery originates from left ventricle and pumps oxygenated blood back to lungs.

Transposition of great vessels

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The most common cyanotic anomaly is?

Tetralogy of Fallot

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Characterized by all pulmonary veins returning blood to the right atrium; to sustain life must be passage between right and left atria (ASD); they may be classified according to route of pulmonary venous return to right atrium with supracardiac being most common with route through superior vena cava

Total anomalous pulmonary venous return (TAPVR)

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This condition is characterized by failure of tricuspid valve to form, resulting in lack of direct communication between right atrium & rt ventricle; you may see small right vertricle & large left ventricle with decreased pulmonary circulation

Tricuspid atresia

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In tricuspid atresia, this condition is also present in about 30% of cases?

Transposition of great arteries

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In this condition you see a failure of foramen ovale to close or malformation on atrial septal wall

ASD

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Failure of ductus arteriosus to close at birth

PDA

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Malformation of the ventricular septal wall is

VSD

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Most common type is an aortic valve with fused leaflets

Aortic stenosis

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Most common type is a defect in the pulmonary valve with fused leaflets

Pulmonary stenosis

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Seen wihen an common artery is overriding a VSD?

Truncus arteriosus

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Agenisis of tricuspid valve, small RV, large LV

Tricuspid atresia

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T or F: CHF is not present when complete transposition of the great vesslels occurs.

True

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Its treatment includes indomethacin

PDA

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Its treatment may include aortic valvulotomy

Aortic stenosis

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This condition is a syndrome of increased PVR & R to L shunting; may see tachypnea, refractory hyoxemia, respiratory distress, cardiomegaly.

PPHN or formerly known as persistent fetal circulation

________ is a vasodilator used to dilate pulmonary vasculature and decrease PVR.

Tolazoline

In this condition no tricuspid valve is present so no blood flow between RA & RV; two anamolies may cause this tricuspid atresia or pulmonary atresia

Hypoplastic Right Ventricle

T or F: When mechanically ventilating for CHD the goal is to minimize variations in oxygenation and acid base to prevent fluctuations in PVR and SVR.

True

T or F: In CHD there are usually lung abnormalities present so RAW is increased.

False; there is not usually lung abnormalities so RAW is normal

You should keep MAP below ____ when MV for CHD.

10 cmH2O

``` Extubation criteria in CHD include: 1. Intact cough 2. ability to clear airway 3. FIO2 < 50% 4. normal CO2 with normal RR A. 1, 2, 3 B. 1, 2, 4 C. 2, 3, 4 D. All of the above ```

B: 1, 2, 4 | FIO2 < 40%

FiO2 management can be utilized when you need to control ______.

PVR

Many cardiac defects will require (higher/lower) PVR.

Many require higher PVR to keep openings available for shunting

Increased inspired CO2 causes acidosis, this will cause (increase/decrease) in PVR.

increase

In subambient O2 therapy methods can include using _____ to decrease FIO2 to less than 21%

Nitrogen

What are the two gases you can use to replace O2 in subambient O2 therapy?

Nitrogen or CO2

This condition is most commonly seen in down syndrome & is characterized by incomplete development of the septa between both atria and ventricles; you have one common valve

Atrioventricular Canal Defecta

How does increased PVR affect your pulmonary blood flow? A. It increases B. It decreases C. No effect

B. increased PVR will decrease pulmonary blood flow

``` For the rule of 40's; How does it effect these values? PaO2 = Fio2 Paco2 Ph SaO2 ? ```

``` PaO2 = 40 Fio2 = 40 pH greater than or equal to 7.40 PaCO2 = 40 with a venous admixture so SaO2 = 75% ```

What is the best weight for best surgical outcomes?

5 kg

Treatment for this condition often includes using PGE1 to dilate ductus & balloon atrial septostomy since there is no tricuspid valve

Tricuspid atresia

Chest xray may appear as total white out, so you need to be sure to rule out RDS or sepsis.

TAPVR

Principal defect is small LV, have little to no output; treatment is transplant; death may occur in less than 1 week

Hypoplastic left heart syndrome

In this condition hypertension often seen in upper extremities so you need to measure BP in both arms and one leg

Coarctation of aorta; 1/2 have an abnormal aortic valve

In this condition may see globular shaped heart.

Hypoplastic left heart syndrome

Two anomalies can cause it: tricuspid atresia or pulmonary atresia; results in no blood flow between RA and RV so must have an ASD or patent foramen ovale for blood to leave RA

Hypoplastic right heart syndrome

When venous admixture must be present a strategy to ventilating is using ______.

Rule of 40's

If you have a difference of greater than ____ % on pulse ox or > ____ torr you may have R-L ductal shunting present.

5% on pulse ox | > 15 torr

In this condition you may hear heart murmur, see widened pulse pressure, bounding pulse

PDA

In this condition you rarely see symptoms in pediatric population, symptoms may not appear until 30's.

ASD

You may see muscle hypertrophy; volume overloads lungs & left side of heart A. ASD B. VSD

B. VSD

Volume overloads lungs and right side of heart. A. ASD B. VSD

A. ASD

Spontaneous closure often happens in small holes; usually do not see symptoms at birth but CHF is common & places at risk for pulmonary vascular disease or bacterial endocarditis

VSD

Accounts for 10% of all CHD; volume will overload lungs & left side of heart.

PDA

If fluid restriction is needed restrict the amount to _____ ml/kk/day

120 ml/kg/day

If patient is < 1000 g & symptomatic what is the treatment for PDA?

to close the PDA

If pt > 1000 g the treatment of PDA is?

Fluid restriction for 48 hrs; in most term babies will close on its own in 1-3 days

Normal transition to extrauterine life depends on the pulmonary vascular system: A. remaining in a steady state of balance with hepatic blood flow B. Changing from a low pulmonary vascular resistance to high C. Changing from a high pulmonary vascular resistance to a low pulmonary vascular resistance D. Maintaining a patent ductus arteriosus

C. Changes from a high pulmonary vascular resistance to low pulmonary vascular resistance

``` Which of the following affects pulmonary vascular resistance? A. Changes in PaO2 B. Changes in PaCO2 C. Changes in pH D. All of the above E. None of the above ```

D. All of the above

``` What are teh two categories that have typically been used to classify congenital cardiac defects? A. right sided vs left sided B. Atrial versus ventricular C. Cyanotic vs acyanotic D. simple versus complex E. above vs below diaphragm ```

C. cyanotic vs acyanotic

``` The PDA connects which two vessels: A. Superior vena cava and pulmonary artery B. Aorta to the pulmonary artery C. Pulmonary artery and pulmonary vein D. Coronary arteries and the aortic arch E. Ductus venosus to right atrium ```

B. Aorta to pulmonary artery

What is the therapeutic goal of subambient o2 therapy? A. increase teh pulmonary vascular resistance B. Balance blood flow between teh vena cava and right atrium C. Decrease pulmonary vascular resistance D. Increase diastolic BP

A. increase the pulmonary vascular resistance

The purpose of managing PVR in the presence of cardiac defects is to ensure the desired balance between systemic and pulmonary blood flow. A. True B. False

A. True

``` Tetralogy of Fallot consists of which four concomitant conditions: I. truncus arteriosus II. Left ventricular hypertrophy III right ventricular hypertrophy IV. Overiding aorta V. Interrupted aortic arch VI. Pulmonary stenosis VII. Ventricular septal defect VIII. Right ventricular outflo tract obstruction A. I, II, III, V B. III, iV, VI, VII C. V, VI, VII, VIII ```

``` B: Tetralogy of Fallot consists of: Right ventricular hypertrophy Overriding aorta Pulmonary stenosis Ventricular septal defect ```

In complete transposition of the great arteries, the aorta and pulmonary artery circulation run in series. A. True B. False

B. False; they run in parallel

``` For which condition is a ventilator strategy utilizing larger tidal volumes, lower rates and shorter I times typically used? A. unrepaired truncus arteriosus B. Total anomalous venous return C. Situs invesus D. Bidirectional Glenn ```

D. Bidirectional Glenn

Increasing gradients between ET CO2 and PaCO2 in patients with CHD are often the result of A. Loss of calibration B. Ventilation perfusion mismatching C. Equipment malfunction

B. Ventilation perfusion mismatching

``` In CHF what is the first sign seen of problem? A. tachypnea B. respiratory distress C. cyanosis D. Mottling of extremities ```

A. tachypnea

How does CHF affect urine output? A. increases B. decreases C. no effect normally until renal failure occurs

B. decreases

Why do you see tachycardia in CHF? A. Increased stress on heart's left ventricle to overcome resistance B. Body is attempting to increase CO C. Body is decreasing CO D. hypovolemia occurs & this is body's normal response

B. body is attempting to increase CO

What happens to your CO with CHF. A. it decreases B. it increases C. no effect

A. it decreases

What is the most important factor indetermining risk of CHD.

Family history

When formen ovale fails to close you have a? A. ASD B. VSD C. PDA

A. ASD

``` What will cause a decrease in PVR? I. Decrease in pH II. Increase in pH III increase in FIO2 IV. decrease in FIO2 V. Decrease in MAP VI. increase in MAP VII. Decrease in PEEP VIII. increase in Peep IX. prostaglandins X. adrenergic agents such as epinephrine ```

``` Decrease in ph Increase in FIO2 Decrease in PEEP Decrease in MAP PGE1 & NO ```

``` If you have a L-R shunt then, I. Your SVR is increased II. SVR is decreased III. Your PVR is decreased IV. Your PVR is increased V. Pulmonary blood flow is increased VI. Pulmonary blood flow is decreased A. I, III, V B. II, IV, VI C. I, III, VI D. II, VI ```

B. With left to right shunt you will see your SVR increased, decreased PVR, pulmonary blood flow increased