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Fall'20 Advanced Principles II > Chd > Flashcards

Chd Flashcards

1
Q

Success of fontan procedure for tricuspid atresia depends on

A

HIGH systemic venous pressure and maintaining both low PVR and low left atrial pressure

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2
Q

For triscuspid atresia failed fontan procedure what may be necessary

A

Heart transplant

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3
Q

What is Tricuspid atresia surgical management

A

Fontan procedure

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4
Q

Tricuspid atresia -babies are cyanotic at birth and require “this” to survive

A

Prostaglandin E1 infusion with or without other palliative procedure

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5
Q

For tricuspid atresia- what is necessary for blood to flow from the left ventricle into the pulmonary circulation

A

PDA or VSD

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6
Q

Tell me exactly what is the problem with tricuspid atresia

A

Absence or permanent closure of the tricuspid valve

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7
Q

Tricuspid atresia-what is the left ventricle and right ventricle

A

Small right ventricle large left ventricle

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8
Q

Tricuspid atresia can have transposition of the great vessels

A

Dextrotransposition

Nondextransposition

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9
Q

What is the flow of blood for tricuspid atresia

A

Blood goes from RA- asd or pfo to LA- through mitral valve to vsd- to pulmonary artery

If no VSD- blood flows through pda

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10
Q

Signs of symptoms of tricuspid atresia

A 
Clubbing in older children
Tachypnea
Prominent a waves
Abnormal pulses
Hepatic enlargement
Heart failure
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11
Q

What is ebstein anomaly

A

Downward displacement of the valve because of abnormal attachment of valve leaflets

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12
Q

What is the most common type of ASD

A

Ostium secundum at the level of foremen ovale

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13
Q

What ASD is associated with mitral regurgitation

A

Located low in atrial septum

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14
Q

What ASD is located high in atrial septum

A

Sinus venous

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15
Q

What type of shunt is ASD

A

Left to right shunt b/w the 2 atria

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16
Q

For ASD what can air bubbles lead too

A

Paradoxical Emboli that can lead to heart attacks and strokes

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17
Q

Treatment of ASD

A

Early repair is advocated

Banding of pulmonary artery to reduce the magnitude of left to right shunt

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18
Q

What infection can occur with ASD

A

Recurrent pulmonary infections

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19
Q

What should be avoided in ASD

A

Increase in SVR-worsen left to right shunting

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20
Q

ASD what is commonly seen post op

A

Svt and about conduction is common

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21
Q

In ASD what will volatiles and positive pressure ventilation do to shunting

A

Decrease svr

Ppv will increase pvr and decrease the shunt

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22
Q

What may present post op with VSD

A

3rd degree heart block may present

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23
Q

What shunt has Recurrent pulmonary infections and CHF are common

A

VSD left to right

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24
Q

True or false

Small VSD close during childhood spontaneously

A

True

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25
Q

Large VSD s usually produce large left to right shunts that vary directly with____ and indirectly with___

A

Directly with SVR

Indirectly with PVR

26
Q

VSD are mostly a symptomatic what type of murmur do they have

A

Loud pan systolic murmur along left stern also border

27
Q

Name the most common VSD

A

Membranous VSD

28
Q

Name the 4 types of VSD

A

Membranous VSD
Muscular VSD
Supra-cristal VSD
Av canal type VSD

29
Q

For a VSD WHAT DO YOU SEE ON THE CXR

A

Biventricular hypertrophy

Pul HTN

30
Q

Transposition of the great arteries must include which holes in the heart for blood to mix

A

Survival is only possible through mixing of blood through foramen ovale-PDA AND SOMETIMES A VSD

31
Q

Transposition of the great arteries includes what medication for survival

A

Prostaglandin E1

32
Q

What ventricle does transposition of the great vessels effect

A

Mimics tof- when a VSD and pulmonic stenosis occurs. Obstruction effects the left ventricle NOT the right

33
Q

Describe total anomalous venous return

A

Pulmonary veins do not connect to the left atrium. Instead blood returns to the right atrium or prior to the ra- and mixes with the deoxygenated blood

34
Q

How does the baby survive total anomalous venous return

A

Blood reaches the left side of the heart via an foramen ovale or an ASD.

35
Q

For total anomalous venous return - why does venous congestion begin to occur.

A

Severe pulmonary congestion occurs when the ductus venous begins to close.

36
Q

How is total anomalous venous return corrected

A

The pulmonary venous trunk is reanastomosed into the left atrium and the asd is closed

37
Q

Describe truncus arteriosus

A

Single arterial trunk supplies the pulmonary and systemic circulation

38
Q

What accompanies truncus arteriosus

A

A VSD to allow both ventricles to eject into it

39
Q

During truncus arteriosus- PVR gradually decreases after birth but pulmonary blood flow increases resulting in what

A

Heart failure

40
Q

Patients with cyanotic heart disease have what response to hypoxemia

A

Blunted response

41
Q

Patients with cyanotic heart disease have what response to hyper apnea

A

Normal response

42
Q

What does methergine do to parturients

A

Increases svr

43
Q

What does oxytocin do to parturients

A

Decreases svr and increases HR and PVR

44
Q

Normal aortic valve area

A

2.5-3.5cm

45
Q

Severe aortic stenosis is when the valve is less than or equal to

A

1cm2

46
Q

Hr for AS

A

60-90
Nsr
Maintain preload, after load, contractility

47
Q

AS
treatment for bradycardia
Treatment for tachycardia

A

Atropine

Esmolol

48
Q

AS when is spinal and epidural tolerated

A

Mild to moderate stenosis

Epidural is better tolerated

49
Q

When are spinal and epidurals contraindicated in aortic stenosis

A

In severe aortic stenosis

50
Q

In AS- what medication is effective for treating svt and ventricular dysrhythmics

A

Amiodarone and lidocaine

51
Q

What medication do we use to treat hypotension in AS

A

Small doses of neo

52
Q

Describe coarctation of the aorta

A

Obstruction located in the descending aorta

53
Q

Describe preductal coaractation of the aorta

A

Narrowing occurs proximal to the opening of the ductus- marked differences occur between the lower and upper half of the body-lower half is cyanotic

54
Q

Coarctation of aorta with or without left ventricular failure=

A

HTN in upper body with bounding pulses and hypotension of lower extremities with weak or absent pulses

55
Q

Which cardiomyopathy is genetically transmitted

A

Hypertrophic cardiomyopathy

56
Q

The most common cause of sudden death in pediatric and young adult population

A

Hypertrophic cardiomyopathy

57
Q

What are the 4 major changes in hypertrophic cardiomyopathy

A

Ventricular hypertrophy
Decreased ventricular chamber size
Increased ventricular wall thickness
Impaired ventricular relaxation

58
Q

What is described as the rapid acceleration of blood traveling through a narrow outflow tract

A

Venturi effect

59
Q

The presence of “this makes the coronary artery walls narrowed in hypertrophic cardiomyopathy

A

Collagen

60
Q

What happens to the left ventricle in hypertrophic cardiomyopathy

A

Asymmetric hypertrophy of inter ventricular septum of LV CAUSES LEFT OUTLFOW TRACT OBSTRUCTION - hemodynamics consequences are similar to AS

Fall'20 Advanced Principles II (7 decks)

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