CHD trigger Flashcards
fixed, split S2 and pulmonic ejection murmur
ASD
MC ASD type
ostium secondum
Associated w fetal alcohol syndrome
ostium secondum
associated with down syndrome (25% of down syndrome kids have this)
ostium premium
CXR shows right sided heart dilation and prominent pulmonary vascularity
ASD
increased oxygen saturation in the RA, RV and pulmonary artery
ASD (seen with a heart catheterization?)
when should adults receive surgery for ASD
- RV enlargement
- paradoxical embolism
- R–>L shunt
what is the absolute MC congenital heart defect (be specific)!!
membranous VSD (upper septum)
holosystolic murmur located at lower left sternal border
VSD
holosystolic murmur plus a thrill and a diastolic rumble in the mitral area
VSD but moderate-large
LVH on EKG
VSD
treated with diuretics and higher calorie feeds
VSD
Surgical intervention indicated w pulm HTN, aortic insufficiency or LA/LV dilation
VSD
connects pulmonary artery and aorta
PDA
holosystolic “machine-like” murmur
PDA
associated with female, preemie and high altitude births
PDA
EKG shows LVH and LAE
PDA
coarctation of the aorta
can also use echo for PDA which is diagnostic!!!
tx with PGE inhibitors for neonates up to 14days. if symptomatic tx with digoxin and fureosemide
PDA
when is surgical ligation indicated for PDA
- left to right shunting
- left sided volume overload
- reversible pulmonary arterial HTN
CBC w schistocytes 2/2 microangiopathic hemolytic anemia
Pulmonic stenosis
When obstruction is severe, increased pressure can cause a R-to-L shunt (Eisenmenger Syndrome) to occur at the atrial level through a PFO
this is for pulmonary stenosis but i think this (eisenmenger syndrome) can happen with alot of things!!
why are PGEs given?
to keep the PDA open during any critical problems during which blood will not get to the lungs such as:
systolic ejection murmur increasing with inspiration and opening click louder w expiration
pulmonary stenosis
when is RV lift found on palpation of the precordium
pulmonic stenosis
dilation of the main and left pulm arteries on CXR
Pulm stenosis
EKG shows RVH
pulmonic stenosis
tx w percutaneous balloon valvuloplasty
pulmonary stenosis
aortic stenosis
this is common in females with turners syndrome
coarctation of the aorta
what other cardiac abnormality often appears alongside coarctation of the aorta
bicuspid aortic valve
what leads to hypoperfusion of the kidneys and therefore secondary hypertension
coarctation of the aorta (deceased blood to lower extremities, increased blood to upper extremities)
increases risk for berry aneurysms and aortic valve dissection
coarctation of the aorta
diamond-shaped systolic murmur with a high pitched decrescendo diastolic murmur
coarctation of the aorta
absent/delayed femoral pulse with lower extremity cyanosis and high BP in upper extremities
coarctation of aorta
diagnostic imaging includes an angiogram
coarctation of the aorta
would also order:
CXR showing 3 sign rib notching
which can use these as tx:
- Resection with end-to-end anastomosis
- subclavian aortoplasty
- Prosthetic patch aortoplasty (rare)
coarctation of the aorta
can also do a balloon angioplasty w stent
Exercise testing is mandatory for these children prior to their participation in athletic activities
coarctation of aorta
Harsh systolic ejection murmur at the upper right sternal border with radiation to the neck. Systolic ejection click at the apex
aortic stenosis
dilation of ascending aorta on CXR
aortic stenosis
Percutaneous balloon valvuloplasty used when
aortic stenosis
pulmonic stenosis
when is the Ross procedure used?
aortic stenosis
i think in sub or supra valvular AS mostly. only in symptomatic pts.
Severe = predisposed to ventricular dysrhythmias and refrain from vigorous activity; avoid all isometric exercise.
but mild has normal O2 and can do exercise as much as they want!
aortic stenosis
what test differentiates cardiac and non cardiac cyanosis
hyperoxia test
PaO2 >250 = no structural cyanotic heart disease
boot shaped heart on CXR
tetralogy of fallot
increased cyanosis of the hands and feet with hot baths, fever, exercise, crying and feeding
tet spell! occurs with TOF
MCC of cyanosis in childhood/infancy
TOF
tx w morphine and bicarbonate and/or what else?
management of tet spell
tx w/
morphine
bicarbonate
phenylephrine
BB
what do you give TOF pts with tet spells to aid in DECREASING dynamic RVOT
BB
Morphine
(phenylephrine given for increasing SVR, bicarb given to decrease PVR)
what do you give TOF pts with tet spells to aid in decreasing PVR
bicarbonate
what do you give TOF pts with tet spells to aid in increase SVR
phenylephrine
these children MUST undergo open heart surgery prior to age 2
TOF
where does the aorta stem off of in D-TGA
the right ventricle!!
PA comes off LV
(backwards from usual)
what is the problem in L-TGA?
correct me if im wrong plz cuz i feel like i dont get this:
the VENTRICLES are switched! like the right ventricle is on the left and the left ventricle is on the right!
risk factors include rubella, alcohol, diabetes, poor nutrition and maternal age of >40 years old
TGA
which TGA is asymptomatic
L-TGA
presents with cyanosis, tachypnea, and acidosis that is UNCHANGED with supplemental oxygen
D-TGA
CXR shows egg on a string with associated lung congestion and cardiomegaly
TGA
ASD/PDA required for post-natal survival in this condition
hypoplastic left heart syndrome
treatment for this condition includes a 3 step surgery occuring at what ages?
hypoplastic left heart syndrome
1st - norwood @ 1-2 weeks
2nd - bidirectional glenn @ 4-6 mo
3rd - fontan @ 2 years
Children who undergo surgical repair can participate in recreational activities but are restricted from competitive and vigorous athletics
hypoplastic left heart syndrome
MC innocent murmur of childhood (what is it and descrive it)
stills murmur
this murmur occurs within the first few days of life and resolves by 1 mo (describe it)
this murmur occurs after age 2 in the right infraclavicular area
this murmur occurs in 30-40% of children in the supraclavicular area
