Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology 2 > Clin Med - Congenital Heart Disease > Flashcards

Clin Med - Congenital Heart Disease Flashcards

1
Q

What is patent ductus arteriosus? (PDA)

A

Blood flowing from aorta to pulmonary artery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What keeps PDA open?

A

Prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What closes PDA?

A

A prostaglandin inhibitor (indomethacin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What triggers the closure of PDA?

A

Highly oxygenated blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who is at risk for non-closure?

A

High altitude births and premature babies at risk for non-closure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When do normal PDAs close?

A

Small PDA normal for 24-48h after birth

  • 20% closed @ 24h
  • 80% closed @ 48h
  • 100% closed @ 96h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What neonates are at greater risk?

A

neonates whose mother contracted Rubella in 1st Trimester are at greater risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PDA in adults

A
  • Very Rare
  • Typically Asymptomatic till middle age (most are small and well tolerated)
  • Again, think about Right Sided Congestive Heart Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PDA Physical Exam & Murmur

A
  • Widened Pulse Pressure
  • Bounding Peripheral Pulses
  • Continuous, Machine-like murmur over Pulmonic area (Left Upper Sternal Border)
  • -A Thrill is COMMON
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should you refer PDA?

A

All adults with a PDA should be referred to a cardiologist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is VSD?

A

Ventricular Septal Defect - the MOST COMMON congenital heart defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What kind of shunting is VSD?

A

Left to right shunt.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What co-morbidity is VSD associated with?

A

Down’s Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Size of VSD

A

Small defects are louder. The smaller the VSD, the louder the murmur.

Small VSDs are typically asymptomatic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Term for acyanotic turning cyanotic

A

Eisenmenger physiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Eisenmenger physiology?

A

Often associated with Large VSD and Long standing VSD and ASD (even PDA).

Pulmonary HTN causes the pulmonary resistance to exceed that of the systemic resistance and left-to-right shunts are reversed causing cyanosis in typically acyanotic defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ventricular Septal Defect : Murmur

A
  • Classic Murmur: Pan/Holo systolic, harsh, vibratory murmur at Left Lower Sternal Border (LLSB)
  • Increases with squatting and hand grip.
18
Q

Ventricular Septal Defect : Imagining

A

ECHO IS DIAGNOSTIC

19
Q

Ventricular Septal Defect : Treatment

A
  • Control the Congestive Heart Failure with diuretics and digoxin
  • Surgery if infant has growth failure, medications not working, or impending pulmonary hypertension
20
Q

VSD: When to Refer

A

All patients with a VSD should be referred to a cardiologist to determine need for long term follow up and surgical intervention

21
Q

Key to Coarctation of Aorta

A

PULSES!! You HAVE to palpate the brachial and femoral pulses at each Well Child Check.

*Co. of A. will have weak femoral pulses

22
Q

When should you begin taking a child’s BP?

A

At and after 3y.o.

Co. of A. should be suspected in young patients with elevated blood pressure

23
Q

Co. of A. : Physical Exam Findings

A
  • BP of Upper extremities is GREATER than that of the lower extremities. (Lower BP can be normal or low)
  • Weak Femoral Pulse
  • Look for signs of Left Sided Congestive Heart Failure (rales/crackles, cough, fatigue)
24
Q

What are the 4 components to tetralogy of fallot?

A

4 components

  • Overriding Aorta
  • Pulmonary Stenosis
  • Ventricular Septal Defect (VSD)
  • Right Ventricular Hypertrophy
25
Q

Significance of tetralogy of fallot

A

Most COMMON CYANOTIC CONGENITAL HEART DEFECT

Right-to-Left Shunt

26
Q

X-ray findings tetralogy of fallot

A

“Boot-Shaped” heart

27
Q

Tetralogy of Fallot Hx

A
  • H/o Blue Spells (Tet Spells) & -Dyspnea
  • Crying
  • Feeding
  • Relieved by assuming a squatting position
28
Q

When to refer a murmur to pediatric cardiologist:

A
  • Greater than Level III
  • Diastolic (NEVER GOOD)
  • Worsens with Standing
29
Q

What kind of ECHO?

A

TEE vs TTE

TEE: looks a the back of the heart, so mitral valve disease and endocarditis

30
Q

What moms are more likely to have child with congenital heart disease?

A

Gestational Diabetic Moms

31
Q

When would you not want to give indomethacin?

A

Transposition of Great Vessels - you want the PDA open.

32
Q

What type of shunting is atrial septal defect (ASD)?

A

Left to Right Shunt due to greater pressure gradient from the system circulation on the Left Side.

33
Q

Atrial Septal Defect – Children

A

ASD will typically closes spontaneously during the first year of life.

  • Typically asymptomatic
  • May have mild fatigue
  • Frequent Respiratory Infections
34
Q

Symptomatic ASD

A

Requires surgical correction.

  • Evidence of Right Ventricular Hypertrophy
  • Signs of Right Sided Congestive Heart Failure (CHF)
  • Exercise intolerance (easily fatigued)
35
Q

Atrial Septal Defect - Adults

A
  • In 25% of adults, the foramen ovale remains patent.
  • Can cause paradoxic emboli and subsequently cerebrovasular events (consider this in your deferential when a pt is <55 and has had a stroke)
  • Typically asymptomatic till their 30s or 40s [be mindful of signs of Right Sided Congestive Heart Failure (CHF) due to Pulmonary Hypertension (HTN)]
  • Symptomatic = Surgical Correction
36
Q

ASD Diagnostic Heart sounds & Murmur

A

-Wide Fixed Split S2
-Systolic ejection murmur in pulmonic area (Left Upper Sternal Border)
-Mid-Diastolic Rumble at the Lower Left Sternal Border
(due to added flow over tricuspid valve)

37
Q

ASD Labs and Imaging

A
  • EKG could show Right Ventricular Hypertrophy
  • ECHO IS DIAGNOSTIC and will reveal the left-to-right shunt of oxygenated blood btw atria as well as, Right Ventricular Hypertrophy (RVH) and Right sided volume overload *get TransThoracic Echocardiagram (TTE)
38
Q

ASD Treatment

A

Unless very small, ASD’s should undergo surgical repair.

Surgical Repair is an absolute if there are any signs of Right Sided over load.

  • Pulmonary HTN
  • Exercise Intolerance
  • Right Ventricular Hypertrophy (RVH)
  • Pedal Edema due to Congestive Heart Failure (CHF)
39
Q

ASD When to Refer?

A
  • At initial discovery on TTE, to investigate any other structural abnormalities of the heart.
  • Symptomatic patients
  • Pt <55 y.o. with an apparent paradoxic embolic event and an ASD
40
Q

Fetal circulation

A
  1. Umbilical VV drains high oxygen blood via ductus venous to IVC.
  2. The IVC drains to RA –> LA via foramen ovale.
  3. The SVC drains low oxygen blood to the RA, making the RA mixed oxygen blood.
  4. RA –> RV –> pulmonary trunk –> lungs, but some of the blood is shunted via ductus arteriosus to the aorta.
  5. Blood in the aorta mixes with blood from the LV and goes to internal iliac AA and tissues.
  6. The umbilical AA sends blood back to the placenta.
41
Q

Neonate circulation

A

Circulation resembles that of an adult after the baby is born.

  1. IVC –> RA –> RV –> pulmonary trunk [ductus arteriosus is no longer present] –> lungs
  2. lungs –> pulmonary veins –> LA –> LV –> aorta –> tissues

Cardiology 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions