Congenital Cardiac Disease Flashcards
How does the heart develop in the embryo at the 2 week mark?
heart develops from 2 simple epithelial tubes
How does the heart develop in the embryo at the 3 week mark?
two simple epithelial tubes fuse to form a single chambered heart
- heart elongates and bends on itself
- endo, myo and epicardium differentiate
- heart begins to beat
How does the heart develop in the embryo at the 4 week mark?
primitive heart, atrial segment assumes cranial position
How does the heart develop in the embryo at the 5 week mark?
endocardial cushions grow towards each other and fuse
How does the heart develop in the embryo at the 8 week mark?
partitioning into 4 chambered heart complete
What are the two openings that connect the left and right side of the heart in the embryonic stage?
ductus arterious and foramen ovale
True or False: Blood flows from the heart to the lungs in the embryonic heart in order to oxygenate the developing lungs
False-blood is shunted from the heart to the lungs for the most part and blood is pushed through the ductus arterious, this is done to protect the developing lungs
How does the fetus recieve oxygenated blood?
from the mother via placenta and travels back via the umbilical vein
When do the ductus arterious and foramen ovale usually close?
foramen ovale-a few days after birth
ductus arterious-within hours after birth
What are the common acyanotic defects of CHD?
Atrial Septal Defect
Patent Ductus Arteriosum
Ventricular Septal Defect
What is the difference between acyanotic and cyanotic defects?
Acyanotic is the absence of cyanosis which means it does not affect oxygen levels in the body
Cyanotic defects mean there is mixing of oxygenated and non-oxygenated blood, which leads to cyanosis
What are common cyanotic defects of CHD?
- transposition of the great vessels
- pulmonary valve atresia
- tetralogy of fllot
- hypoplastic left heart syndrome
- shone’s syndrome
- TAVPR
- coarctation of the aorta
What type of shunt does patent ductus arteriosum (PDA) create?
What is the clinical presentation of PDA?
left to right shunt (aorta to pulmonary artery) which creates high pressure in the pulmonary artery and may need surgical intervention
infant might fatigue quickly, susceptible to pneumonia
What type of shunt do atrial septal defects cause?
left to right shunt which creates volume overload to the right heart and results in pulmonary vasculature damage, this may result in right heart failure and cause a shortened life span
What is the most common congenital heart defect?
What type of shunt does this defect create?
What happens if pressures in the right ventricle become too high?
Ventral Septal Defects
Left to Right shunt
blood can shunt right to left which is a condition called Eisenmenger’s syndrome (a cyanotic problem)
What is coarctation of the aorta?
pinching of the aorta which may be due to abnormal involution of ductus arteriosus
What is Tricuspid Atresia?
What type of shunt does it create?
when tricuspid valve fails to develop which leads to limited blood flow from RA to RV, leading to an underdeveloped RV
right to left shunt
What is pulmonary valve atresia?
pulmonary valve fails to develop which means no exit from the right ventricle and blood gets regurgitated into the left atrium via the foramen ovale
requires intervention soon after birth
What four defects form tetralogy of fallot?
What are the signs of this defect?
- Ventricular Septal Defect (VSD)
- Pulmonary Valve Stenosis
- Overriding Aorta (usually lies over VSD)
- RV hypertrophy
blueness appears soon after birth, in infancy or childhood and infants might have sudden episodes of cyanosis or unconsciousness
What is transposition of the great vessels?
positions of pulmonary artery and aorta reversed which means deoxygenated blood from RV goes into systemic circuit and O2 from blood goes back into the lung
child only survives if AS, VSD, or PDA present
What is hydroplastic left heart syndrome?
failure or inadequate development of the left ventricle (variable aortic and mitral involvement)
- child is dependent upon a PDA for systemic perfusion
- without intervention, HLHS is fatal within the first weeks of life
What is the Norwood procedure?
When is it usually performed?
surgeons create a new aorta and connect it to the right ventricle, a shunt is then placed from either the aorta or righ ventricle to the pulmonary arteries making the heart a “single ventricle” capable of pumping mixed blood to lungs and periphery
first 2 weeks of life
What is the bi-directional glenn shunt procedure?
When is it usually performed?
creates a direct connection between the pulmonary artery and the superior vena cava which allow direct return of venous blood to lungs from the UEs, right ventricle still pumps mixed blood but this procedure reduces it’s work
4-6 months of age
What is the fontan procedure?
continuation of bi-directional glenn shunt procedure where the inferior vena cava is also attached to the pulmonary arteries, venous blood now completely bypasses the right side of the heart
once this procedure is complete oxygen rich and oxygen poor blood no longer mix in the heart and the infant’s skin will be cyanotic and the child may still need a heart transplant
What are the PT considerations when working with children who have CHD?
- labored breathing and increased RR
- Impaired tolerance to activity
- Irritable (Track Using NIPS scale)
- Post Op: prevent complications and educate the family
- early mobilization
- Positioning: prone->side lying->supine for ventilation/perfusion matching
- some pts. may need guidance away from competitive sports
