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Peds > Congenital defects > Flashcards

Congenital defects Flashcards

1
Q

Acynotic defects

A 
VSD
ASD
Atrioventricular canal
PDA
Coarctation of aorta
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2
Q

Cyanotic defects

A 
5T's
Tetralogy of fallot 
Truncus arteriosus
Transposition
Tricuspid atresia
Total Anomalous pulmonary venous return (TAPVR)
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3
Q

Classification of acyanotic defect

A

Left to right shunt = increased pulmonary blood flow

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4
Q

Sxs of left to right shunt

A
  • Tachypnea
  • Hypertrophy
  • Fluid in the lungs on CXR
  • May see failure to thrive
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5
Q

Most common congenital defect

A

VSD

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6
Q

VSD murmur

A

Holosystolic at LLSB

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7
Q

VSD Physical exam findings

A
  • Failure to thrive
  • Poor growth
  • Tachypnea
  • Hepatomegaly
  • GERD
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8
Q

Most common defect associated w/ VSD

A

Down’s syndrome

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9
Q

What murmer is louder; smaller or larger

A

Smaller (greater resistance to blood flow)

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10
Q

VSD diagnostic studies

A

ECG: LV hypertrophy
CXR: Cardiomegaly
ECHO: Location of defect, size of shunt, pressure gradient, other associated lesions

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11
Q

VSD Mgt

A
  • Diuretics
  • ACE inhibitors (LV unloading)
  • +/- Digoxin
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12
Q

VSD indication for surgery

A
  • Unmanagable heart failure
  • Failure of medical mgt
  • Shunt > 1.5-2
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13
Q

Most common type of ASD

A

Secundum ASD (septum primum and secundum don’t overlap)

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14
Q

ASD murmur

A

Pulmonary flow murmur in 2nd intercostal space (same place as innocent murmur so rule out)

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15
Q

Why is ASD not very symptomatic

A

Not much increase in blood flow (L&R atria about the same size)

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16
Q

Why is there are risk of paradoxical emboli in ASD

A

During valsalva the RA pressure goes high and blood goes the opposite way -> blood/clot cn travel to the brain-take care of before adolescence

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17
Q

What size ASD will close on its own

A
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18
Q

Sxs of ASD

A

usually asymptomatic +/- fatigue, palpitations, exercise intolerance

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19
Q

When does septation of the AV canal happen

A

End of 4th wk

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20
Q

Most common prenatal Dx of CHD

A

AVSD

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21
Q

common defect associated with AVSD

A

Down’s syndrome (not most common)

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22
Q

Complete AVSD

A

large VSD and ASD w/ common AV valve (develop regurg) Pulm HTN

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23
Q

Why should you repair complete AVSD in infancy

A

To prevent pulmonary vascular obstructive disease

24
Q

partial AVSD

A

large ASD, no VSD w/ 2 separate AV valves. Norm pulm pressure

25
Q

When to repair partial AVSD

A

18-24mos

26
Q

Problems associated w/ partial AVSD

A

Subaortic stenosis

Left AV valve regurg

27
Q

PDA murmur

A

Continuous mechanical murmur-hyperdynamic precordium (heard during systole & diastole) Can be heard in the back

28
Q

Sxs of PDA

A

Cardiomegaly
Wet lungs
Bounding pulses

29
Q

PDA closure

A
  • Indomethacin/Ibuprofen
  • Catheter
  • Surgical (left thoracotomy)
30
Q

What keeps the ductus arteriosus open

A

Prostaglandins (PGIs)

31
Q

Stills (innocent) murmur

A

LSB musical/vibratory

not heard in the back, decreases w/ exp/standing.

32
Q

Etiology of innocent murmur

A

Physiologic peripheral pulmonic stenosis

33
Q

Where is innocent murmur best heard

A

Axilla bilaterally

34
Q

Classification of cyanotic CHF

A

Right to left shunt

  • Intra-cardiac defect/obstruction of pulmonary blood flow
  • Admixture of pulmonary and systemic venous return
35
Q

Is obstructive blood flow self correcting

A

No

36
Q

Physical exam finding of cyanotic CHD

A

Cyanosis, bounding/absent/delayed arterial pulse, split S2 / fixed split

37
Q

how much deoxygenated Hgb makes you look cyanotic

A

5mg/dl

38
Q

When can’t you tell if a child is cyanotic

A

Anemia (check upper and lower extremities)

39
Q

Tetralogy of fallot

A

Combination of heart defects that cause obstruction

40
Q

Xtics of tetralogy of fallot

A
  • RV obstruction (valvar/supravalvar stenosis)
  • VSD
  • Overriding aorta (straddles septum + blocks RV)
  • RV hypertrophy
41
Q

Tet spell

A

hyper-cyanotic event due to muscle spasm

42
Q

Factors that precipitate Tet spell

A
  • Crying
  • Dehydration
  • Anesthesia
43
Q

How to fix tet spell

A

Increase resistance on the left side so blood can stay on the right side->pink baby

  • Squatting (push baby’s legs up ton increase venous return)
  • volume resuscition
  • Vasoconstrictors
44
Q

Truncus arteriosus

A

Failure of truncus to separate into aorta and pulm artery

45
Q

Classification of truncus arteriosus

A

Right to left shunt
Large VSD
Excessive pulmonary blood flow +/- cyanosis

46
Q

Genetic association of truncus

A

22q11 deletion (DiGeorge) in 25%

47
Q

When to do closure of VSD

A

Within first 2wks

48
Q

TAPVR

A

Pulm veins not getting back to LV

49
Q

Classification of TAPVR

A
  • Supracardiac (vertical vein to innominate vein)
  • Cardiac (to coronary sinus, fix in first 6mo)
  • Infracardiac (obstructed, drains into liver via descending vein)
50
Q

Sxs of infra cardiac TA PVR

A 
Very sick with wet lungs, cyanotic, pulm HTN
EMERGENT Repair (Rule out using ECHO)
51
Q

Coarctation of aorta

A

Juxtaductal overgrowth of tissue that closes the ductus EMERGENT!! (babies=little/no perfusion of legs, kids=blood supply to legs but weak pulse)

52
Q

What do you give for coarctation

A

PGIs

53
Q

Most common defect associated with Coarctation of aorta

A

Turner’s syndrome

54
Q

Coarctation murmur

A

Systolic, LUSB

55
Q

presentation of coarctation

A

Neonates: Extremis-Emergent
Infants: Irritability, tachypnea, poor feeding, FTT, CHFs
Decreased/absent femoral pulses
Teens: HA, nose bleed, diminished femoral pulses, unexplained HTN

56
Q

Diagnostic studies for coarctation

A

ECG: LV hypertrophy
CXR: Cardiomegaly, rib notching (yrs)
ECHO: Difficult to visualize
CT Angio/MRA-Gold std

57
Q

Coarctation mgt

A

Surgical (left thoracotomy)

Stent recurrences

Peds (11 decks)

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