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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
When to repair partial AVSD
18-24mos
26
Problems associated w/ partial AVSD
Subaortic stenosis | Left AV valve regurg
27
PDA murmur
Continuous mechanical murmur-hyperdynamic precordium (heard during systole & diastole) Can be heard in the back
28
Sxs of PDA
Cardiomegaly Wet lungs Bounding pulses
29
PDA closure
- Indomethacin/Ibuprofen - Catheter - Surgical (left thoracotomy)
30
What keeps the ductus arteriosus open
Prostaglandins (PGIs)
31
Stills (innocent) murmur
LSB musical/vibratory | not heard in the back, decreases w/ exp/standing.
32
Etiology of innocent murmur
Physiologic peripheral pulmonic stenosis
33
Where is innocent murmur best heard
Axilla bilaterally
34
Classification of cyanotic CHF
Right to left shunt * Intra-cardiac defect/obstruction of pulmonary blood flow * Admixture of pulmonary and systemic venous return
35
Is obstructive blood flow self correcting
No
36
Physical exam finding of cyanotic CHD
Cyanosis, bounding/absent/delayed arterial pulse, split S2 / fixed split
37
how much deoxygenated Hgb makes you look cyanotic
5mg/dl
38
When can't you tell if a child is cyanotic
Anemia (check upper and lower extremities)
39
Tetralogy of fallot
Combination of heart defects that cause obstruction
40
Xtics of tetralogy of fallot
- RV obstruction (valvar/supravalvar stenosis) - VSD - Overriding aorta (straddles septum + blocks RV) - RV hypertrophy
41
Tet spell
hyper-cyanotic event due to muscle spasm
42
Factors that precipitate Tet spell
- Crying - Dehydration - Anesthesia
43
How to fix tet spell
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
Truncus arteriosus
Failure of truncus to separate into aorta and pulm artery
45
Classification of truncus arteriosus
Right to left shunt Large VSD Excessive pulmonary blood flow +/- cyanosis
46
Genetic association of truncus
22q11 deletion (DiGeorge) in 25%
47
When to do closure of VSD
Within first 2wks
48
TAPVR
Pulm veins not getting back to LV
49
Classification of TAPVR
- Supracardiac (vertical vein to innominate vein) - Cardiac (to coronary sinus, fix in first 6mo) - Infracardiac (obstructed, drains into liver via descending vein)
50
Sxs of infra cardiac TA PVR
``` Very sick with wet lungs, cyanotic, pulm HTN EMERGENT Repair (Rule out using ECHO) ```
51
Coarctation of aorta
Juxtaductal overgrowth of tissue that closes the ductus EMERGENT!! (babies=little/no perfusion of legs, kids=blood supply to legs but weak pulse)
52
What do you give for coarctation
PGIs
53
Most common defect associated with Coarctation of aorta
Turner's syndrome
54
Coarctation murmur
Systolic, LUSB
55
presentation of coarctation
Neonates: Extremis-Emergent Infants: Irritability, tachypnea, poor feeding, FTT, CHFs Decreased/absent femoral pulses Teens: HA, nose bleed, diminished femoral pulses, unexplained HTN
56
Diagnostic studies for coarctation
ECG: LV hypertrophy CXR: Cardiomegaly, rib notching (yrs) ECHO: Difficult to visualize CT Angio/MRA-Gold std
57
Coarctation mgt
Surgical (left thoracotomy) | Stent recurrences

Peds (11 decks)

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