Congenital Heart Conditions Flashcards
What type of shunt results in absent cyanosis?
Left to Right
What are 3 Left to Right Shunts?
3D’s
- ASD
- VSD
- PDA
Do Left to Right shunts typically present at birth?
NO – not causing cyanosis
What is a potential late complication of Left to Right shunts?
Eisenmenger Syndrome
= Increased blood flow to the lungs results in pulmonary HTN and eventually causes reversal of the shunt to Right to Left shunt
What is often heard with an ASD?
Wide and Fixed split S2
With both ASD’s and VSD’s what type of diastolic sound can be heard?
Mid-diastolic rumbles
What part of the heart may be enlarged with ASD’s?
Right atrial enlargement
Right ventricular hypertrophy
What is the treatment for most ASD’s and VSD’s?
NOTHING
– often close spontaneously
– surgery if severe symptoms are occurring
What is the most common type of congenital heart condition?
VSD
What is unique about the sound of the VSD?
The size of the VSD is inversely proportional to the intensity of the murmur
– Smaller VSDs = LOUDER murmurs
What is often heard with a VSD?
Harsh HOLOsystolic murmur at the lower left sternal border
What part of the heart is often enlarged with VSD’s?
Left ventricular hypertrophy
+/- Right ventricular hypertrophy
What does the PDA (patent ductus arteriosus) connect?
Aorta sends blood to Pulmonary A.
When should the PDA close?
First few days of life
If the PDA does not close, what type of murmur is often heard?
Continuous machinery like murmur at left 2nd ICS
If the PDA does not close, what type of murmur is often heard?
Continuous machinery like murmur at the left 2nd ICS
What are 2 other features that can be seen with PDA?
Wide pulse pressure
Bounding peripheral pulses
What is the pneumonic to remember what the treatment is for a PDA?
Come IN and CLOSE the door
What is the treatment in order to close the PDA?
Indomethacin (NSAID)
If you want to keep the PDA open what should be given?
Prostaglandin E1
Where is the aorta most often constricted with coarctation of the aorta?
Distal to the left subclavian artery
What 2 things are often present with coarctation of the aorta?
Bicuspid aortic valve
Turner Syndrome
With coarctation of the aorta and many other right to left shunt heart conditions, what is essential to survival?
PDA or a septal defect
What is the main sign of Coarctation of the aorta?
UE HTN or uneven blood pressures between arms
Besides UE HTN, what are 3 other signs of Coarctation of the aorta?
- Weak femoral pulses
- LE claudication
- Radiofemoral delay
What are 2 items that can be seen on CXR with coarctation of the aorta? Why?
- Rib notching
- 3 sign
=> Formation of collateral circulation
If a patient is cyanotic with a heart condition, what type of shunt is present?
Right to Left
How can you tell if a baby is cyanotic due to a heart condition or lung condition with supplemental oxygen?
Heart conditions hypoxemia will NOT correct with supplemental oxygen whereas lung conditions will
What is a Breath Holding Spell?
Emotional trigger for a child causes loss of consciousness or cyanosis
- Will resolve with time; benign condition
List 5 Right to Left shunts
- Truncus Arteriosus
- Transposition of great vessels
- Tricuspid Atresia
- Tetralogy of Fallot
- Total anomalous pulmonary venous return
What is the setup with Transposition of the great vessels?
Aorta connects to the RV and the Pulmonary A. connects to the LV
– BLOOD NEVER MIXES
Transposition of the Great Vessels is not compatible with life unless?
A septal defect is present
Will there be a murmur with Transposition of the Great Vessels?
Not unless there is a septal defect present
What will the heart look like on CXR with Transposition of Great vessels?
Egg shaped heart with a narrow base
What are 2 risk factors for development of Tetralogy of Fallot?
Maternal PKU
DiGeorge Syndrome
What are the 4 things present with Tetralogy of Fallot?
- Pulmonary stenosis
- RV hypertrophy
- Overriding aorta
- VSD
What are the 4 things present with Tetralogy of Fallot?
- Pulmonary stenosis
- RV hypertrophy
- Overriding aorta
- VSD
What defect with Tetralogy of Fallot is the Right to Left shunt
VSD
The cyanosis will develop over the first 2 years of life with Tetralogy of Fallot along with?
Dyspnea and fatiguability
Why may a child squat with Tet spells?
Squatting relieves the hypoxemia by increasing systemic vasculature pressure and forces blood into the lungs
What will the heart look like on CXR with Tetralogy of Fallot?
Boot shaped heart
What is Total Anomalous Pulmonary Return?
Right heart –> Lungs –> Right heart
With a majority of the Right to Left shunt heart conditions what should be given before surgery can be done?
PGE1 to keep the PDA open
What does uncontrolled maternal diabetes cause to the heart?
Transient Hypertrophic Cardiomyopathy
If a child has a thickened interventricular septum due to maternal diabetes, what is the treatment?
Nothing – will regress
