Congenital Heart Defects Flashcards
______ defects are the most common type of birth defect
Congenital heart defects
cyanotic vs acyanotic congenital heart defects
RT -> LT Shunt
Cyanotic
oxygen-poor blood is pumped through body
Cyanotic vs Acyanotic Congenital Heart Defect
RT <- LT
Acyanotic
blood is oxygenated, there’s just not enough of it
oxygenated blood is cycled through lungs a 2nd time
The 5 Ts of Cyanotic Heart Disease
Truncus Arteriosus
Transportation of the Great Arteries
Tricuspid Atresia
Tetralogy of Fallot
Total Anomalous Pulmonary Return
What?
Truncus Arteriosus
What?
Transposition of the Great Arteries
What?
Tricuspid Atresia
tricuspid valve never formed. Pt will likely have an atrial & ventricular septal defects, which we will try to keep open to buy the pt some time before tricuspid valve Sx. poorly oxygenated blood running through your body is better than no blood.
what?
Tetralogy of Fallot
- Ventricular Septal Defect
- Pulmonic stenosis
- Overriding aorta - the aortic valve is enlarged and seems to open from both ventricles. Aortic valve sits directly on top of the ventricular septal defect
- RT ventricular hypertrophy (more of a result due to the other 3 main causes)
Tricuspid Atresia Repair Options
Fontan procedure connect SVC to pulmonary arteries. Direct route to lungs for oxygenation
“Tet Spells”
Infants/children are agitated for mins-hrs due to cyanosis
Why do pts with heart defects squat after physical activity?
squatting increases systemic vascular resistance -> decreases RT->LT shunt
This is from Dr. V. I’m a lil confused about the shunt explanation. I recall Dr. Ryan just saying it increases resistance to limbs, so more blood is pumped to brain
Tetralogy of fallot murmur
Systolic ejection murmor at LT sternal border due to pulmonic stenosis
What does Tetralogy of Fallot look like on CXR, EKG, and Echo?
CXR: “boot shaped heart” upturned cardiac apex due to RV hypertrophy
EKG: RV enlargement
Echo: VSD, overriding aorta, RV wall hypertrophy
What imaging makes the definitive dx for Tetralogy of Fallot?
Echocardiogram shows VSD, overriding aorta, RV wall hypertrophy
IVS = interventricular septum; VSD = ventricular septal defect; A= Aorta
Cyanotic kid + “boot shaped heart” =
Tetralogy of Fallot
Trmnt for Tetralogy of Fallot
Very symptomatic -> Oxygen, beta-blockers, epi (the key is a lil veinoconstriction), IV fluids
Prostaglandin E1 -> *prevent PDA closure *to help maintain pulmonary blood flow
**Sx closure **(4-12months old)
What is the #1 thing you gotta repair in Tetralogy of Fallot?
PULMONIC STENOSIS
Most common cyanotic heart disease
Tetralogy of Fallot
“Pink” vs “Blue” Tet
Pink = adequate pulmonary blood flow at birth
Blue = restricted pulm blood flow (cyanosis at birth). PDA dependent; give prostaglandin E1 to keep it open
Which genetic syndrome is most commonly associated with Tetralogy of Fallot?
Trisomy 21 (Down Syndrome)
Total Anomalous Pulmonary Venous Return (TAPVR)
What does type 1 Total Anomalous Pulmonary Venous Return (TAPVR) look like on CXR?
Snowman
Blue babies get ____
ECHOS for poss congital heart defect
Are CXRs used to dx congenital heart defects?
NO, just to see issue. Can only Dx with ECHO
After birth, an Atrial Septal Defect is initially a ____ to ____ shunt
cyanotic or acyanotic?
RT <- LT
Acyanotic
Bc LT side of heart is higher pressure than RT (low pressure lungs)
Patent Ductus Arteriosus is defined as failure of DA to close within ___hrs
72
What is Eisenmenger Syndrome and how does it affect ASDs and VSDs?
After birth, flow through the septal defects are acyanotic RT<-LT shunts Bc the pulm circuit is lower pressure than the systemic circuit. Over time you push more blood into pulm circuit and it can get so bad to the point where the pressure is greater in the pulm circuit than in the systemic circuit. Flow through septum flips RT -> LT (cyanotic)
