Congenital Heart Defects

Question 1

When should the ductus arteriosum close by?

Answer 1

by the 4th day of life

Question 2

risk factors for congenital heart defects

Answer 2

maternal rubella, maternal ETOH, maternal over 40y, maternal DM1, sibling with congenital heart defect, parent CHD, chromosomal aberration, non cardiac congenital abnormality

Question 3

right to left shunt

Answer 3

blood from the right side of the heart enters the left

Question 4

right to left shunt signs

Answer 4

hypoxia, cyanosis and increased viscosity

Question 5

left to right shunt

Answer 5

blood flow from high pressure left side enters low pressure right side

Question 6

left to right shunt signs

Answer 6

tachypnea, dyspnea, pulmonary edema, pulmonary hypertension

Question 7

Symptoms of pulmonary HTN

Answer 7

tachycardia, tachypnea, S3 and S4, dyspnea, diaphoresis, easily fatigued, difficulty eating, enlarged spleen, enlarged liver

Question 8

types of acyanotic defects with increased pulmonary blood flow

Answer 8

ASD, VSD, PDA, AVC

Question 9

types of acyanotic defects with obstruction to the blood flow from ventricles

Answer 9

coarctation of aorta, aortic stenosis, pulmonic stenosis

Question 10

types of cyanotic defects with decreased pulmonary blood flow

Answer 10

metrology of fallot, tricuspid atresia

Question 11

types of cyanotic defects with mixed blood flow

Answer 11

transportation of great arteries, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome

Question 12

atrial septal defect

Answer 12

abnormal opening between the right and left atriums

Question 13

atrial septal defect clinical manifestations

Answer 13

asymptomatic, CHF symptoms, murmur and atrial dysrhythmias

Question 14

treatment options for atrial septal defect

Answer 14

surgical-dacron patch or nonsurgical-closure treatment in cardiac cath

Question 15

Ventricular septal defect

Answer 15

abnormal opening between the left and right ventricles

Question 16

types of ventricular septal defects

Answer 16

membranous and muscular

Question 17

clinical manifestations of ventricular septal defect

Answer 17

CHF, murmur, bacterial endocarditis, eisenmenger syndrom

Question 18

treatment of ventricular septal defects

Answer 18

surgical-palliative or complete repair, nonsurgical- closure with cardiac cath

Question 19

patent ductus arteriosus

Answer 19

failure of the ductus arteriosus to close all the way after the first weeks of life

Question 20

What type of shunt is a patent ductus arteriosus

Answer 20

left to right

Question 21

alteration of blood flow in patent ductus arteriosus patients

Answer 21

increased workload on the left side of the heart, increased pulmonary vascular congestion and resistance, potential increase in right ventricular pressure and hypertrophy

Question 22

signs of alteration of blood flow in patent ductus arteriosus patients

Answer 22

there would be higher BP in the head and low BP in the lower extremities

Question 23

clinical manifestations of patent ductus arteriosus

Answer 23

asymptomatic, CHF symptoms, machinery like murmur, widened pulse pressure and bounding pulse

Question 24

Coarctation of the Aorta

Answer 24

narrowing of the aortic arch near the insertion of the ductus arteriosus

Question 25

what pressures result from coarctation of the aorta

Answer 25

increased pressure proximal to narrowing and decreased pressure distal to the narrowing; this produces an obstruction of blood flow through the aorta causing increased left ventricular pressure and workload

Question 26

clinical manifestations of coarctation of the aorta

Answer 26

increased BP, bounding pulses in arms but weak pulses in the legs, cool lower extremities, severe acidotic, hypotensive, dizziness, faintness, headache

Question 27

Tetrology of Fallot (four main defects)

Answer 27

pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Question 28

what happens to the blood flow in tetrology of fallot

Answer 28

When the RV contracts there is resistance of the blood r/t pulmonary stenosis. The blood is shunted across the VSD into the aorta and LV giving persistent arterial unsaturation and cyanosis

Question 29

clinical manifestations of teratology of fallot

Answer 29

cyanosis, clubbing, systolic murmur, delayed growth and development, hypoxia, tet spells, squatting

Question 30

patients with teratology of fallot are at risk for…

Answer 30

emboli, brain abscess, seizures, loss of consciousness, sudden death

Question 31

treatment of teratology of fallot

Answer 31

surgical repair within one year of life

Question 32

TGA and TGV

Answer 32

the pulmonary artery leaves the left ventricle and aorta exits the right ventricle with no communication between systematic and pulmonary circulations

Question 33

treatment of TGA and TGV

Answer 33

IV prostaglandin E1

Question 34

when a child has a heart defect, what complication can arise from being dehydrated

Answer 34

stroke

Question 35

meds for heart defects

Answer 35

Digoxin, Ace inhibitors, Diuretics

Question 36

Kawasaki Disease

Answer 36

an infectious or possibly toxic trigger that initiate t=an immune response that effects medium sized arteries by thickening and scarring the vascular wall

Question 37

Acute stage of Kawasaki (10 to 14 days)

Answer 37

faver, bacterial non-purulent conjunctivitis, strawberry tongue, swelling of hands and feet with erythema of palms and soles, generalized erythematous rash, enlarged cervical lymph nodes, tachycardia and irritability

Question 38

Subacute stage of kawasaki (15 to 25 days)

Answer 38

fever gone, anorexia, irritability, desquamation of fingers and toes, arthritis, arthralgia, cardiovascular symptoms

Question 39

Convalescent Stage of Kawasaki (26 days till ESR returns to normal)

Answer 39

deep beau lines on nails, all other symptoms disappear unless irreversible complications occur

Question 40

Treatment of Kawasaki

Answer 40

IVIG and anti-pyretic therapy, aspirin therapy, corticosteroids