Congenital heart defects

Question 1

patent ductus arteriosus (PDA)

Answer 1

• blood flows from higher pressure aorta to newly lowered pulmoary artery, L>R shunt
• increased pulmonary flow, congestion, increased workload on LV
• SS: machinery-like murmur, widened pulse pressure, bounding pulses
• TX: indomethacin(prostaglandin inhibitor), surgical, cardiac cath, coils to occlude

Question 2

Atrial Septal Defect

Answer 2

• L>R shunt
• SS: murmur, can be asymptomatic, primarily fatigue or HF, atrial arryhthmias + emboli formation
• TX: open closure with patch or sture, cardiac cath -septal occluder

Question 3

Ventricular Septal Defect

Answer 3

• L>R shunt (high to low pressure)
• spontaneous closure on 30-40% cases - 1st yr of life
• SS: murmur , HF
• TX: surgical , open closure with patch or sture. cardiac cath (only high risk)

Question 4

Atrioventricular Septal Defect (Endocardial Cushion Defect)

Answer 4

Systolic pulmonary flow murmur

Question 5

Pulmonary Stenosis

Answer 5

• narrowing of valve, RV hypertrophy can lead to RV failure, decrease amount of blood going to lung
• SS: murmur, mild-severe cyanosis, cardiomegaly
• TX: transventricular pulmoic valvotomy, cardiac cath (balloon angioplasty tp dilate)

Question 6

Aortic Stenosis

Answer 6

• narrowing of aortic valve, hypertrophy LV leads to pulmonary vascular HTN/edema- not enough room for blood
• SS: murmur, exercise intolerance, chest pain, poor feeding, may cause HoTN w/ weak pulses
• TX: aortic valvotomy, cardiac cath (balloon angioplasty)

Question 7

Coarctation of Aorta

Answer 7

• narrowing of aorta near ductus arteriosus, increase stress in heart
• increase pressures, bounding pulses in head/arms and decreased pressures with weak/absent pulses in LEs
• SS: murmur, HTN, big diff in pressure between UEs and LEs, HF (infants)
• TX: mon+ control BP w/ antihypertensives, cardiac cath (angioplasty), surgical (resection, subclavian flap)

Question 8

causes of CHD

Answer 8

• exposure to toxins
• rubella during pregnancy
• maternal DM
• maternal alcohol
• chromosomal abnormalities

Question 9

cardio assessment

Answer 9

• heart sounds, rhythm (murmurs)
• peripheral/central pulses
• BP in all 4 extremeties
• respiratory effort, lung sounds
• Hx of weight gain (fluid overload?)
• skin color , temp, clubbing

Question 10

cardiac catheterization

Answer 10

• pre: assess, teaching, sedation
• post: assess pulses, temp, color of affected extremity, VS +BP, dressing, response to sedation meds
• bleeding: apply direct pressure above site
• bedrest for 4-6 hr
• caution: cath can occlude brachial or femoral pulses , watch for bleeding

Question 11

transition from fetal to postnatal circulation

Answer 11

• closure of foramen ovale, ductus arteriosus, and ductus venosus
• increased pressures: LA & LV, aorta & systemic vascular resistance
• decreased pressures main and peripheral pulmonary vessels (pulm vas. resistance
• increased pO2
• decreased pCO2 , decrease in circulating prostaglandins, decrease in acidosis

Question 12

Child Digoxin admin

Answer 12

• xml 2x/day-morning and evening (months-yrs)
• dig helps heart pump more effectively, improving circulation, and normal elimination of body fluid
• give 20-30 min before feeding
• measure with syringe only
• put few drops in child’s mouth , then let swallow , then give more
• forget to give single dose? give when you remember
• if child vomits, do not repeat dose, resume dig next dosage time
• if miss or child vomits 2x in a row/ call cardio department
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