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PMPR 430 > Congenital Heart Defects > Flashcards

Congenital Heart Defects Flashcards

1
Q

What are the risk factors for acquiring congenital heart defects

A

Mother has diabetes, uses illicit drugs, viral infection, down syndrome

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2
Q

What occurs in fetal circulation up to the right atrium

A

Umbilical arteries to blood to the placenta where it becomes oxygenated, the umbilical veintakes oxygenated blood to ductus venous, ductus venous takes blood to the inferior vena cava, inferior vena cava dumps blood into the right atrium

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3
Q

How are the two weays blood moves in the fetal right atrium

A

Oxygenated blood will move from the right atrium to the left atrium through the foramen ovale then the left atrium will dump to the left ventricle for systemic circulation/ oxygenated blood will move into the right ventricle to pulmonary artery but moves to the aorta through the DUCTUS ARTERIOSUS (due to high pulmonary resistance) connection for systemic circulation

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4
Q

How can heart defects be diagnosed

A

Ultrasounds/echocardiogram, heart mumur, cyanosis, hypotensive extremity, widened pulse pressure

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5
Q

What are the acyanotic heart defects

A

Atrial septic defect (ASD), ventricular septic defect (VSD), endocardial cushion defects (AV canal/AVSD), PATENT DUCTUS ARTERIOSUS (PDA), Coarctation of the aorta (CoA)

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6
Q

What occurs in PDA defect

A

The ductus arteriousus doesn’t close causing oxygenated blood to leave the aorta to the pulmonary vein causing too much blood for the lungs and right side of the heart

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7
Q

How are PDA treated, MOA, what is the last resort

A

Indomethacin OR ibuprofen to close the ductus arteriousus, prostaglandin inhibitors to cause less prostaglandins to keep DA open, surgery

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8
Q

What are the doses for ibuprofen or indomethacin in PDA, side effects

A

Indomethacin: Every 12 hours for 3 doses, Ibuprofen: every 24 hours for 3 doses/ nephrotoxicity, low platelets, GI bleed/perforation

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9
Q

What is Coarctation of the aorta

A

Narrowing of the Aorta causing increased pressure before the narrowing and lower pressure after the narrowing causing different blood pressures at higher extremeties

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10
Q

How is CoA treated, complication, treatment of the complication

A

Surgery, rebound hypertension, beta blocker or ACEi

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11
Q

What are the cyanotic defects

A

Hypoplastic left heart syndrome, tetralogy of Fallot, transposition of the great arteries, Truncus arteriosus

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12
Q

What is hypoplastic left heart syndrome, what defects are present

A

Hypoplastic (under-developed) left heart cannot support systemic circulation, foramen ovale is still open, ductus arterious is needed to stay open for oxgenated blood to get to the aorta

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13
Q

What is given for hypoplastic left heart syndrome, why, administration, side effects

A

Prostaglandin E1, keeps the DA allowing for some oxygenated blood to enter the aorta, continuous IV administration through a large vein or umbilical artery catheter/ apnea, flushing, hypotension, fever (similar to sepsis)

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14
Q

What are the 3 surgeries needed to fix hypoplastic left heart syndrome

A

Norwood procedure (1st week): ligate the DA and place the aorta where the pulmonary artery used to be and add BT shunt to provide pulmonary blood flow from the aortic arc to reach the pulmonary artery/ Hemi-Fontan procedure (4-6 months): reduces the load of the right ventricle by removing the BT shunt and connecting the superior vena cava to the pulmonary artery/ Fontan procedure (two years): connects IVC to same pulmonary artery causing no blood to enter the right atrium allowing for the atrium to only receive oxygenated blood and pump systemically

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15
Q

What is Tetalogy of Fallot, what is given

A

Four seperate defects including: Ventricular septic defect (VSD), overidding aorta, pulmonary stenosis/artesia, Right ventricular hypertrophy/ PGE1 for pulmonary blood flow

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16
Q

What is the surgery for ToF

A

Patch closure of VSD, Patch to enlarge the pulmonary artery, removal of subpulmonary obstructive tissue

17
Q

What is transposition of the great arteries, what drug is given

A

Aorta from the right artrium and the pulmonary artery from the left atrium/ PGE to keep the DA open

18
Q

What is the temporary repair for TGA

A

Balloon atrial septosomy: pull a catheter through the foramen ovale causing permanent opening between the atria allowing for mixing of oxgenated and dexoygenated blood (PE1 no longer required)

19
Q

What is the permanent repair for TGA

A

The two arteries are switched (1st week of life)

20
Q

What is Truncus arteriosus

A

Pulmonary artery and Aorta are connected for one big vessels, gives rise to coronary arteries branch pulmonary arteries and aortic arch, Large VSD along with RV hypertrophy(does not need PE1 because not DA dependant)

21
Q

How is truncus arteriosus repaired, symptoms managed

A

Patch closure of VSD, valved homograft from RV to pulmonary artery/diuretics, digoxin and ACEi

22
Q

How often must homografts be repaired

A

3-6 years and again in adolescence

23
Q

What syndrome occurs in 25% of patients undergoing cardiopulmonary bypass, highest risk, signs and symptoms

A

Low Cardiac Output Syndrome, neonates/ tachycardia, poor peripheral perfusion, oliguria, cardiac arrest

24
Q

What are the treatment options for Low Cardiac Output Syndrome and what is the goal for each treatment

A

Fluid resuscitation: maintain preload and systemic blood pressure
Inotropic agents: support myocardial contractility
Afterload reducing agents: decrease ventricular, enhance cardiac output, and improve perfusion
Extracorpeal membrane oxygenation

25
Q

How is post-op failure treated

A

Acute management same as LCOS unless chronic (ACEi, digoxin and diuretics)

26
Q

What is the most common post op arrhythmia, others

A

Junctional ectopic tachycardia (JET), Suprventricular Tachcharidia (SVT), bradyarrhythmias, ventricular arrhythmias

27
Q

What is the treatment for JET, SVT, bradycardia, ventricular arrhythmias

A

Amiodarone, adenosine, pacing, following PALS algorithim

28
Q

How is adenosine given in SVT, what should be expected, what if ineffective

A

Rapid IV administration followed by rapid NS flush, asytole prior to conversion to normal sinus rhytm/ double dose and repeat to a max single dose of 0.3mg/kg or 12 mg

29
Q

What pateints are most at risk for post-op thrombosis, what is given

A

placement of shunt/ low-dose heparin infusion, asprin, warfarin, enoxaparin

30
Q

What is the goal urine output for renal dysfunction

A

0.5 to 1 ml/kg/hour

31
Q

T/F: To prevent post op infection antibiotics are given prior to a surgical incision and may be continued 24 to 48 hours post operation or until chest tubes are removed

A

True

32
Q

Why should fever be treated agressively for children with heart defects

A

High fevers causes increased oxygen consumption

PMPR 430 (21 decks)

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