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Apex Review > Congenital heart disease > Flashcards

Congenital heart disease Flashcards

1
Q

What is the organ of respiration in the fetus?

A

the placenta

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2
Q

How is the circulation arranged in the fetus?

A

parallel (adults is in series)

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3
Q

Describe SVR and PVR in the fetus?

A

SVR- low
PVR- high

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4
Q

What kind of shunting occurs in the fetus?

A

right-to-left shunting across the foramen ovale and ductus arteriosus

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5
Q

Describe the umbilical vein and artery of the fetus.

A

one umbilical vein that carries oxygenated blood from the mother to the fetus
two umbilical arteries that carry deoxygenated blood from the fetus to the mother

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6
Q

The fetal circulation is ________ dependent

A

shunt

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7
Q

Shunts in the fetus are

A

beneficial in utero but can be problematic during extrauterine life

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8
Q

___________ shunts blood from the right atrium to the left atrium bypassing the lungs

A

foramen ovale

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9
Q

__________ shunts blood from the umbilical vein to the IVC bypassing the liver)

A

ductus venous

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10
Q

________________ shunts blood from the pulmonary artery to the aorta (bypassing lungs)

A

ductus arteriosus

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11
Q

What is pulmonary blood flow like in the fetus?

A

minimal

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12
Q

A ductus arteriosus that remains open produces a

A

systolic and diastolic murmur

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13
Q

Describe what happens in the lungs with the first breath.

A

lung expansion–> increased PaO2 and decreased PaCO2–> decreased PVR

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14
Q

What leads to an increased SVR for the neonate.

A

the placenta separates from the uterine wall (or cord clamp)

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15
Q

What occurs with a decreased PVR and increased SVR for the neonate?

A

LA pressure> RA pressure–> the flap valve of the foramen ovale closes

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16
Q

What causes closure of the ductus arteriosus?

A

decreased circulating PGE1 (released from the placenta)
decreased PVR–> reversal of blood flow through the ductus arteriosus–> exposes the DA to increased PO2

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17
Q

When does the foramen ovale close?

A

3 days

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18
Q

What leads to closure of the foramen ovale?

A

LAP>RAP (umbilical cord clamping–> increased SVR)

19
Q

A patent foramen ovale leads to the risk of

A

paradoxical embolism (the embolus travels to the brain instead of the lungs)

20
Q

When does the ductus arteriosus close?

A

several weeks via fibrosis

21
Q

A patent ductus arteriosus can be closed with

A

indomethacin, a prostaglandin synthase inhibitor

22
Q

A patient ductus arteriosus can be opened with

A

prostaglandin E1 (PGE1)

23
Q

Which conditions increase pulmonary vascular resistance? (select 3)
a. light anesthesia
b. Trendelenburg position
c. alkalosis
d. nitric oxide
e. anemia
f. hypercarbia

A

a. light anesthesia
b. Trendelenburg position
f. hypercarbia

24
Q

Conditions that increase PVR include

A

hypercarbia
hypoxemia
acidosis
atelectasis
Trendelenburg position
hypothermia
vasoconstrictors
light anesthesia
pain

25
Q

_____________ occurs when there is abnormal communication between the pulmonary and systemic circulations.

A

Shunting

26
Q

The size and direction of the shunt are dependent on

A

three factors

27
Q

The following influence the size and direction of the shunt:

A
  1. ratio of the PVR to SVR
  2. pressure gradients between the cardiac chambers or vessels involved
  3. compliances of the cardiac chambers
28
Q

Conditions that decrease PVR include

A

hypocarbia
adequate oxygenation
alkalosis
nitric oxide
hemodilution

29
Q

Conditions that increase SVR include

A

vasoconstrictors, fluid bolus, and increased SNS tone

30
Q

Conditions that decrease SVR include

A

volatile agents
propofol
histamine
hemodilution
sepsis

31
Q

When does a right to left shunt occur?

A

when PVR is greater than SVR

32
Q

When does a left to right shunt occur?

A

when SVR is greater than PVR

33
Q

Which congenital defects are MOST likely to cause hypoxemia? (select 3).
a. tetralogy of Fallot
b. ventricular septal defect
c. patent ductus arteriosus
d. coarctation of the aorta
e. Eisenmenger’s syndrome
f. Ebstein’s anomaly

A

a. tetralogy of Fallot
e. Eisenmenger’s syndrome
f. Ebstein’s anomaly

34
Q

What are the two types of shunts?

A

cyanotic shunt (R to L)
Acyanotic shunt (L to R)

35
Q

Cyanotic shunts include:

A

Five t’s: tetralogy of fallot
transposition of the great arteries
Tricuspid valve abnormality (Ebstein’s anomaly)
truncus arteriosus
total anomalous pulmonary venous connection

36
Q

Acyanotic shunts include:

A

ventricular septal defect
atrial septal defect
patent ductus arteriosus
coarctation of the aorta

37
Q

A right to left shunt is associated with a ____________ inhalation induction and a ___________________ IV induction

A

slower; faster

38
Q

A left to right shunt has ___________________ inhalation induction and _____________________ IV induction

A

negligible effect on the rate of; possibly prolongs the onset of an

39
Q

______________________ is when a left-to-right shunt changes to a right-to-left shunt secondary to pulmonary hypertension

A

Eisenmenger syndrome

40
Q

A right to left shunt leads to

A

decreased pulmonary blood flow
hypoxemia
LV volume overload
LV dysfunction

41
Q

Hemodynamic goals of a right to left shunt include

A

maintain SVR
decrease PVR- hyperoxia, hyperventilation, avoid lung hyperinflation

42
Q

A left to right shunt leads to

A

decreased systemic blood flow- low cardiac output, hypotension
high pulmonary blood flow- pulmonary hypertension, RVH

43
Q

Hemodynamic goals of a left to right shunt include

A

avoid increased SVR
avoid decreased PVR by avoiding alkalosis, hypocapnia, high FiO2, vasodilators

44
Q

Consequences of increased pulmonary blood flow include

A

ventricular hypertrophy
volume overload of both ventricles–> biventricular failure
biventricular failure
decreased lung compliance + increased airway resistance
pulmonary hypertension

Apex Review (224 decks)

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