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Cardiology > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

what are the 2 extra connections in a fetal heart that close after birth

A
  • patent foramen ovale: passage between atria, R to L shunt from high O2 right side to left side
  • ductus arteriosus: connects pulmonary artery to aorta, shunting blood away from the pulmonary bed to the body
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2
Q

Why do the PFO and DA eventually close after birth

A

because L sided pressure is higher than R sided after breathing and systemic vascular resistance increases

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3
Q

What is the time frame in which the PFO and the DA close

A

PFO: within 6 months (due to the loss of R sided pressure)

DA: within 2-3 days (due to L-R pressure change & ecrease in prostaglandins from mom)

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4
Q

Describe some risk factors for CHD

A
  • prematurity
  • family history
  • genetic syndromes
  • maternal factors (DM, HTN, obesity, thyroid, connective tissue, epilepsy, substances)
  • fertility (assisted reproductive therapy)
  • in utero infection (CMV, rubella, etc)
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5
Q

When is a standard OB ultrasound done with cardiac windows

A

18-22 weeks
- evaluates outflow tract and 4 chambers
- not all lesions identifiable
- does not evaluate rhythm or function yet
- can proceed to fetal echo if higher risk of CHD

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6
Q

Describe cyanotic CHD

A

lesions that allow circulation of deoxygenated blood into systemic circulation via intracardiac or extracardiac shunting

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7
Q

Describe ductal-dependent CHD

A

dependent upon a patent ductus arteriosus to supply pulmonary or systemic blood floow or to allow adequate mixing between parallel circulations

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8
Q

Describe critical CHD

A

refers to lesions requiring surgery or catheter based interventions in the 1st year of life

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9
Q

List some acyanotic CHD

A
  • atrial septal defect
  • ventricular septal defect
  • patent ductus arteriosus
  • coarctation of the aorta
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10
Q

List some cyanotic CHD

A
  • truncus arteriosus
  • HLHS
  • tetralogy of fallot
  • total anomalous pulmonary venous return
  • transposition of great vessels
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11
Q

Describe some physical manifestations of hypoperfusion

A
  • cold extremities
  • cyanotic
  • poor cap refill
  • tachy
  • metabolic acidosis
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12
Q

What is ECMO

A

extracorporeal mechanical oxygenation
- pulmonary bipass
- does job of the lungs
- kids waiting for emergent CHD repair can sit on ECMO for days

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13
Q

Describe cardiogenic shock

A

circulatory failure
- tissue hypoxia d/t reduced oxygen delivery and/or increased oxygen consumption or inadequate utilization

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14
Q

Can kids with VSD, ASD, and PDA participate in sports?

A

Yes, with rare exceptions, as long as hemodynamically insignificant

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15
Q

What is the average O2 sat in utero

A

60%

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16
Q

Which CHDs are ductal dependent

A

coarctation of the aorta and transposition of the great vessels

17
Q

Describe the etiology of atrial septal defect

A

Septation between atria fails to close resulting in a L to R shunt

Pathophys depends on location, compliance of ventricles, & size of defect

Oxygenated blood going back into lungs & venous circulation

18
Q

Describe the etiology of patent foramen ovale

A

Transient shunting between R and L atria during times of high R sided pressure (coughing, valsalva, straining)

Normal shunting in fetus but doesn’t spontaneously close as it should

19
Q

Describe the etiology of ventricular septal defect

A

Common, Communication between ventricles (single or multi), shunting L to R

Location class
- peri/membranous
- muscular defects
- outlet defects (subpulmonic)
- inlet defects (AV canal)

20
Q

Describe the etiology of patent ductus arteriosus

A

Fetal vascular connection between main pulmonary artery & aorta that diverts blood away from pulm bed - fails to completely close postnatally

Results in some oxygenated blood leaving LV and going back to lungs, L to R

21
Q

Describe the etiology of coarctation of the aorta

A

Narrowing of descending aorta usually at ductus arteriosus, often assoc with other CHDs

Cardiac output must cross narrow segment to reach lower extremities after birth

Cardiac output increases over time d/t resistance/outflow tract obstruction resulting in LV overload

22
Q

Describe the etiology of truncus arteriosus

A

Blood vessels from heart fail to separate in development (typically see VSD too), resulting in a connection between the aorta and pulmonary artery and mixing of systemic & pulmonary blood flow

23
Q

Describe the etiology of HLHS

A

Diminutive LV and small L side structures incapable of supporting systemic circulation so RV supports

Survival depends on PDA to maintain systemic circulation and ASD to allow adequate mixing of oxygenated and deoxygenated blood

24
Q

Describe the etiology of tetralogy of fallot

A

10% of all CHD, most common cyanotic CHD

During development the septum deviates:
1. VSD
2. Overriding aortic root
3. R ventricular outflow tract obstruction
4. RV hypertrophy

25
Q

Describe the etiology of total anomalous pulmonary venous return

A

Failure of pulm veins to join normally to L atrium during development, leading to veins abnormally emptying into R atrium via drainage into a systemic vein

Equal oxygenation across all chambers of heart

Must have ASD or PFO to survive

26
Q

Describe the etiology of transposition of the great vessels

A

20% of all cyanotic defects

Aorta arises from R ventricle & pulm artery arises from L ventricle (opposite) - systemic & pulmonary circulations are parallel circuits
- deO2 blood drains appropriately into R atrium & pumped from RV back to systemic circulation
- O2 blood returns to L atrium & LV & recirculated to lungs

27
Q

What does a CXR show for tetralogy of fallot

A

boot shaped heart

28
Q

What does a CXR show for coarctation of the aorta

A

rib notching and figure 3 sign

29
Q

What is notable about the murmur for coarctation of the aorta

A

it radiates to the back (L subscap area)

30
Q

What is this

A

patent foramen ovale

31
Q

What is this

A

ventricular septal defect

32
Q

What is this

A

patent ductus arteriosus

33
Q

What is this

A

truncus arteriosis

34
Q

what is this

A

HLHS

35
Q

What is this

A

tetralogy of fallot

36
Q

what is this

A

total anomalous pulmonary venous return

37
Q

what is this

A

transposition of the great vessels

Cardiology (15 decks)

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