Congenital Heart Disease Flashcards
What are the four sources of shunting in fetal circulation?
1) placenta
2) ductus venosus (liver)
3) foramen ovale
4) ductus arteriosus
What does the foramen ovale do?
shunts blood from right to left
allows you to take blood directly to brain
What can cause a small head?
transposition of great arteries
oxygenated blood isn’t going to the head since it is getting shunted to the pulmonary veins
What allows blood to bypass lungs?
ductus arteriosus
connects aorta to pulmonary artery
allows oxygenated blood to bypass the lungs
What happens to foramen ovale at birth?
higher LAP shuts it closed
pressure snaps the door shut
What is the foramen ovale?
hole between the left / right side of the heart
What two values drop at birth?
pulmonary resistance and pulmonary pressure
What 2 things close the ductus arteriosis?
1) PaO2 increases
2) prostaglandin drops
What forms the aorticopulmonary septum?
neural crest cells
What can lead to transposition of great vessels, ToF, etc?
aorticopulmonary septum problems
What is most common form of ASD?
secundum ASD from increased reabsorption of septum
What becomes dilated in ASD?
the atria from increased volume
What side of heart will become hypertrophied in ASD?
right-side due to the left to right shunt
What is a key PE finding of coarctation of aorta?
difference in LE and UE blood pressure
What is commonly associated with coarctation of aorta?
bicuspid aortic valve
If you hear a murmur in the back, what does this point to?
the aorta
Is coarctation of aorta a pressure or volume lesion?
a pressure lesion due to increased afterload needed
can lead to LVH
What causes coarctation of aorta?
problem with ductal arteriosus closure which causes a kink
When does ductal arteriosus normally close?
5-7 days after birth
What happens to aortic flow in coarctation of aorta?
continuous flow in diastole since you can’t get blood through
What would you do if you have critical CHF with coarctation of aorta?
try to keep the DA open through prostaglandin use
What are the 5Ts of cyanosis?
Truncus arteriosus
Transposition
Tricuspid atresia
Tetralogy of fallot
Total anomalous pulmonary venous return (TAPVR)
What type of shunts cause cyanosis?
right to left shunts
oxygen poor blood isn’t flowing back to lungs, is flowing the rest of the body
Concave MPA segment indicates …
tetralogy of Fallot
Where is aorta in tetralogy of Fallot?
sitting overtop of ventricular septum
What makes murmur worse in ToF?
more pulmonary stenosis
Why does agitation worsen ToF?
increased HR means less filling time and less preload
even less oxygenated blood to go through systemic circulation
What does cyanosis mean?
deoxygenated blood is going to aorta (blue blood) rather than the lungs
What does knee to chest do in ToF?
increased preload
What else can you do to break exacerbation of ToF?
decrease HR
give phenyleprine (increase preload without increasing HR)
Why can you not give supplemental O2 in ToF?
blood isn’t ever going to lungs to get oxygenated
oxygen will not travel into systemic circulation
How does TGA present?
small head
normal besides cyanosis at birth
What happens in TGA?
right ventricle pumps into the aorta which circulates deoxygenated blood into system
left ventricle pumps into pulmonary vein and oxygenated blood just circles around lungs
How can you fix TGA?
tear a hole in the atrial septum to allow more mixing of oxygenated and deoxygenated blood
made ASD / PFO
can also use prostaglandins to help for a little
