Congenital Heart Disease Flashcards
What is the prevalence of congenital heart defects?
5-8 per 1,000 live births
___ are more likely to have severe cardiac defects.
Boys
What are two big risk factors for congenital heart disease?
Maternal diabetes and having a first-degree relative with a congenital heart disease
What are the first and second most common congenital heart defects?
1st = VSD; 2nd = PDA
The ductus arteriosus is held open with __________.
prostaglandins
PDA severity depends on ____________.
diameter of the opening, pressure difference between the aorta and the pulmonary artery, and the difference in resistance
What are some symptoms of PDA?
Pulmonary edema, congestive heart failure, feeding intolerance (occasional bowel ischemia), renal insufficiency, pneumonia, diaphoresis, and stroke
Presenting signs of PDA include _______.
bounding pulse, increased work of breathing, machine-like murmur along the left upper sternal border, and wide pulse pressure
There are two holes and two septa that develop throughout embryology: ___________.
the ostium primum is divided by the septum primum, and the ostium secundum is divided by the septum secundum
The septum secundum develops on the ______ side of the septum.
right
________ type of ASD is most common.
Secundum
Secundum ASDs form from too large an _______ or too small a _______.
ostium secundum; septum secundum
Why don’t ASDs present immediately after birth?
The pulmonary resistance is higher in utero, so there isn’t as much of a difference between the right and left sides of the heart. Once the child grows, the pulmonary resistance lowers and the shunt begins.
The ______ ventricle is more compliant.
right
The most common type of VSD is __________.
perimembranous VSD
In VSDs, louder murmurs can indicate __________.
closure of the opening
In VSD, murmurs that go away can indicate ____________.
equalization of pressure–a bad thing
ECGs of those with VSD can show ___________.
hypertrophy and/or right axis deviation
What is the tetrology of Fallot?
(1) VSD; (2) aorta sitting directly over the VSD; (3) right ventricular hypertrophy; (4) right ventricular outflow tract obstruction
In tetrology of Fallot, what is RV outflow tract obstruction?
It is narrowing of the infundibulum of the pulmonary artery, leading to decreased pulmonary blood flow
Right-to-left shunts in tetralogy of Fallot result from __________.
higher resistance in the pulmonary artery
Tet spells, which are uncommon, are thought to arise from ___________.
vasospasm of the pulmonary artery
What is the typical presentation of TOF?
Blue baby with loud murmur
Any unrepaired cyanotic heart disease can lead to ____________.
cerebral abscesses
What does squatting do, in TOF?
It increases systemic vascular resistance.
Hypertension is rare in children. As such, if a child has hypertension, think of two things: ____________.
coarctation of the aorta and kidney problems
Why should you check femoral pulses in young children?
To detect coarctation of the aorta
With large PDAs, the __________ can be enlarged on X-ray.
left atrium and left ventricle
In symptomatic PDA in a neonate, first give ___________.
cyclo-oxygenase inhibitors (IV indomethacin or IV ibuprofen)–but only after waiting until 48 hours after birth
In symptomatic PDA in an older child, treat with ____________.
percutaneous occlusion
Untreated PDA can result in two worrisome syndromes: ____________.
Eisenmenger’s and endocarditis
In terms of murmurs, ASD often presents with ____________.
systolic ejection murmurs in the pulmonic valve and diastolic rumble in the tricuspid valve from too much blood flow as well as delayed P2 from too much blood
On X-ray and echo, ASD presents with ___________.
enlarged pulmonary artery
In ASD, _______ are sometimes given to treat fluid overload.
diuretics
Those with __________ can also have hepatomegaly.
ASD
Radiographically, VSD presents with ____________.
cardiomegaly, enlargement of the pulmonary arteries, and excessive pulmonary vascularization
To treat the symptoms of congestive heart failure in VSD, give __________.
digoxin and ACE inhibitors
What murmur is associated with large VSDs?
blowing holosystolic at LLSB
