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Neo Pathophys 2 > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

Name the presenting sings of Heart Disease in Neonates (5)

A
  1. Cyanosis
  2. Shock
  3. Congestive Heart Failure
  4. Murmurs
  5. Arrhythmias
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2
Q

What fraction of Cyanotic CHD are found on U/S?

A

2/3

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3
Q

Name the clues to Cyanotic CHD

A
  1. Cyanosis w/normal lung exam, without RDS PCO2 is normal or low (w/compensation) but low SpO2’s
  2. Unresponsive to Oxygen (PO2 <150 on 100% FiO2)
  3. Murmurs (often present)
  4. Abnormal heart on CXR
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4
Q

What is the best site for a blood gas to evaluate for Cyanotic CHD?

A

Right wrist–Preductal

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5
Q

What are high-risk situations of Cyanotic CHD? hint-same as for any CHD at all

A

Chromosomal abnormalities
Multiple congenital anomalies
IDM’s
Family Hx of CHD

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6
Q

What is the % of CHD if a sibling has CHD?

A

3-4%

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7
Q

What is the % of CHD if a parent has CHD?

A

5-10%

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8
Q

What Cyanotic CHD is it?

An x-ray describes:
Cardiothoracic ratio >0.6
Large, Boot-shaped heart, Apex tipped up
Decreased lung vascularity
Missing main pulmonary artery marking
A

Tetrology of Fallot

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9
Q

Where does the least oxygenated blood flow back to the heart from?

A

Head

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10
Q

What is often the first clue of a cyanotic CHD?

Is it responsive to giving O2?

Why or why not?

A

Cyanotic baby w/low SpO2’s

No

Some of the blue blood going back to the body is going out through the Aorta. Nothing you do to the lungs will help this.

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11
Q

Can you have absolutely normal PO2’s with Cyanotic CHD?

A

No

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12
Q

Is saturation a sensitive measure?

Why or why not?

A

No

W/Hgb F can have PO2 of 50 and Saturations high 90’s.

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13
Q

In lecture what PO2 level is used to determine a cyanotic lesion?
What can it depend on?

A

Can’t get PO2 >150 Torr (not perfect system)

Depends on degree of pulmonary blood flow

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14
Q

Can you get a venous stick to get a blood gas to detect cyanotic heart dz?

A

No, Must be Arterial (preferably right wrist)

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15
Q

Is a murmur definitive of cyanotic heart Dz?

A

No, not all w/Cyanotic CHD have murmurs and not all w/murmurs have Cyanotic CHD

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16
Q

In a TOF heart, why is the apex tipped up on CXR?

A

There’s a thick R heart and the Diaphragmatic surface of the heart is the R Ventricle

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17
Q

What diagnostic test can pick up CHD better than in-utero U/S?

A

Fetal Echocardiogram

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18
Q

Describe Fetal circulation starting with oxygenated blood from the placenta.

A

Placenta–>Umb. Vein–>Ductus Venosus & IVC–>R. Atrium (via FO)–>L. Atrium–>Mitral Valve–>L. Ventricle–>Aortic Artery–>Aortic Arch to head/coronary A’s or Descending Aorta to body–>Deox. blood from head via SVC–>R. Atrium–>Tri valve–>R. Ventricle–>Pulmonary Artery–>(almost all through) Ductus Arteriosis–>lower body via Descending aorta–>most to placenta via Umb. Arteries

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19
Q

What 2 organs require the most oxygeated blood in-Utero and post-natally?

Where does it come from?

A
  1. Coronary Arteries
  2. Head

Supplied by blood from LV/Aortic Artery

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20
Q

How much oxygenated blood flows across the Aortic Isthmus down the descending Aorta?

A

~10%

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21
Q

Where is the least oxygenated blood in the fetus?

A

That coming back from the upper body–it extracts the most oxygen.

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22
Q

What is his rudimentary definition of Cyanotic CHD?

A

Blue blood somehow comes from the Vena Cava through the Aorta & Red blood comes back (in the absence of lung dz, normal pulmonary venous saturation-close to 100%)

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23
Q

Why don’t you get much effect from supplemental oxygen in babies w/cyantoic CHD?

A

The cyanotic blood is going to the systemic circulation, not pulmonary–so in the absence of lung dz, extra O2 won’t affect their cyanosis.

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24
Q

In order for blue blood o get out to the Aorta, there needs to be what?

Is this sufficient to create cyanotic CHD?

A

A site of mixing

No–depends on the flow-most L–>R shunts don’t create cyanosis

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25
Q

What is required for Cyanotic CHD?

A

Something that makes it hard for systemic venous blood to go to the lungs

  • Rt side obstruction
  • Unfavorable streaming
  • Complete mixing with decreased pulmonary flow
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26
Q

What is the ultimate condition of Unfavorable streaming of blood?

A

Transposition of the Great Vessels/Arteries

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27
Q

Name the Right-sided obstructive lesions (5).

A
  1. Tricuspid Atresia
  2. Ebstein’s Anomaly
  3. Tetrology of Fallot
  4. Pulmonary Atresia
  5. Pulmonic Stenosis w/Atrial shunting
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28
Q

Name the 3 complete mixing lesions w/decreased pulmonary blood flow.

A
  1. Atresia of any valve
  2. Single ventricle
  3. TAPVR
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29
Q

What does Atresia mean?

A

Complete absence of a connection

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30
Q

True/False:

Babies are designed to allow R–>L shunting?

A

True, via FO

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31
Q

With Tricuspid Atresia, all PULMONARY blood must cross either of what 2 things?

A

VSD

PDA

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32
Q

What is the tx for babies w/Tricuspid Atresia?

A

Palliation

Treated like a single ventricle defect, can’t fix it.

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33
Q

With Tricuspid Atresia with PDA, there will be more/less blood going out to the lungs?

Would baby be more/less symptomatic w/PDA?

A

More

Less

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34
Q

Obstruction at the Tricuspid valve makes it easier/more difficult for blue blood to get to the lungs?

A

More Difficult

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35
Q

Ebstein’s Anomaly causes the blood to do what at the Tricuspid valve?

A

Leak

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36
Q

What is Ebstein’s anomaly?

A

Anomaly of the Tricuspid valve. It fails to delaminate from the RV endocardium.

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37
Q

Ebstein’s is a/w _______ regurgitation & ____ sided Atrial enlargement

A

Tricuspid

Right

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38
Q

What type of shunt is there w/Ebstein’s?

A

Right–>Left Atrial

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39
Q

Tricuspid regurgitation may do what to forward flow of blood?

A

Impair forward flow

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40
Q

True/False: w/Ebstein’s there’s “Atrialized” Right ventricular tissue?

A

True

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41
Q

True/False: TOF is a very common form of cyanotic heart disease?

A

True

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42
Q

TOF is mixing at what level?

Why?

A

Mixing at the Ventricular level

Wall between Lt & Rt Ventricular outflow tract is underdeveloped and it get’s pulled over to the Rt

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43
Q

TOF consists of 4 things, what are they?

A
  1. Obstruction of the pulmonary outflow tract
  2. Over-riding Aorta
  3. VSD
  4. R.V. hypertrophy
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44
Q

True/False: w/TOF, there can be several levels of obstruction of blood flow to lungs?

A

True

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45
Q

True/False: With many types of Cyanotic heart disease, Opening the Ductus Arteriosus is a good thing to do, even when you don’t know what the cause is.

How?

A

True

Prostaglandins, PGE1

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46
Q

Pulmonary Atresia w/Intact Ventricular Septum is a mild/extreme form of TOF.

A

True, but it can also be w/o an intact ventricular septum

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47
Q

What are the only 2 places blood can go once in the Rt Ventricle with Pulmonary Atresia with intact Ventricular Septum?

What can sometimes happen w/this D/O?

A

Backward across the Tricuspid valve or backward flow in to the veins that normally drain from coronary arteries to RV (coronary sinusoids)

MI (d/t lack of blood flow to septum of the heart)

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48
Q

In Pulmonary Atresia w/Intact V Septum, all systemic venous flow must cross what?

Pulmonary blood flow arises mainly from?

Eventually will need what done?

If they can have a Balloon Pulmonary Valvuloplasty, this allows what?

A

Atrial Septal Defect

Ductus Arteriosus (sometimes will stent it open)
Single ventricle palliation, Blallock-Taussig shunt

Right ventricle to develop normally

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49
Q

What is Critical Pulmonic Stenosis?

If Pulmonic stenosis is only mild, what might you have?

What kind of shunt?

Is often responsive to what?

A

Obstruction to pulmonary outflow at pulmonary valve

Only a murmur

R–>L across PFO

Balloon Valvuloplasty

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50
Q

There are 2 parallel circuit circulations in what anomaly?

A

Transposition of the Great Arteries

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51
Q

With transposition of the great arteries, you must have what?

A

Some form of communication (many are Atrial) but also need a PDA; otherwise they die
**must have a way to get blue and red blood to mix

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52
Q

With transposition, to get mixing you must have what kind of flow?

Is this an efficient form of blood flow?

A

Bi-directional flow

No

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53
Q

If you have to have a single site of mixing, which site is better, Atria (PFO) or Ductus Arteriosus?

A

Atrial shunt (PFO)

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54
Q

If a baby needs a PFO to allow mixing, what is the name of the procedure used to create it?

A

Balloon Atrial Septostomy

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55
Q

What 3 things determine the Arterial oxygen Saturation (SaO2)?

A
  1. How blue is the blue blood? (systemic venous saturation)
  2. How red is the red blood? (pulmonary venous saturation)
  3. How much is mixed?
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56
Q

In a complete mixing lesion with more Pulmonic flow versus Systemic flow there would be a higher/lower SaO2?

A

Lower

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57
Q

In a complete mixing lesion with more Systemic versus Pulmonic flow, there would be higher/lower SaO2?

A

Higher

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58
Q

With a complete mixing lesion and opening the ductus, you may see a baby go from profound cyanosis to no visual cyanosis.

A

True

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59
Q

If you have a lesion with unfavorable streaming (from TGA) or Rt-sided obstructive lesion, what will help the pulmonary flow of the baby?

A

Open the DA

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60
Q

What happens to the pulmonary venous connection with TAPVR?

A

The Pulmonary veins that should come back to the L Atrium, did not form that connection.

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61
Q

What happens to circulation in TAPVR?

A

Persistent fetal circulation (fetal connections of pulmonary veins to SVC or IVC persist).

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62
Q

There are 2 forms of TAPVR what are they? Which one is a surgical emergency?

A 
Supracardiac TAPVR
Infracardiac TAPVR (this one is emergent d/t flow of blood-can't get blood into or out of the lungs)
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63
Q

Supracardiac TAPVR is classified as what type of lesion?

A

Nearly complete mixing lesion. All blue and red blood comes back to R. Atrium

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64
Q

True/False, with supracardiac TAPVR, the only blood to the L. Atria is that from the R.A. across the PFO.

A

True

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65
Q

With what 2 cardiac lesions is it possible to have post-ductal saturations higher than pre-ductal?

A

Supracardiac TAPVR

Transposition of the Great Arteries

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66
Q

With Supracardiac TAPVR, most of the red blood travels where?

Most of the blue blood travels where?

If there’s a PDA, some of the red blood can travel where creating possibility of higher post-ductal saturations than pre-ductal?

A

SVC–>R.A.–>tricuspid valve–>R.V.

IVC–>R.A.–>PFO–>L.V.

To the descending Aorta

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67
Q

With TAPVR if the pulmonary veins are obstructed, there’s what?

If the pulmonary veins are unobstructed, there’s what?

A 
Pulmonary Edema (lungs white-out)
Decreased Pulmonary flow

Increased Pulmonary flow
Little Cyanosis
Congestive Heart Failure

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68
Q

True/False: In Infracardiac TAPVR is almost always a complete mixing lesion.

A

True, surgical emergency

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69
Q

In Tricuspid Atresia, when the DA closes, what happens?

What procedure can be done to help this baby?

A 
Increased cyanosis
(Less blood flow to lungs = less red blood to body)

Blalock-Taussig shunt (subclavian artery to pulmonary artery shunt to get some blood to lungs)

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70
Q

What shunt was the first one done to help babies w/CCHD?

A

Blalock-Taussig shunt

subclavian artery to pulm artery

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71
Q

True/False: We have good treatments for almost all forms of CHD.

What are some exceptions?

How long can single ventricle palliations last?

A

True

Single ventricle anomalies (no way to make a ventricle) i.e. Tricuspid Atresia
Decades

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72
Q

What is the goal of blood flow w/single ventricle anomaly?

Could you put in a Blalock-Taussig shunt at birth?

Why?

A

Get the venous return to go directly to the lungs.

No (can do bi-directional Glenn at 4 mos)

PVR is very high just after birth

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73
Q

What happens w/Bi-Directional Glenn?

A
  1. Blalock-Taussig shunt is disected.
  2. SVC is connected directly to Rt. Pulmonary artery (passive flow)
  3. Ligation, Dissection, or Banding of Pulmonary Artery off R.Ventricle
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74
Q

Can a Fontan procedure be done right away?

A

No, at age 2-3 y/o that creates a conduit from IVC to SVC (allows blue blood from IVC out directly to lungs)

75
Q

What is a Fontan?

A

A connection done at 2-3 y/o

76
Q

If you only have 1 ventricle, the goal of that blood flow is what?

A

Get blood to the systemic circulation

a connection can be surgically made to get blood to the lungs

77
Q

What can be done for complete repair of TOF?

A
  1. Resection of valvular pulmonic stenosis area (no valve)
  2. Patch closure of VSD
  3. Patch augmentation of RV outflow tract (Pulm Artery)
78
Q

What may be needed later in life in someone who has had a complete TOF repair?

A

A Pulmonary valve replacement

79
Q

What were the first operations done for TGA?

A

Mustard or Senning operation

baffling blue blood inside the R. atrium and directed it to L. A. toward mitral valve–>lungs

80
Q

What is the down-side of the Mustard or Senning operation?

A

R.V. has to do L.V. pumping workload

but people can live into 30’s with these procedures

81
Q

What is the current option for TGA?
When is this done?

Down side of this procedure?

A

Arterial Switch procedure (w/closure of ASD/VSD if present)
Done at ~ 1 wk of age

Have to move the coronary arteries

82
Q

What is shock?

A

Inadequate Systemic Perfusion

83
Q

What is a late sign of shock?

A

Hypotension

84
Q

True/False: Hypertension can be seen early in shock.

A

True

85
Q

Shock can be difficult to detect, what is the best tool to recognize it?

A

Experienced bedside RN

86
Q

What types of neonatal Heart dz can present with Shock?

A 
Left-sided Obstructive lesions
Sustained Tachycardia (SVT or Ventricular)
Profound Bradycardia
87
Q

Name Left-sided obstructive lesions

A

Coarctation, Critical Aortic Stenosis, Hypoplastic Left Heart Syndrome

88
Q

Is shock instantaneous w/SVT?

A

No, ~48 hrs

89
Q

With Left-sided obstructive lesions is the baby blue?

Will they have low saturations?

How do you know they have perfusion issues?

A

No

No

Low U.O. (low CO), Cap refill, Periph pulses

90
Q

The CCHD test is designed to detect what lesion?

Is it perfect?

A

Coarctation of the Aorta

No

91
Q

Where does Coarctation occur usually?

A

Adjacent to the Ductus (Juxtaductal)

92
Q

Are babies w/Coarctation usually ok in the normal nursery?

A

Yes (due to Ductus)

93
Q

When the ductus closes, which side closes first?

A

The Pulmonary Artery end

functional closure–first 24-48 hrs

94
Q

When do babies w/Coarctation get into “trouble”?

Why?

A

Couple weeks of age

PDA finishes closing on Aortic Arterial side (Anatomic closure) and it becomes more difficult for the blood to get around the Coarct “shelf” ( the little diverticulum into the aorta)

95
Q

What happens to blood flow with coarctation?

A

Less flow to descending Aorta–>Very high Afterload–>Decreases C.O.–>L. Ventricle can’t squeeze well–>Increased pressure on L. Atrium–>Pulmonary Edema & Decreased Perfusion to lower part of body (low U.O., increased edema, Renal failure)

96
Q

Think about what lesion in every baby?

Do what at every opportunity?

A

Coarctation

Feel the Femoral vs. Brachial pulses

97
Q

Do what if a baby comes back in w/Jaundice, Sepsis, Feeding difficulties?

A

Feel the Femoral Pulses, R/O Coarctation. It can be tough to pick up.

98
Q

Are there good results from tx/repair of Coarctation?

A

Yes, very good results

99
Q

With any baby in Shock, Assume they have what until proven otherwise?

A

Coarctation of the Aorta

-Many more babies die of Coarctation than Septic Shock

100
Q

True/False: with Coarctation, there’s always a discrepancy of b/p from upper to lower extremities.

A

False, this time is fleeting

L.V. just can’t pump very well and eventually just have bad pulses everywhere

101
Q

True/False: You can use the DA to maintain either Pulmonary or Aortic blood flow.

A

True. It can be used w/Coarct

102
Q

What would you do 1st in baby w/Coartation?

What would you do 2nd?

A

Intubate (take away their WOB)

Start PGE ASAP

103
Q

With Critical Aortic Stenosis are the saturations typcially normal?

How is this tx’d?

A

No
Is Ductal dependent, likely fail CCHD

PGE, balloon or surgical valvotomy, Norwood

104
Q

Which babies likely fail CCHD?

A

Critical Aortic Stenosis

105
Q

Hypoplastic Left Heart Syndrome is really the extreme form of?

A

Aortic Stenosis

106
Q

What is often present with HLHS?

A

Aortic Atresia or Stenosis

Mitral Atresia or Stenosis

107
Q

Which side is dependent upon to be the pumping chamber of the heart for the body with HLHS?

A

The Right Ventricle

108
Q

Do babies w/HLHS have pulmonary edema?

Decreased systemic flow?

Are they ducal dependent?

A

Yes

Yes

Yes

109
Q

Are most HLHS diagnosed prenatally?

A

Yes, most of the time.

110
Q

What tx is there for HLHS?

A

PGE
Norwood
Transplant
Comfort Care

111
Q

True/False: when the DA closes in a baby with HLHS, there will be increased pulmonary edema.

A

True

112
Q

Babies w/HLHS are typically what color.

Why?

A

Grey (not blue)

D/t low C.O.

113
Q

Why is a PDA necessary w/HLHS?

A

Depending blood flow from Ductus through Aorta for systemic blood flow —O2 sats may actually increase w/open DA

114
Q

In what cardiac lesion do you need to be very judicious with O2 use?

Why?

A

HLHS

O2 is a very potent pulmonary vasodilator–> easier for blood to go to lungs–>R.V. may not be able to increase the output enough

115
Q

What is the ratio aim for Pulmonary to Systemic blood flow in a baby with a complete mixing lesion?

A

1:1

116
Q

If you have a baby w/HLHS with saturations in the 90’s, is this good or bad?

What is the cause?

A

Bad, want 75-85%

It is caused by increased pulmonary blood flow.

117
Q

The tx of HLHS is to create a reliable connection from R.V. to the Aorta by first the Norwood, then the Glenn, lastly the Fontan. What is the Norwood Procedure?

A

Norwood Procedure:

  1. Anastamose proximal Pulmonary Artery to Ascending Aorta
  2. Enlarge Aortic Arch, dissect ductal tissue
  3. Shunt from Aorta to Distal Pulmonary Artery
  4. Enlarge ASD
  5. Mixing with controlled pulmonary flow
118
Q

With HLHS when going from Norwood to Glenn, what does this do?

A

Creates bi-directional flow (connects SVC to Pulm Artery, & they get rid of Arterial shunt)

119
Q

With HLHS what does the ultimate Fontan procedure do?

A

Allows the blue blood from the lower extremities go directly to the lungs

120
Q

What is CHF?

A

Failure of the Heart to Pump Adequately

121
Q

Some of the signs of CHF overlap with what signs? Plus?

A

Signs of Shock
+Sweating w/feeds
Enlarged Liver
Increased Respiratory Effort

122
Q

What lesions can cause CHF?

A

Large L–>R shunts (ASD, VSD, Truncus, Single Ventricle w/o Pulmonary Stenosis)
Left-Sided obstructive lesions
Cardiomyopathy
Longstanding Tachycardia/Bradycardia

123
Q

With a small VSD you will hear?

A

Harsh, High-Pitched Holosystolic Murmur

124
Q

Will you always hear a murmur with a Large VSD?

Why?

A

No

Less Turbulence

125
Q

With a VSD, Is it typical to have signs of CHF before 6 wks?

Why/why not?

A

No

see when PVR falls

126
Q

Would you be more likely to have CHF with a large or small VSD?

A

Large

127
Q

With VSD, A Diastolic Rumble heard at the Apex is better heard with Bell or Diaphragm?
Caused from?

A

Bell–easiest to hear when you press down first, then let up on the pressure

Turbulence across Mitral valve

128
Q

Do muscular VSD’s get smaller?

A

Yes

129
Q

What is an Atriovetricular Septal Defect?

A

A hole in the middle of the heart/septum both Atrially and Vetricularly

130
Q

What babies have increased relative risk of Atrioventricular Septal Defects?

A

Babies w/Down Syndrome

131
Q

With Atrioventricular Septal Defect, what kind of shunt do they have L-R or R-L?

A

L–>R

132
Q

About how many babies w/Down Syndrome have CHD?

In Down Syndrome is AVSD more or less common than VSD?

A

50%

Less

133
Q

Is Truncus Arteriosus a Cyanotic Lesion?

A

No, Almost never

134
Q

What is Truncus Arteriosus?

A

A single Artery Valve that forms, giving rise to both the Pulmonary Artery and the Aorta.

Usually the blood goes to the correct Artery though.

135
Q

Typically Truncus is R->L or L->R lesion?

A

L->R

136
Q

Is there much cyanosis with truncus?

A

Almost never/minimal–sats near normal (90’s)

137
Q

What is the major problem with Truncus?

A

Increased Pulmonary blood flow (both systole and diastole)
Decreased blood to coronary sinuses (easier for blood to go to pulm artery vs coronary arteries) ->MI, Ischemia & sudden death

138
Q

When is repair of Truncus usually done?

A

Before Discharge

139
Q

In repair of Truncus, the truncal valve stays connected to which ventricle?

A

LV (a conduit is connected RV to distal pulmonary artery)

140
Q

W/single ventricle, if you have increased pulmonary blood flow w/o obstruction, you can have same physiology as what other lesion?

A

Large VSD/AVSD

141
Q

What is the big problem w/single ventricle?

A

Excessive Pulmonary blood flow

142
Q

What % of kids will have a mumur at some time?

A

80%

143
Q

Murmurs are usually what?

May indicate what?

A

Benign

Structural Heart Dz

144
Q

What grade murmur indicates an abnormaltiy of the heart?

A

3-6/6

145
Q

What is the best part of your hand to feel a thrill?

A

The base of the fingers near the palms, feels like a cat purring.

146
Q

“Innocent” murmurs are also called what?

What kinds are there?

A

Functional or Normal

  • Peripheral Pulmonic Stenosis Murmur (most common)
  • Pulmonary flow murmur (esp anemia of prematurity)
  • Transitional murmur
147
Q

An innocent murmur is a systolic/diastolic murmur?

Grade?

A

Systolic

Grade less than 4/6 (no thrill)

148
Q

Where is a PPS murmur best heard?

What population has increased PPS murmurs?

A

Axillae (equally) & back (crescendo-decrescendo murmur)

Preemies–usually gone by 6 mos

149
Q

What is a PPS murmur caused from?

A

Turbulence of flow at the Pulmonary Arteries

150
Q

Where is a Pulmonary flow murmur heard?

A

Upper Left Sternal Border

151
Q

What is a transitional murmur caused from? (2 types)

A
  1. Closing PDA (can hear it into Diastole)

2. Transient Tricuspid Regurigation

152
Q

Where would you hear a transitional murmur from PDA?

A 
Upper Left Sternal Boarder
Systolic or continuous
Louder as PDA gets smaller
Occasionally Vibratory
Typically heard 12-48 hrs of age
153
Q

Where would you hear a transitional murmur from Transient Tricuspid Regurgitation?

A

Lower Left Sternal Border
Regurgitant, systolic (blowing, holosystolic)
Heard in Asphyxiated or those w/PPHN
Resolves over several days

154
Q

What murmurs need evaluation?

A

Loud
Diatolic
Don’t fit into innocent murmur caetgory
Those w/other signs of CHD (Shock, CHF, Cyanosis)

155
Q

What CHD presents as an Asymptomatic Murmur?

A

Septal Defects
Outflow Tract Obstruction
PDA

156
Q

Where would you hear Aortic stenosis?

A
  • Systolic, ejection
  • Upper Right Sternal Border, Radiating to neck
  • Systolic ejection click at apex (valvular sound)
  • May have thrill in Suprasternal Notch
157
Q

Babies w/anemia of prematurity often have what kind of murmur?

A

Pumonary flow murmurs

158
Q

When babies are first born, RV and LV pressures are what?

Will you hear a VSD in the first day or so?

A

The same

No-it will increase as PVR falls. If it is large, may not have much turbulence->not much murmur heard

159
Q

If a baby has a large VSD, they will have what signs?

A

Increased LA pressure
Increased pulmonary edema
Increased WOB
Poor growth

160
Q

The murmur with an ASD is a/w pulmonary flow. Do you hear an Atrial murmur?

Is CHF seen with an ASD?

A

No, because the Atrial flow is low pressure.

No, not generally

161
Q

Which Neonatal Arrhythmias are of concern?

A
  1. Too fast
  2. Too Slow
  3. Too Irregular (could become too fast or too slow)
162
Q

Name the 3 Tahcyarrhytmias

A
  1. Sinus tachy
  2. Supraventricular tachy
  3. Ventricular tachy
163
Q

What will you see with sinus tachy?

A
  1. Narrow QRS
  2. P waves visible
  3. Rate <230
  4. Gradual onset and termination
  5. A/W underlying cause (fever, hypovolemia)
164
Q

How do you tx sinus tachy?

A

Tx underlying cause (fever, fluids, etc)

165
Q

What would you see w/SVT?

A
  1. Narrow QRS
  2. P waves burried in T wave
  3. Rate >240, monotonous
  4. Sudden onset and termination
  5. Often result of re-entry
166
Q

What is the most common form of SVT?

A

Wolff-Parkinson-White syndrome
-An accessory connection allowing conduction to go SA down the AV node or down the accessory conduction site-interfering w/normal rhythm causing pre-excitation

167
Q

What do you do if a baby is in shock and has SVT?

A

Shock w/0.25-1 Joules/Kg
Synchronized DC cardioversion
Very unusual to need to do

168
Q

If hemodynamically stable in SVT, what should you get before, during and after termination?

A

ECG

169
Q

What are the usual tx’s of acute SVT?

A

Valsalva (ice to face)

Adenosine

170
Q

Adenosine causes what?

A

Transient AV block

Slows Sinus Node

171
Q

Adenosine has an extremely short/long duration of action

A

Short

172
Q

True/False: RBC’s rapidly break down Adenosine.

A

True-so don’t pull blood back into med syringe.

173
Q

Does Adenosine work on Atrial Flutter?

Accessory Connection-Mediated tachycardia?

A

No

Yes

174
Q

Ventricular tachy has what signs?

A

Wide QRS (maybe only slightly)
AV dissociation in VT
Underlying cause

175
Q

If needing to synchronize DC cardiovert, what must be done after every shock?

A

Re-synchronize after every shock

176
Q

In sinus bradycardia, what is slow?

A

Both atrial and ventricular rate

177
Q

in AV block what is slow?

A

Ventricular rate is slower than Atrial

178
Q

Sinus bradycardia is almost always what?

A

Vagally mediated

179
Q

Besides vagal maneuvers, how can Sinus bradycardia be tx’d?

A

Atropine
Isoproterenol
Pacing

180
Q

What is the Etiology of AV block?

A 
Congenital
Surgical
Infectious
Vagal
Drugs
181
Q

How do you tx Acute AV block?

A

Tx underlying cause
Drugs (Atropine, Isoproterenol)
Pacing

182
Q

PAC’s are very ________ & very ______

A

Normal & benign
normal QRS, P waves present (may be in T wave)
May be blocked or conducted aberrantly

183
Q

Are PVC’s common?
Are they normal?
What do they look like?
What are they from?

A

Yes
Yes
Wide QRS, no P-wave, may not be a pulse from PVC
Metabolic, Drugs, Mechanical stim (CVP cath inventricle), idopathic

Neo Pathophys 2 (20 decks)

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