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Week 8: Heart Murmur > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

When is the critical time for heart development?

A

3-6 weeks

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2
Q

What are some causes of congenital heart defects?

A 
Family history
Prematurity
Genetics
Environment
Multifactorial/Unknown
Alcohol exposure
Infections
Medications
Maternal conditions
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3
Q

What is the most common type of congenital heart defect?

A

VSD

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4
Q

What is the first branch of the aorta?

A

Coronary arteries

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5
Q

What is the common heart defect from Down’s?

A

Atrioventricular septal defect

Gives a common AV valve

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6
Q

Size of appendages in LA vs RA

A 
RA = large appendage
LV = small apppendage
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7
Q

What does

  1. Situs
  2. Solitus
  3. Inversus
  4. Isomerism
A
  1. Position or location in body
  2. Normal
  3. Inversus
  4. Mixed up
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8
Q

4 causes of pump malfunction

A

Muscle of the pump is defective
Inadequate filling of the pump
Too much fluid to pump
Too much resistance to output

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9
Q

Reasons for muscle pump being defective

A

Most common intrinsic muscle disease (myocyte, storage, metabolic)
Abnormal coronary supply (ischemia)

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10
Q

Reasons for pump inadequately filling

A 
Pericardial restriction (fluid or fibrosis)
Muscle restriction
Obstruction of venous return (systemic or pulmonic)
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11
Q

Reasons for too much fluid to pump (excessive preload)

A

Left to right shunt

Regurgitant valve lesions

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12
Q

Reasons for excessive resistance (increased afterload)

A

Left side: could be due to aorta, aortic valve, sub-aortic shelf, left heart
Right side: could be due to pulmonary valve, obstruction

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13
Q

How can a fetal diagnosis be made?

A

Recognized on ultrasound

Allows you to get a good picture of the 4 chambers of the heart as long as fetus is positioned well

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14
Q

3 diagnoses we can make prenatally

A

Heart rate and rhythm block (congenital heart block or tachyarrhythmia)
Hydrops fetalis (edema of whole body)
Structure abnormality

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15
Q

When is the fetal anomaly screen?

A

18-20 weeks

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16
Q

How does fetal circulation work

A 
Pumped into aorta
Through systemic circulation
Oxygen is picked up from the placenta
Oxygenated blood enters RA
Through foramen ovale 
Into LA
Into LV
Out into aorta
17
Q

Transitional circulation

A

Once baby begins to breath
Equal L and R ventricular pressure
Still have a patent ductus arteriosus and foramen ovale (close within a couple of days)

18
Q

Critical heart disease

A

Requires appropriate intervention within the first month for optimal outcome
Typically the lesions are duct-dependent
May be masked by transitional circulation
Beware early hospital discharge

19
Q

What screen should every newborn get?

A

Pulse oximetry screening

Enhances teh detection of critical congenital heart disease

20
Q

What is the classification for cyanosis? When can you see it?

A

Technically under 95%

See it under 85%

21
Q

5 presentations in the newborn

A 
Cyanotic CHD
R-L shunt
Complex mixing
Transposition
Heart failure complex
22
Q

4 defects in the tetralogy of Fallot

A

VSD (membranous part)
Pulmonary stenosis
Dextroposition of the aorta (moved to the right and overrides the septum, so gets blood from RV and LV)
RV hypertrophy (compensatory)

23
Q

Babies with tetralogy of Fallot present with…

A

Cyanosis
Because PA is narrow, less blood enters lungs to be oxygenated
RV attempts to overcome resistance and hypertrophies, but ends up pumping blood through VSD into LV
Mixing of oxygenated and deoxygenated blood in the aorta
Need a surgical repair

24
Q

How can you survive a transposition?

A

If you have an open ASD
Mixing must occur to allow some oxygenated blood to go to the systemic circulation
Will have really low O2 sats

25
Q

Coarctation

A

Narrowing of the aorta

26
Q

Innocent murmur is recognized by (6)

A 
Sternal location
Systolic timing
Stays sternal
Short duration
Soft intensity
Sounds are normal
27
Q

What is the resp rate in a child to be worried about?

A

60 breaths/min

Normal is about 45-50

28
Q

What medications do you not give to children for CHD?

A

Prostaglandins

Week 8: Heart Murmur (10 decks)

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