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Clinical Specialties - Pediatrics > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

What is the most common congential heart defect?

A

VSD

(also believed 1/2 of these repair themselves and never come to medical attention)

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2
Q

What is an atrial septal defect?

A

persistent opening in the interatrial septum after birth that allows for direct communication between the l. and r. atria

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3
Q

What is the prevalence of ASD?

A

1:1500 live births

10% of all congenital heart disease

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4
Q

What is the consequence of an ASD?

A

blood ordinary shunted from left–>right

volume overload in right atrium

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5
Q

What is Einsemenger Syndrome?

A

When a shunt that was formerly left-to-right becomes right-to-left

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6
Q

What is the common presentation for ASD?

A
  • May be asymptomatic
  • DOE
  • Fatigue
  • Recurrent lower respiratory tract infections
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7
Q

What are the exam/test findings with ASD?

A

RV heave along LSB

S2 wide, fixed splitting

murmur is mid-systolic left USB

cardiac cath - measures higher O2 in right atria

echo - shows shunt on doppler

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8
Q

Rx for ASD?

A

Surgical-

  • direct suture closure
  • pericardial or synth patch
  • percutaneous apporahc with septal occluder device
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9
Q

How prevalent is VSD?

A

1.5-3.5:1000 live births

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10
Q

How do you diagnose VSD?

A

echocardiography

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11
Q

What are the symptoms and signs of VSD?

A
  • depends upon the size of the defect ranges from no symp. to heart failure
  • harsh, holosystolic murmur along LSB
  • systolic thrill
  • if reversed shunt, cyanosis and dyspnea
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12
Q

What is the Rx for VSD?

A
  • 1/2 close spontaneously by age 2
  • closure indicated with s/sx of CHF or pulmonary vascular disease
  • same as ASD methods for closure
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13
Q

What is the tetraology of Fallot?

A

4 Defects:

  1. VSD
  2. pulmonic stenosis
  3. overridng aorta (communicates with right ventricle through VSD)
  4. RVH
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14
Q

How common is tetralogy of Fallot?

A

Pretty rare: 5:10k live births

but most common cyanotic heart disease in childhood

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15
Q

What are the s/sx of tetralogy of Fallot?

A
  • “Tet” Spells - hyperventilation, cyanosis, syncope and squatting after exertion, feeding, crying
  • dyspnea on exertion
  • mild cyanosis and clubbing
  • RV heave
  • systolic ejection murmur at left USB
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16
Q

What is the Rx for tetralogy of Fallot?

A

surgery-close VSD and increase pulmonary artery width

*if necessary, temporarily create connection between aorta and pulmonary artery to reduce hypertension

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17
Q

What is transposition of the great vessels?

A

aorta arises from the RV

pulmonary artery arises from the LV

so, aorta pumps deoxygenated blood and the pulmonary artery carries oxygenated blood to the heart

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18
Q

What is the prevelence of transposition of the great vessels?

A

40:100k births (7% congenital)

most common neonatal cyanosis

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19
Q

What are the s/sx of transposition of the great vessels?

A

blue baby - extremely hypoxic and cyanotic

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20
Q

How do you diagnose transposition of the great vessels?

A

echocardiogram

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21
Q

What is the Rx for transposition of the great vessels?

A

arterial switch surgery is definitive

until that can occur, use prostaglandins to keep ductus arteriosis open (only way to get some oxygenated blood circulating)

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22
Q

Who still gets pre-dental/surgical antibiotic prophylaxis with congenital heart disease?

A

unrepaired cyanotic heart disease

post-repair for six months

post-repair with residual defects

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23
Q

What is coarctation of the aorta?

A

narrowing of the aortic lumen

(can be postductal -98% or preductal - 2% for the DA)

24
Q

how common is coarctation of the aorta?

A

1:6k live births

25
Q

What are the s/sx of coarctation of the aorta?

A
  • most asymptomatic, but severe will be evident in a newborn
  • preductal has cyanosis in LE
  • femoral pulses weak and delayed
  • midsystolic murmur
  • elevated UE BP
26
Q

How do you diagnose coarctation of the aorta?

A
  • x-ray may show indented aorta and notches on inferior part of the ribs
  • echo confirms
27
Q

What is the treatment for coarctation?

A

severe - prostaglandin to keep DA open

definitive - excision and reanastamosis (balloon +/- stenting)

28
Q

What is patent ductus arteriosus (PDA)

A

when embryological anastamosis between aorta and pulmonary artery fails to close after birth

29
Q

What is the prevalence of PDA?

A

1:2500-5000 live births

30
Q

What are the s/sx of PDA?

A

small are asymptomatic

moderate - fatigue, dyspnea, palpitation

large - left-to-right shunt HF

Afib can develop if left atria dilates

“machine” like murmur

31
Q

How do you diagnose PDA?

A

echo

32
Q

What’s the treatment for PDA?

A
  • prostaglandin synthesis inhibitor - indomethacin
  • NSAIDs
  • surgical ligation or division
  • transcather coiling
33
Q

What is congenital aortic stenosis?

A

Abnormal development of the aortic valve with resulting obstruction of flow. Usually bicuspid leaflet or unicuspid (more severe)

34
Q

What are the s/sx of aortic stenosis?

A

most are symptomatic, but when symptoms occur, looks like AS in grown-ups.

35
Q

What is pulmonic stenosis and what is its prevalence?

A

obstruction across the pulmonic valve due to abnormal development of the valve, outflow tract, or artery.

It’s very rare

36
Q

What are the signs and symptoms of pulmonic stenosis?

A

usually asymp.

when there are symptoms, DOE, exercise intolerance, right-sided HF

  • On exam:
    • prominent jugular venous a wave
    • RV heave and thrill
    • widely split S2 and soft P2
    • loud, late-peaking, crescendo-decrescendo systolic murmur at upper LSB
37
Q

How do you dx and grade pulmonic stenosis?

A

echo to confirm and assess pressure gradient

Mild <50 mmHg

Moderate 50-80 mmHg

Severe >80 mmHg

38
Q

What’s the Rx for pulmonic stenosis?

A

moderate or severe cases treated - transcatheter balloon valvuloplasty

RV hypertrophy usually regresses!

39
Q

What is rheumatic heart disease?

A

valvular disease that follows as a sequelae of rheumatic fever

mitral - 75-80%

aortic - 30%

tricuspid and pulmonic - 5%

40
Q

what is heard on auscultation of an ASD?

A
  • fixed, split S2
  • ejection murmur may be heard at left upper sternal border
  • diastolic rumble of relative tricuspid stenosis may also be present
41
Q

what are the common signs on PE of VSD?

A

holosytolic murmur

diastolic rumble or thrill

large can cause CHF symptoms

42
Q

What are the common signs on PE of Tetralogy of Fallot

A

Tet spells

systolic ejection murmur at the upper left sternal border (pulmonic stenosis)

43
Q

What is Kawasaki disease?

A

multisystem vasculitis

occurs primarily in young children (>80% are 5 years or less)

44
Q

what is the treatment for Kawasaki disease?

A

IVIG

and high-dose aspirin during acute phase (fever)

low dose ASA for 6-8 weeks

echocardiograms every 5 years for life (more often with congenital ht dz)

45
Q

what are the cardiac signs of Kawasaki disease?

A

pericardial effusion/pericarditis

myocarditis/endocarditis (usually resolves when fever resolves)

prolongation of the PR and QTc and reduced volatage on EKG

cardiac aneurysms may form and can regress

46
Q

What are the criteria for diagnosing rheumatic heart fever?

A

JONES PEACE

Jones are major - joints, oh my heart, nodules, erythema marginatum, syndenham’s chorea

PR interval prolongatio, ESR elevation, arthralgias, CRP elevated, elevated temp.

47
Q

What is the treatment for rheumatic fever?

A

Penecillin G IM

anti-inflammatory - ASA or corticosteroids

treat any CHF

treat chorea with phenobarbital, haloperidol, valproic acid, diazepam

48
Q

What are the criteria for diagnosing Kawaski disease?

A

FEAR ME

Fever for equal to or greater than 5 days

Eye injection - conjunctivitis

Adenopathy - greater than 1.5 cm

Rash - bullous and vesicular lesions common

Mucous membrane changes - red/cracked lips strawberry tongue

Extremity Changes -palm and sole edema and desquamination

49
Q

what is the biggest concern in Kawasaki disease?

A

children less than 1 year are more likely to have atypical symptoms and still have coronary artery aneurysms

50
Q

What is the inheritance pattern for hypertrophic cardiomyopathy?

A

autosomal dominant

(sometimes sporadic)

51
Q

what are the symptoms of hypertrophic cardiomyopathy?

A

dyspnea on exertion

chest pain

syncope

ventricular gallop (S3)

mumur of mitral regurgitation - holosystolic apical murmur

52
Q

When should cardiac causes of syncope be suspected?

A
  • when it occurs while lying down
  • provoked by exercise
  • chest pain with it
  • family hx of sudden cardiac death
53
Q

how do you diagnose hypertrophic cardiomyopathy?

A

echocardiogram

54
Q

what is the treatment for hypertrophic cardiomyopathy?

A

activity restriction

  • Beta blockers
  • calcium channel blockers
  • in severe cases, anti-arrythmics or an ICD
55
Q
A

Clinical Specialties - Pediatrics (18 decks)

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