Congenital Heart Disease

Question 1

The majority of heart disease in children is

Answer 1

Congenital (5 to 8 of every 1000 live births)

Question 2

The three causes of congenital heart disease

Answer 2

Genetic, Environmental, multifactorial (combo of genetic and environmental)
Multifactorial makes up the majority

Question 3

What does congenital mean

Answer 3

A disease that exists at birth or develops during the first month of life.

Question 4

Syndromes with Congenital Heart Disease

Answer 4

Down, Turner, Marfan, Noonan, 18, 13,

Question 5

Infections that can lead to congenital heart disease

Answer 5

Rubella

Question 6

Diseases that lead to congenital heart disease

Answer 6

PKU

Question 7

Drugs that lead to CHD

Answer 7

Thalidomide, Accutane, Trimethadione

Question 8

Toxins that lead to CHD

Answer 8

ALcohol and cocaine

Question 9

One mechanism that can lead to CHD is altered flow patterns during cardiac development

Answer 9

true

Question 10

Decreased right heart flow during cardiac development leads to

Answer 10

Tricuspid Atresia (TAT), Pulmonary Stenosis Valvular (PSV), Atrial septal defect (ASD)

Question 11

Decreased Left Heart Flow

Answer 11

Atrial Septal Defect (ASD), Coarctation of the Aorta, Mitral Atresia (MAT)

Question 12

At birth, systemic resistance does what?

Answer 12

Increases

Question 13

At birth, pulmonary resistance does what?

Answer 13

decreases (lungs expand)

Question 14

At 24 hours, pulmonary resistance is (blank) of systemic resistance

Answer 14

one half

Question 15

Most common CHD

Answer 15

Ventricular septal defect…by a long shot.

Then atrial septal defect, pulmonary stenosis

Question 16

The various CHD abnormalities can be grouped into three categories. They are

Answer 16

abnormalities causing a Left to right shunt, Right to left shunt, and obstruction

Question 17

Dusky blueness of skin. What shunt is it?

Answer 17

Right to left shunt. blood avoids pulmonary circulation

Question 18

Left to right shunt

Answer 18

Expose the low pressure, low reisistnace pulmonary vasculature to increased volume and increased pressure. Leads to increased pulmonary vascular resistance which leads to right heart hypertrophy and eventually failure. With time, this increased resistance can cause reversal of the shunt to right to left.

Question 19

Atresia

Answer 19

Complete obstruction

Question 20

Most common shunt

Answer 20

Left to right…ASDs, VSDs, PDA (patent ductus arteriosus)

Question 21

What does the Foramen ovale do in fetal circulation

Answer 21

Allows blood to flow from the right atrium to the left. Bypasses the fetal lungs.

Question 22

pulmonary hypertension associated with

Answer 22

Left to right shunt. This pulm HTN can lead to a reversal of shunting and thus cyanosis. Seen earlier and more frequently at this severity in VSDs than ASDs.

Question 23

Whats the point of the ductus arteriosus during intrauterine life?

Answer 23

Its like a bridge between the pulmonary artery and the aorta. It permits blood flow from the pulm arteries to the aorta so that blood can bypass the unoxygenated lungs.

Question 24

When is the ductus usually obliterated

Answer 24

First few months of life

Question 25

PDA characteristics.

Answer 25

High pressure left to right shunts. Sounds like machinery in systole

Question 26

Cyanotic CHD (right to left shunt) associated with what conditions

Answer 26

tetralogy of fallot and transposition of the great vessels

Question 27

Physiologic murmurs

Answer 27

PPS, PFO

Question 28

Physiologic murmurs in toddlers

Answer 28

Still's, venous hum, pulmonary flow, carotid bruit

Question 29

Adult phyiologic murmurs

Answer 29

Mammary SOufle

Question 30

Are Physiologic murmurs ver in diastole

Answer 30

NO....only systole

Question 31

Are physiologic murmurs ever associated witha thrill

Answer 31

no

Question 32

Physiologic murmurs localized to left sternal border

Answer 32

yes

Question 33

AV valve murmur during systole

Answer 33

regurgitation...mi, tri, sys, regurg

Question 34

AV valve during diastole

Answer 34

Stenosis

Question 35

Semilunar valves during sys

Answer 35

stenosis

Question 36

Semilunar during diastole

Answer 36

regurg

Question 37

Murmurs of relative stenosis occur when?

Answer 37

When abnormally large amounts of blood flow pass across a structurally normal valve.

Question 38

When is cyanosis typically observed

Answer 38

When the concentration of desaturated Hgb is above 4 gm/dl

Question 39

Cardiac vs. non cardiac causes of cyanosis

Answer 39

Cardiac cause = perfusion of systemic circulation with desaturated blood.

Question 40

Non-cardiac causes of cyanosis

Answer 40

Peripheral vasoconstriction, desaturation of pulmonary venous blood Desaturation of pulmonary venous blood (hypoventilation, pneumonia, pneumothorax)

Question 41

Hyperoxia test tells you what

Answer 41

Whether the Cyanosis is a problem of the heart or a problem of the lungs. Administer 100% FiO2 by hood or ETT. If PO2 is less than 100, the probability of congenital heart disease goes way up.

Question 42

Cyanotic heart defects

Answer 42

Tunk, tran, tri, tet, tot Trunkus arteriosus, transposition of the great arteries, Tricuspid atresisa, Tetralogy of Follot Total anomalous pulmonary venous return

Question 43

Is an unrestrictive VSD in a newborn likely associated with a murmur

Answer 43

no

Question 44

Unrestrictive VSD in a 2 month old likely associated with what?

Answer 44

Systolic murmur and diastolic rumble