Congenital Heart Disease Lecture Powerpoint

Question 1

Ductus arteriosus

Answer 1

Connects the aorta to the pulmonary arteries allowing for a bypass of pulmonary circulation in fetal circulation

Question 2

Ductus venosus

Answer 2

A shunt from oxygenated maternal blood directly into the inferior vena cava from the umbilical cord in fetal circulation

Question 3

Foramen ovale

Answer 3

A bipass between the right atrium to the left to allow for a bipassing of the majority of the pulmonary circulation in the fetal circulation

Question 4

Mechanism of shifting from utero to newborn breath

Answer 4

• aeration of lungs causes them to inflate
• sees a dramatic fall in pulmonary vascular resistance and marked increase pulmonary blood flow causing pressure on right side of heart to decrease
• systolic systemic BP is about 75-80 mmHg, and pulmonary drops from 1/2 that to about 1/3rd

Question 5

Patent foramen ovale

Answer 5

As left side atrial pressures begin to exceed right side, “flaps” of the atrial septum are supposed to close, msot do by 1 year but up to 1/3 of adults continue to have a patent

Question 6

Patent ductus arteriosus

Answer 6

Should close within 24 hours of life in healthy, infants life and especially before discharge, premature infants may require indocin therapy or surgery to promote closure if there are signs of overcirculation

Question 7

Routine blood pressures are not recommended in children unless symptomatic concern until the age of…

Answer 7

….3 or older

Question 8

Grading of murmurs

Answer 8

1 - barely audible
2 - soft but easily audible
3 - moderately loud but no thrill
4 - louder and has thrill
5 - audible with stethoscope barely on chest
6 - audible with stethoscope off chest

Document where you heard the loudest**

Question 9

Thrill

Answer 9

Vibratory sense upon palpation during cardiac exam

Question 10

__% of children will have an innocent murmur at some point during childhood, most commonly preschool aged

Answer 10

80%

Question 11

Stills murmur

Answer 11

Most common innocent murmur of preschool age thru adolescence, low frequency, vibratory cooing sound, heard lest at the left lower sternal border

Question 12

Peripheral pulmonary flow murmur

Answer 12

Innocent murmur auscultated in newborn period from 0-6 months, occurs systolic in the branching of the pulmonary arteries creating turbulence, auscultated best in the upper sternal borders with radiation across clavicles to axilla

Question 13

Venous hum

Answer 13

Innocent murmur heard continuously in young children, auscultated in either the right or mid clavicular area, no audible changes in supine position*** and changes with intensity with rotation of head

Question 14

Most common type of birth defect

Answer 14

Congenital heart defects - specifically ventricular septal defect

Question 15

Most common obstructive heart defect, most common cyanotic heart defect

Answer 15

Coarctation of aorta, tetralogy of fallot

Question 16

Syndromes with high incidence of congenital heart defects (4)

Answer 16

• trisomy 21
• turner’s
• williams syndrome
• digeorge syndrome

Question 17

Fetal echocardiography

Answer 17

Followup to assess for congenital heart defects in fetus after level 2 ultrasound (done routinely during 20 weeks), high risk women are recommended to undergo as well (diabetic, family history of congenital heart disease, etc)

Question 18

Ventricular septal defect

Answer 18

Holosystolic murmur, heard best at 3rd or 4th intercostal space, typically has palpable thrill, sees systemic blood cross from left to right and then be shunted into the pulmonary circulation resulting in pulmonary edema and pulmonary hypertension, are often tachypnic, have poor weight gain and feeding intolerance

Question 19

Mitral prolapse murmur

Answer 19

Midsystolic cllick and murmur usually heard best at the apex of the heart

Question 20

Atrial septal defect murmur

Answer 20

Usually heard best at 2nd left intercostal space with patient siting up, sees left atrium force small amount of blood to right atrium and turbulence with the vena cavae blood flow results

Question 21

4 components of tetralogy of fallot

Answer 21

1) overriding of the aorta into the septum
2) right ventricular outflow tract obstruction (sub valvular, valvular, or supravalvular)
3) Ventricular septal defect
4) right ventriclular hypertrophy
can see 2 murmurs VSD or pulmonary stenosis

Question 22

Aortic stenosis

Answer 22

Failure of the aortic valve to open completely, heard best in the right upper intercostal space, seen in a newborn with harsh systolic ejection murmur radiating across precordium, typically only treated when symptomatic with aortic balloon valvuloplasty

Question 23

Coarctation of the aorta

Answer 23

Congenital heart disease where the aorta things beyond the great vessels, will see long systolic ejection murmur that often radiates to the back, left ventricular hypertrophy, high upper extremity BP and low lower extremity BP

Question 24

What condition is coarctation often seen with?

Answer 24

Bicuspid aortic valve

Question 25

When should a PCP refer a child for a murmur (2)

Answer 25

• infancy symptoms such as poor weight gain, cyanosis, tachypnea
• childs or adolescents with exercise intolerance or a new murmur that has never been previously heard (most innocent murmurs present in early childhood and if asymptomatic don’t need referral)