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DT3- EXAM 1 > Congential Heart Disease- Leah (3) > Flashcards

Congential Heart Disease- Leah (3) Flashcards

1
Q

Two diseases that present at the time of PDA closure (3-4 days old) without cyanosis?

What must be done if these conditions are suspected?

A
  1. Aortic coarctation
  2. Hypoplastic left heart.

Always give these kids PGE1

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2
Q

Four CHDs that are not causes of cyanosis and do not directly correlate with time of PDA closure?

A
  1. ASD
  2. VSD
  3. PDA
  4. AVSD

*probably the least symptomatic of all of the congenital defects.

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3
Q

Most common congenital defect?

With what is it commonly associated?

A

VSD
associated with fetal alcohol poisoning
(Yes, I agre this important!)

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4
Q

Defect Assc with:

  1. Turners
  2. Digeorge
  3. Downs
  4. Heretotaxy
A
  1. Turners: aortic coarctation
  2. Digeorge: truncus arteriosus
  3. Downs: AVSD
  4. Heretotaxy: TAPVR
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5
Q

Most common cyanotic lesion?

A

Tetralogy of Fallot

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6
Q

How to treat cyanotic spell/ tet spell?

How does it work?

A

Knee chest position
Decreases systemic venous return; Increases LV resistance
Decreases R –> L shunt

*^ SVR–> ^ resistance in Lt ventricle–> Decreases R–>L shunting (I had to write this to visualize)

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7
Q

Classic murmur Assc with PDA?

A

Constant machine like murmur

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8
Q

Classic VSD murmur

A

Holosystolic murmur between T/M regions

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9
Q

Murmurs Assc with ASD?

A

Basically right sided stenotic murmurs.

  • Systolic murmur in pulmonic region
  • Diastolic murmur in tricuspid region
  • widely fixed and split s2
  • this is because you see right sided hypertrophy/ L –> R shunting.
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10
Q

Condition Assc with decreased femoral pulse?

A

Aortic coarctation.

Blood doesn’t flow through the aorta distal to the subclavian.

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11
Q

Classic murmur Assc with tetralogy

A

HARSH pulm stenosis murmur radiating into the BACK!

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12
Q

One murmur you can expect to hear in truncus arteriosus? Why?

A

Condition causes VSD.

Will cause the same murmur + cyanosis.

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13
Q

What murmur does TAPVR mimic?

A

ASD; causes right sided hypertrophy

* but will also have cyanosis.

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14
Q

Symptoms Assc with transposition of the great arteries?

A

CHF-like + cyanosis.

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15
Q

Tricuspid atresia Presentation: (3)

A

Single S2, left PMI, cyanosis.

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16
Q

Five diseases that present with CYANOSIS.

A

The five T’s.

  1. Truncus Arteriosus. (1 great artery)
  2. Transposition of the (2) great arteries
  3. TRIcuspid atresia
  4. TETralogy of fallot
  5. TAPVR (5 letters)
17
Q
  1. Most common cause of ASD?
  2. Physical changes that occur as a result of ASD
  3. Symptoms
  4. Heart exam findings (3)
A
  1. Usually ostium secundum defect.
  2. Causes L –> R shunting; R sided hypertrophy; increased pulmonary flow.
  3. Usually asymptomatic, don’t present at birth/ during PDA closure/ with cyanosis.
  4. Get RV impulse, split S2, and two right sided murmurs (sounds like pulmonary + tricuspid stenosis)
18
Q

VSD

  1. Most common cause
  2. Physical effects
  3. Symptoms
  4. Heart exam findings (1)
A
  1. Usually membranous defect
  2. L–> R shunting; LEFT hypertrophy; increased pulmonary flow.
  3. Typically asymptomatic; falure to thrive a 1 mos if severe
  4. Hear holosystolic murmur between T + M
19
Q

PDA:

  1. Common cause/ Assc
  2. Physical effects
  3. Symptoms
  4. Classic murmur
  5. Treatment for preemies
A
  1. Assc with maternal rubella infection (first aid)
  2. Causes aortic –> pulm shunting after birth, leads to left hypertrophy
  3. Tachypnia/hepatomegly
  4. Constant machine like murmur
  5. NO indomethacin for term babies!!!!
20
Q

Describe the COMPLETE AVSD defect (4).
What is the heart exam like? (2)
How do these patients present?

A
  1. -ostium Primum defect
    - one AV valve annulus
    -no mitral valve
    -inlet ventricular septal defect
    (Heart = Giant, hollow hole! good)
  2. Hear VSD + ASD like murmurs, very loud S2
  3. Kiddos have symptoms of CHF but not cyanosis.
21
Q

Describe the PARTIAL AVSD defect (4).
What is the heart exam like (3)?
How do these patients present?

A
  1. -ostium primum defect
    - TWO AV valve annuli
    - mitral valve present but cleft
    - no ventricular septal defect
  2. Presents like an ASD; largely asymptomatic
  3. pulmonary stenosis like murmur; RV impulse; split S2
  • sounds so much like an ASD; I think the only way to differentiate in a test question is if the stem involves a kid with Downs.*
22
Q

Two conditions Assc with aortic coarctation:

A
  1. Turners syndrome

2. 50% have bicuspid aortic valves = aortic stenosis later in life.

23
Q

Where is the coarctation in aortic coarctation?

A

Just distal to subclavian

24
Q

Aortic coarctation classic presentation (3)

A
  • CHF symptoms 3-4 days after birth
  • absent femoral pulse (upper extremity hypertension, lower extremity)
  • Gallop rhythm.

rib notches on CXR late in life

25
Q

Hypoplastic left heart syndrome

  1. Physical cause
  2. Classic presentation (2)
A
  • Aortic + mitral stenosis —> atresia (severity varies)
  • Right heart is dominant; complete mixing of venous/ arterial blood in the right atrium
  • Shock at 3-4 days after birth
26
Q

Tetralogy of Fallot- name the four defects

A 
IHOP 
Interventricular septal defect
Hypertrophy of the right heart 
Overriding aorta (over-rides the ventricular defect) 
Pulmonary stenosis
27
Q

What kind of shunt is seen in tetralogy of Fallot?

A

Initially it is L –>R, but it progresses from R–> L as pulmonary stenosis increases.

28
Q

Classic murmur and CXR Assc with Tetralogy?

A
  1. Boot shaped heart on CXR

2. Harsh pulmonary stenosis murmur radiating into the back

29
Q

Truncus Arteriosus

  1. Physical defect
  2. Assc findings on heart exam (3)
  3. Symptoms
A
  1. Single great vessel overlying ventricular septal defect (all blood- venous and arterial- mixes in the single vessel)
  2. Hear VSD murmur + systolic click and diastolic murmur at the truncal valve
  3. Kiddo will be cyanotic

Note: This disorder is caused by improper neural crest cell migration, as is transposition of the great vessels.

30
Q

Transposition of the great vessels

  1. most common form
  2. Symptoms (2)
  3. Classic CXR findings
  4. What do these babies need? What do you give them!?
A
  1. D-TGA (aorta is anterior and right; receives deoxygenated blood).
  2. Babies will present with CHF + cyanosis
  3. “Egg on string” appearance on CXR
  4. These babies need a PDA to send any oxygenated blood to the body. Must administer PGE
31
Q

Tricuspid atresia is Assc with what other physical effects? (3)

A

Most often kids also have VSD, ASD, and RV hypoplasia

findings are kind of non-specific aside from cyanosis

32
Q

Describe the TAPVR defect. What is necessary to maintain blood flow?

A

Pulmonary veins empty into the right atrium.
In order for kids to have any oxygenated blood flow, they need a patient foramen ovale/ ductus arteriosus. Have to give PGE1 if they have PDA + TAPVR

33
Q

Symptomatic. Presentation of TAPVR (2 scenarios)

Heart exam findings?

A

Venous return OBSTRUCTED:

  • Severe respiratory distress at the time of birth
  • Heart exam may not be specific.

Venous return NOT OBSTRUCTED:

  • Baby is asymptomatic at birth but fails to thrive
  • Presents with cyanosis
  • Heart exam findings similar to ASD.
34
Q

Defect Assc. With maternal diabetes

A

Transposition of GA

DT3- EXAM 1 (26 decks)

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