CP Final: Pediatric Cardiology Flashcards
When does heart begin to form?
at 18 days
When do tubes fuse?
21 days and are beating by 22 days
When do atrium and ventricles separate?
at day 24
When will blood begin to circulate through the embryo from heart?
day 27
When does atrium partition?
days 27-31 foramen ovale is now open
When do the ventricles divide?
by 7 weeks
Which side is dominant during utero?
right side
When is development usually complete by?
week 10
What is fetal blood flow circuit?
- oxygen returns to fetus through umbilical vein
- RA through Foramen ovale to LA
- red blood then goes to LV and out through aorta to body
- fetal blood returning goes back to RA and blue blood then goes to RV and instead of going to lungs goes through ductus arteriosus
- DA sends blue blood to lower half of body to return blood to placenta to get oxygen
When happens at a new borns first breath?
lungs expand with air, lung pressure falls, blood flows into lungs
What happens when blood returns to right atrium in newborn?
higher pressure now on left side of heart, functionally F.O will close off a few hours after birth and fully closed by 3 months
oxygen levels of blood rises
When does D.A constrict?
10-15 hours after birth due to increased PaO2
What is a normal HR for a 0-3 month old?
100-150 then drops until normal HR achieved with the biggest drop in the first year
What is normal BP of 0-3 month old?
65-85/ 35-45 then increases with age until normal due to growing body
When can a congenital heart defect occur?
at any point during the development of cardiac system
What can cause a CHD?
- genetics
- maternal rubella
- maternal infection before week 10
- maternal substance abuse/ diabetes/ radiation exposure/ obesity
What are clinical signs of CHD?
tach, JVD, crackles, cyanosis, abnormal heart sounds
Failure to thrive is big one but may not notice this one for months or years
What are some respiratory distress symptoms?
tach, retractions, nasal flaring, grunting, stridor, head bobbing, pallor
What are the two main types of defects?
- Acyanotic
2. Cyanotic
What are acyanotic defects?
not as bad, defects that cause a left to right shunt of blood but does not mix deoxygentaed blood going out to body
this impairs preload and after load and impairs contractility, like CHF
What is atrial septic defect?
most common is patent foramen ovale, more common in females than males and FO does not close at birth
What happens in ASD over time?
pressure shift from left to right causing RA and RV hypertrophy
sx: could lead to stroke, loud systolic murmur, Sx of R CHF
Tx: surgery if not closed by 2-3, on anti coags for 6 months
What is ventricular septal defect?
hole or multiples holes within inter ventricular septum, blood is shunted from left to right ventricle during systole
this is worse than ASD
What is happening during VSD?
increases blood going back to lungs, making gas exchange less efficient , also returning more blood to LV which may stretch it
What are sx of VSD?
loud systolic murmur, dyspnea, diffculty feeding, failure to thrive, perfuse sweating, sx of CHF, resp distress
TX: some may close on own by age 2 but if not by 5-7 then surgery
What is atrioventricular septal defect?
AVSD, large hole in IV septum moving larger amounts of blood from left to right side
common in babies with down syndrome
What are sx of AVSD?
significant lung congestion, pulm HTN, increased WOB, failure to thrive
tx: surgery within first few months of life
What is patent ductus arteriosis?
DA remains and allows blood to flow between aorta and pulm artery, causing more blood to go to lungs
What are sx of PDA?
depends on size, pulm congestion, sx of CHF, dyspnea, failure to thrive
tx: antibiotics, meds to close DA (Indomethacin), surgery if those don’t work
What is coarctation of aorta?
narrowing of aorta by DA, increasing after load and pressure significantly
What are sx?
none until DA closes then CHF and often shock
What is aortic stenosis?
usually in toddlers or above, narrowing of the outflow tract of the LV, increasing after load and CHF
What are sx?
none at rest but exercise intolerance, dizziness
TX: aortic surgery
What are cyanotic defects?
these effects allow for right to left shunting so deoxygenated blood is sent out into the body
results in cyanosis, clubbing due to decreased PaO2
What is Tetralogy of Fallout?
most common cyanotic CHD, consisting of large VSD, pulm stenosis, aorta over VSD which maximizes mixing, RV hypertrophy
Why does this result in hypoxia?
blood flow to pulm artery is obstructed- therefore due to path of least resistance will go to aorta bc of VSD
What are sx?
cyanosis, fatigue, fainting, polycythemia, shock
TX: surgery, 5% mortality rate with surgery
What is hypo plastic left heart syndrome?
decreases size of left ventricle, may have absent mitral or aortic valves
worst mortality of all CHD
What are sx?
nothing until DA closes then baby goes into shock and organ failure
TX: use of prostoglandins to keep DA open or surgery even LVAD or transplant possible
What is transposition of great vessels?
pulm artery and aorta are switched during gestation, aorta from RV, PA from LV
more common in males
What are sx?
sx: cyanosis, shock and organ failure
TX: try to keep DA open or surgery to switch aorta back
What is rheumatic fever?
strep A from strep throat with fever and joint pain can lead to rheumatic heart disease
What is RHD?
this can cause endocarditis, autoimmune reaction in the heart, bacterial sludge grows on heart causing valve issues like mitral or aortic stenosis
TX: antibiotics, ASA, anti inflammatories (steroids)
What is cardiomyopathy?
defined as decrease in CO caused by myocarditis, genetics, neuromuscular disorder, metabolic disorders
What are the three types of cardiomyopathy?
- dilated- overstretch of left, right or both ventricles
- hypertrophic- stiff and thickened heart due to abnormal growth and arrangement of myocytes
- restrictive- decreased ability of heart to relax in diastole
What are sx?
depends on what side affect but could be fatigue, activity intolerance, low BP, abnormal HD to activity
TX: drugs to increase contractility, decrease workload of heart, decrease after load
What is most common age for pediatric heart transplant?
newborn to one y/o likely due to CHD when other options have failed
ages 1-17 cardiomyopathy most common reason for transplant
What are survival rates?
72% for 0-1 is 7 years
50% for 1-10 is 17.5 years
50% for over 10 is 11 years
What is Marfan’s syndrome?
inherited disorder of connective tissue can lead to cardiac manifestations such as aortic dilation, aortic/mitral valve regurgitation
What is Ehlers-Danlos syndrome?
connective tissue disorder with decreased amount of collagen, same cardiac issues as marfans
What is myocarditis?
inflammation of myocardium usual due to viral infection
What is pericarditis?
inflammation of pericardium
What are CDC recommendations for activity with children?
60 minutes of moderate to vigorous activity a day, 3x a week for vigorous
What is recommendation for muscle strength?
3x/ week- gymnastics, rope/tree climbing
What about for bone building?
3x /week jump rope, group sports, running, hopping, skipping
