CV125 Congenital Heart Disease

Question 1

Stenosis

Answer 1

narrowing of valve or artery

Question 2

coarctation

Answer 2

narrowing of blood vessels (used specifically when talking about arteries)

Question 3

atresia

Answer 3

complete blockage

Question 4

regurgitation

Answer 4

valve leakage

Question 5

When does the fall in Pulmonary Vascular Resistance occur in babies?

Answer 5

1) the first 48 hrs of life

2) full drop occurs by 2 months of age

Question 6

what are the most common types of Left to Right Shunt?

Answer 6

1) Atrial septal defect (ASD)
2) ventricular septal defect (VSD)
3) patent ductus arteriosus
4) AV Canal defect

Question 7

Describe how blood flows in an ASD

Answer 7

Secundum (middle part of the atrial wall) is missing. RA blood flows into the RV and into the lungs but once blood gets to the LA, the blood goes back into the RA because of the higher pressure in the LA. The lungs see more blood than they should.

Question 8

What is a VSD?

Answer 8

A hole in the ventricular septum

Question 9

what happens to SVR when the placenta is disconnected?

Answer 9

increase in SVR

Question 10

what triggers/promotes the beginning of spontaneous closure of ductus arteriosus?

Answer 10

increased arterial oxygen level during first days of life which causes constriction of the smooth walls of the ductus arteriosus (it squeezes tight and closes). contraction is followed by permanent fibrosis. This is usually complete by Day 3. Permanent closure usually happens first 2-3 days of life.

Question 11

what causes the closure of the foramen ovale?

Answer 11

increased LA pressure due to systemic vascular resistance increase.

Question 12

How long does it take for the foramen ovale to close?

Answer 12

between 4-6 months of life

Question 13

What takes longer to close, foramen ovale or ductus arteriosus?

Answer 13

foramen ovale

Question 14

How long does it take for the majority of PVR to fall in a newborn?

Answer 14

This occurs in the first 48 hrs but a full drop occurs by 2 months of age.

Question 15

What are factors that alter normal heart transition in the newborn?

Answer 15

1) prematurity because there is immature smooth muscle in ductus arteriosus making it difficult to shut
2) neonatal stress such as hypoxia, acidosis, sepsis which cause a delay in PVR drop

Question 16

What are the 3 most common presenting features that alert people of congenital heart disease?

Answer 16

1) murmur
2) congestive heart failure
3) cyanosis

Question 17

What are the 2 large groups of heart defects?

Answer 17

acyanotic and cyanotic

Question 18

What is the difference between acyanotic and cyanotic heart defects?

Answer 18

Acyanotic are more common. Do not make the babies overall oxygen saturation impaired

Question 19

What are the 2 types of cyanotic heart defects?

Answer 19

1) left to right shunt

2) obstruction

Question 20

How to fix ASDs?

Answer 20

usually fix later in life, at 3-4 years of age to see if it fixes itself. Can detect because hear a murmur. cover hole

Question 21

Describe blood flow in VSD

Answer 21

Blood from LV moves into the RV because of higher pressure

Question 22

What is the most common congenital heart defect?

Answer 22

VSD

Question 23

What is a patent ductus arteriosus?

Answer 23

when the ductus arteriosus fails to close

Question 24

Describe blood flow in PDA

Answer 24

Because ductus arteriosus is not closed, blood from the aorta (due to high pressure) flows back into the pulmonary artery and into the lungs. Therefore, more blood goes to the lung that should.

Question 25

What is An AV Canal defect?

Answer 25

Where there is a hole in both the atrial septum and the ventricular septum where there is no tricuspid and bicuspid valve (just an entire large one)

Question 26

What congenital heart defect is found almost exclusively in children with Down’s syndrome?

Answer 26

AV canal defect

Question 27

What is Eisenmenger syndrome ?

Answer 27

When a child has a left to right hole that does not get repaired, this leads to chronic flow through hole which then leads to irreversible pulmonary hypertension and hypertrophy. This leads to progressive cyanosis and death because pressure in the right side becomes higher than in the left (blue blood travels into systemic circulation)

Question 28

What are some cardinal signs of cardiac failure in childhood ?

Answer 28

1) tachycardia
2) tachypnea (breathing faster than they should)
3) hepatomegaly (liver is larger - congested and swollen) due to venous pressure back-up
4) failure to thrive (grows normally by doesn’t gain weight properly)

Question 29

What are the 2 types of acyanotic lesions with obstruction?

Answer 29

No shunting, just blockage

1) aortic stenosis (narrowing of the valve
2) coarctation of the aorta (narrowing of the aorta)

Question 30

What is Aortic Stenosis?

Answer 30

Valve is abnormal. Something is preventing the leaflets from opening properly. Turbulence through the valve presents as a murmur.

Question 31

What is Coarctation of the aorta?

Answer 31

A tightness and pinching in of the aorta. Allowing adequate blood flow to the head but not enough to the lower areas (legs etc).

Question 32

What is iterated Aortic Arch?

Answer 32

An extreme form of coarctation of the aorta in which the aortic arch is completely detached from the descending aorta. If the ductus arteriosus is open then the baby will get blue blood flow to the rest of the body. As soon as it closes, the baby will go into severe shock

Question 33

What is a hyperoxic test?

Answer 33

administration of 100% oxygen with failure to raise the partial pressure of oxygen above 150 mmHg.