Exam 2 Flashcards
What are 6 risk factors associated with increased risk of CHD?
Prematurity
Family History (first degree relative with CHD)
Genetic Syndromes
Maternal Factors (medical hx, drug use, smoking and Alcohol use)
Fertility treatments
In utero Infection
What are 7 in utero infections associated with CHD?
Rubella
Influenza
CMV
Coxsackie
Toxoplasmosis
Roseola
Fifth’s Disease
What 2 types of CHD are linked to fertility treatment?
Septal defects
Cyanotic CHD
What are the 2 most common causes of CHD?
Cyanotic
Acyanotic
Is a right to left shunt cyanotic or acyanotic?
cyanotic
*dangerous
*pressure + volume overload
–>deoxygenated blood –>oxygenated blood –> body
–>pulm –>systemic –> body
What is the most common Acyonotic CHD?
Ventral Septal Defect
What are the 5 types of cyanotic CHD?
Truncus arteriosis (1 vessel)
*Transposition of the Great Vessels (2 vessels switched)
*Tricuspid valve atresia (3 valve cusps)
**Tetralogy of Fallot (4 components)
*Total Anomalous Pulmonary Venous Return (5 words)
Also;
pulmonary and tricuspid atresia
you will also see in ARDS
acronym TPT (tet of fallot, pulm + tricuspid atresia)
What are 4 types of Acyanotic CHD?
VSD (25% of most cases; most common CHD surgical repair)
*ASD
*PDA (patent ductus arteriosus)
*Coarctation of the aorta
acronym “VAP” for VSD, ASD, PDA
Right to left shunt is indicative of which type of CHD?
Cyanotic
Left to right shunt is indicative of which type of CHD?
Acyanotic
This is when the pressure in the left side of the heart is greater than the pressure in the right side
not as dangerous as right to left shunt
–>oxygenated blood –>deoxygenated blood –>lungs
systemic –> pulmonary –>lungs
What happens during a TET spell (tetrology of fallot)?
-cyanosis
-hypoxemia (65% - 85%)
-clubbing
-polycythemia (report hgb over 22g/d)
Tetrology of fallot interventions
-knees to chest (infant)
-squatting (older kids)
-do NOT interrupt sleep
-provide a calm, quiet environment upon waking
-pacifier during sleep
-small frequent feedings
-swaddle
What is the definition of CHD?
Structural abnormalities of the heart and or great vessels occurring during fetal development.
What is the definition of Cyanotic CHD?
Heart defect in which less than normal oxygen levels are delivered to the body.
What is the definition of Acyanotic CHD?
Heart defect in which oxygen levels delivered to the body typically remain normal.
True or False In some infants with CHD, murmurs may not be heard during the initial examination but
may be detected at or beyond the age of six weeks.
True
What is the universal newborn screening for CHD?
Pulse oximetry
Pulse ox screening will diagnose which type of CHD?
R to L shunt
Cyanosis
How is the pulse ox screening performed?
Pulse ox on right hand and either foot.
List 3 criteria for a positive pulse ox screening in CHD?
Any sat less than 90%
Sat less than 95% in both extremities on 3 measures, each separated by an hour.
More than 3% absolute difference in sat between the right hand and foot on 3 measure each separated by one hour.
Is a positive pulse ox screening for CHD passing or failing?
Failing
What are some PE findings that suggest
CHD?
Abnormal HR: obtain ECG
* Abnormal BP in 4 extremities (i.e.: blood pressure ≥10 mmHg higher in the arms
than legs)
* Abnormal S2 splitting
* Abnormal extra heart sounds
* Abnormal precordial activity
* Pathologic murmurs (>3 intensity)
* Hepatomegaly
* Diminished pulses in lower extremities
* Extracardiac anomalies (in latest reports, noted in about 20% of children with CHD)
Name 8 associated history finding in cyanotic CHD.
Irritability or decreased level of activity
Diaphoresis and crying w/feedings.
Decreased amount of formula per feed
Hx of longer time per breast feeding
Poor weight gain
Fast and or irregular breathing
Bluish or purple discoloration of the skin or mucous membrane
Older children may present with exercise intolerance including dyspnea, diaphoresis, cyanosis, or palpations during exercise.
Name 10 physical exam findings for cyanotic CHD.
Cyanosis
* Tachypnea
* Increased work of breathing
* Pulmonary edema
* Tachycardia
* Heart murmur
* Hepatomegaly (Liver edge located more than 2.5 cm below the right costal margin)
* Weak femoral pulses
* Signs of poor perfusion or shock
* Lethargy