exam 3: chapter 27

Question 1

Risk factors for congenital heart defects

Answer 1

○ Major cause of death in the first year of life other than prematurity
○ Maternal rubella or increased age, diabetes, alcoholism, PKU, drugs, and hypercalcemia
○ Antepartal bleeding
○ Prematurity
○ Chromosome aberrations
○ Hemodynamic alterations:
■ Right-to-left shunt, left-to-right shunt
○ Status of tissue oxygenation:
■ Cyanotic defects (blood is low on oxygen)
■ Acyanotic defects (blood contains enough oxygen but is pumped abnormally around the body)

Question 2

Anatomy of congenital heart defects; AaSD, VSD, TGA, TOF (and understanding of cyanotic vs acyanotic vs mixing defects)

Answer 2

○ AaSD: Atrial septal defect
■ Left to right shunt (between atria)
○ VSD: ventricular septal defect (most common)
■ Abnormal communication between the ventricles
○ TGA:
■ Transposition of the great arteries
● Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle
■ Results in two separate, parallel circuits
● Unoxygenated blood circulates continuously through the systemic circulation
● Oxygenated blood circulates continuously through the pulmonary circulation
● Other defects allow mixing of these circuits
○ TOF: Tetralogy of Fallot
■ Cyanosis or hypoxia
● Ventricular septal defect (VSD)
● Overriding aorta
● Pulmonary valve stenosis
● Right ventricle hypertrophy
○ Cyanotic: bluish coloration of the skin and mucous membranes, which is caused by reduced oxygen levels in the blood
○ Acyanotic: normal or pink coloration of the skin and mucous membranes, indicating adequate oxygenation of the blood
○Mixing:
■ Truncus arterious
■ Hypoplastic left heart syndrome

Question 3

define Kawasaki disease

Answer 3

Acute, self-limiting systemic vasculitis usually occurs in children under 5 years of age and in winter or spring

Question 4

what are the stages of Kawasaki disease

Answer 4

Acute: Capillaries, venules, arterioles, and the heart become inflamed

Subacute: Inflammation of larger vessels; coronary aneurysms appear

Convalescent: Medium-sized arteries begin granulation process; small vessel inflammation decreases

Post Convalescent: Scarring of vessels, thickening of tunica intima, calcification, coronary artery stenosis

Question 5

what findings are needed to diagnose Kawasaki disease

Answer 5

■ Fever for 5 or more days
■ Bilateral conjunctivitis without exudation
■ Erythema of oral mucosa (strawberry tongue)
■ Changes in the extremities, peripheral edema and erythema of palms and soles
■ Polymorphous rash
■ Cervical lymphadenopathy