Intro to Pediatric Cardiology and Congenital Heart Disease

Question 1

two broad categories of pediatric acquired heart disease

Answer 1

1. CHF from valve disease or myocardial failure
2. arrhthmia

Question 2

3 broad categories of pediatric congenital heart disease

Answer 2

1. CHF: L–> R shunts, obstructive defects, myocardial disease
2. cyanosis: R–>L shunts
3. arrhythmia

Question 3

outline how different shunts cause CHF vs cyanosis for congenital pediatric heart diseases

Answer 3

L–> R shunts cause CHF

R–> L shunts cause Cyanosis

Question 4

incidence of congenital heart disease in alberta

Answer 4

Incidence of CHD = 12.2 / 1000 live births, and at least 1/2 will need surgery

Question 5

 At what age do most critical congenital heart
defects present?

Answer 5

most critical defects present in the first 204 weeks of life

• you can usualyl get an 18 week prenatal diagnosis and counselling.

Question 6

T/F many severe congenital heart defects present with a detecatble murmur at birth

Answer 6

false.

Many severe congenital heart defects do NOT
present with a murmur.

Question 7

3 most common defects that cause congenital heart disease (Acyanotic)

Answer 7

1. ventral septal defect
2. atrial septal defect
3. atrio-ventricular septal defect

Question 8

major problems of the congenital heart diseas in infants

Answer 8

• premature death, often in infancy.
•  Most mortality before age 1 year
•  After 1 year, mortality rate is similar to other children
•  Higher mortality rate as adults

— Chronic disease / morbidity

Question 9

rate of prevalence of CHD trend

Answer 9

it is increasing, might be due to the fact that kids are living longer now

Question 10

outline the natural history of CHD in regard to functionality

Answer 10

more than 90 % have normal activity level with full time work or school

• most CHD femalres can manage pregnancy but some high risk
• many require frequent medical supervision
• neuro-developmental outcomes are a concenr.

Question 11

most common chromosomal abnormalities in CHD

Answer 11

trisomy 21

Question 12

What three cardiac shunts are present in the fetal
circulation?

Answer 12

1. ductus venosus
2. foramen ovale
3. ductus arteriosus

— Abnormal transition of these shunts can occur with CHD

Question 13

label the three fetal main shunts

Answer 13

1. Ductus venosus 2. Foramen ovale 3. Ductus arteriosus

Question 14

outline the prenatal blood supply and what they turn into

Umbilical vein –>Ligamentum teres

Ductus arteriosus–> Ligamentum arteriosum

Umbilical artery–> Lateral umbilical ligament

Answer 14

Umbilical vein –>Ligamentum teres

Ductus arteriosus–> Ligamentum arteriosum

Umbilical artery–> Lateral umbilical ligament

Question 15

 What is the most common outpatient pediatric
cardiology presentation?

Answer 15

Heart murmur

Other common referrals
 Palpitations
 Family history of heart disease
 Genetic syndrome

Question 16

presentations of CHD

Answer 16

• often are asymptomatic
• murmurs
• benign arrhthmia
• syncope
• L-R shunt
• Lt heart obstruction
• myocardial failure
• cyanosis (R-L rhunt)

Question 17

murmurs are Unlikely to be innocent if:

Answer 17

— Symptomatic

— Cardiomegaly

— Abnormal heart sounds

— Murmur characteristics:

1) Murmurs > 4/6
2) Diastolic murmurs
3) Pansystolic murmurs
4) Continuous murmurs

Question 18

types of “less innocent” murmurs

Answer 18

1. Loud 4/6 murmurs

2) Diastolic murmurs
3) Pansystolic murmurs
4) Continuous murmurs

Question 19

main types of innocent murmurs

Answer 19

STILLS MURMUR MOST COMMON

— Still’s murmur

— Physiological peripheral pulmonary stenosis (PPS)

— Carotid bruits

— Pulmonic outflow murmur

— Venous Hum

Question 20

pathogenesis of stills murmur

• age most common
• grade of murumur
• region best heard:
• exacerbating and alleviating factors

Answer 20

produced by: increased velocity flow across a low-normal diameter left ventricular outflow tract. or due to vibrations of LV tissue

• ages 2-7 years
• grade 1-3/6
• best heart between apex and LLSB
• increases with exercise, fever, supine position
• decreases with sitting or standing or valsalva

Question 22

T/f pediatric syncope is common and often benign

Answer 22

true. usually vasovagal syncope. history is the most important diagnostic tool

Question 23

pediatric syncope is common and often benign. When should you do an ecg for syncope?

Answer 23

ECG if:

— History not consistent with vasovagal syncope (most common reason for pediatric syncope)

— No prodrome before syncope

— Mid-exertional event

— Triggered by loud noise or startle

— Family Hx of sudden death or cardiac disease in young
individuals

— Abnormal exam

Question 24

the ___ shunt shunts a portion of umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver.

Answer 24

ductus venosus

Question 25

ductus ___ serves as a shunt between the pulmonary artery and the aorta. … Since the blood is already oxygenated after leaving the placenta and entering the body, the ductus ___ allows for it to bypass the pulmonary circulation and enter directly into the systemic circulation.

Answer 25

ductus arteriosus serves as a shunt between the pulmonary artery and the aorta. … Since the blood is already oxygenated after leaving the placenta and entering the body, the ductus arteriosus allows for it to bypass the pulmonary circulation and enter directly into the systemic circulation.

Question 26

___ ___ allows blood to enter the left atrium from the right atrium.

Answer 26

FORAMEN OVALE allows blood to enter the left atrium from the right atrium.

Question 28

T.F most chest pain in children are due to cardiac factors

Answer 28

false.

Most chest pain in
children is non-cardiac
 Coronary artery disease
is RARE in children

 Most commonly
musculoskeletal pain
(15-30%)

Question 29

Outline causes (cardiac and non cardiac) chest pain in children

Answer 29

Question 30

Note:

Question 31

note: normal vitals for children

Question 32

Some characteristics of fetal circulation:

Question 33

Some characteristics of fetal circulation:

___ is the dominant or systemic ventricle and
delivers blood to the placenta for O2
uptake via the ductus ___.

Higher O 2
content blood directed toward LV and
cerebral circulation (ductus ___, foramen
ovale

Answer 33

RIGHT VENTRICLE is the dominant or systemic ventricle and delivers blood to the placenta for O2
uptake via the ductus ARTERIOSUS.

Higher O 2
content blood directed toward LV and
cerebral circulation (ductus VENOSUS, foramen
ovale

Question 34

at birth, decreased vascular blood flow occurs so that there is increased ___ ___ ___

Answer 34

peripheral blood flow– expansion of lung, increased oxygenation, changes in NO and prostaglgandins

Question 35

change in systemic vascular resistnce (SVR) at birth

Answer 35

increased

-Pulmonary vascular resistance falls completely by 4-6
weeks postnatally

Question 36

Transitional Physiology