Intro to Pediatric Cardiology and Congenital Heart Disease Flashcards
two broad categories of pediatric acquired heart disease
- CHF from valve disease or myocardial failure
- arrhthmia
3 broad categories of pediatric congenital heart disease
- CHF: L–> R shunts, obstructive defects, myocardial disease
- cyanosis: R–>L shunts
- arrhythmia
outline how different shunts cause CHF vs cyanosis for congenital pediatric heart diseases
L–> R shunts cause CHF
R–> L shunts cause Cyanosis
incidence of congenital heart disease in alberta
Incidence of CHD = 12.2 / 1000 live births, and at least 1/2 will need surgery
At what age do most critical congenital heart
defects present?
most critical defects present in the first 204 weeks of life
- you can usualyl get an 18 week prenatal diagnosis and counselling.
T/F many severe congenital heart defects present with a detecatble murmur at birth
false.
Many severe congenital heart defects do NOT
present with a murmur.
3 most common defects that cause congenital heart disease (Acyanotic)
- ventral septal defect
- atrial septal defect
- atrio-ventricular septal defect
major problems of the congenital heart diseas in infants
- 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
rate of prevalence of CHD trend
it is increasing, might be due to the fact that kids are living longer now
outline the natural history of CHD in regard to functionality
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.
most common chromosomal abnormalities in CHD
trisomy 21
What three cardiac shunts are present in the fetal
circulation?
- ductus venosus
- foramen ovale
- ductus arteriosus
— Abnormal transition of these shunts can occur with CHD
label the three fetal main shunts
- Ductus venosus 2. Foramen ovale 3. Ductus arteriosus
outline the prenatal blood supply and what they turn into
Umbilical vein –>Ligamentum teres
Ductus arteriosus–> Ligamentum arteriosum
Umbilical artery–> Lateral umbilical ligament
Umbilical vein –>Ligamentum teres
Ductus arteriosus–> Ligamentum arteriosum
Umbilical artery–> Lateral umbilical ligament
What is the most common outpatient pediatric
cardiology presentation?
Heart murmur
Other common referrals
Palpitations
Family history of heart disease
Genetic syndrome
presentations of CHD
- often are asymptomatic
- murmurs
- benign arrhthmia
- syncope
- L-R shunt
- Lt heart obstruction
- myocardial failure
- cyanosis (R-L rhunt)
murmurs are Unlikely to be innocent if:
— Symptomatic
— Cardiomegaly
— Abnormal heart sounds
— Murmur characteristics:
1) Murmurs > 4/6
2) Diastolic murmurs
3) Pansystolic murmurs
4) Continuous murmurs
types of “less innocent” murmurs
- Loud 4/6 murmurs
2) Diastolic murmurs
3) Pansystolic murmurs
4) Continuous murmurs
main types of innocent murmurs
STILLS MURMUR MOST COMMON
— Still’s murmur
— Physiological peripheral pulmonary stenosis (PPS)
— Carotid bruits
— Pulmonic outflow murmur
— Venous Hum
pathogenesis of stills murmur
- age most common
- grade of murumur
- region best heard:
- exacerbating and alleviating factors
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
T/f pediatric syncope is common and often benign
true. usually vasovagal syncope. history is the most important diagnostic tool
pediatric syncope is common and often benign. When should you do an ecg for syncope?
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
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.
ductus venosus
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.
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.
___ ___ allows blood to enter the left atrium from the right atrium.
FORAMEN OVALE allows blood to enter the left atrium from the right atrium.
T.F most chest pain in children are due to cardiac factors
false.
Most chest pain in
children is non-cardiac
Coronary artery disease
is RARE in children
Most commonly
musculoskeletal pain
(15-30%)
Outline causes (cardiac and non cardiac) chest pain in children
Note:
note: normal vitals for children
Some characteristics of fetal circulation:
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
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
at birth, decreased vascular blood flow occurs so that there is increased ___ ___ ___
peripheral blood flow– expansion of lung, increased oxygenation, changes in NO and prostaglgandins
change in systemic vascular resistnce (SVR) at birth
increased
-Pulmonary vascular resistance falls completely by 4-6
weeks postnatally
Transitional Physiology
