L10 - Pediatric Cardiology Flashcards
What is the common physiologic consequence of congenital heart disease (CHD)
Volume overload lesions
Which is false regarding congenital heart disease?
A) it is an anatomic defect of the heart, present at birth (eg valves narrowed)
B) most common of all birth defects (followed by club foot and cleft palate)
C) incidence is 6-8/1000 live births
D) Often results in abnormal ejection conditions on the heart, which leads to CHF
D - abnormal LOADING conditions on the heart which lead to CHF
• heart cannot pump blood effectively to meet the body’s metabolic demands
• CHF can occur in different clinical settings and for different underlying reasons such as volume overload lesions
Left to right shunt defect at ventricular level
Ventricular septal defect: produces classic CHF symptoms
Normal fetal physiology:
- what is the source of o2 in utero?
- T/F SVR > PVR?
- what causes high pulmonary resistance (3)?
- placenta
- F: PVR>SVR
- inc smooth mm in pulmonary vessels, collapsed lungs, alveolar hypoxia
Which is false regarding fetal circulation changes at birth?
A. Shift of blood flow for gas exchange from placenta to the lungs.
B. Expansion of lungs, decrease alveolar oxygen tension.
C. Fall in PVR due to potent vasodilatory effect of O2 on pulmonary vascularity
D. Subsequent rise in pulmonary blood flow occurs (blood flows to areas of least resistance)
B. Expansion of lungs, increase alveolar oxygen tension
Pulmonary vascular resistance and pulmonary blood flow at:
- birth
- 6-8wks
- PVR: high; PBF: low
2. PVR: low; PBF high
Why do ventricular septal defects begin to show CHF symptoms at 2-3 months of age?
This is when PVR drops to its lowest level (therefore PVR flow across VSD (L to R) will be at its max
When is prompt referral required for CHD?
Cyanosis (in newborns) or HF (at 4-6 weeks)
Does family history impact recurrence risk of CHD?
Yes
• Recurrence risk 1/50 with h/o single previous child with CHD
• Recurrence risk is 1/10 when parent affected
Risk higher when parent with CHD is mother
Postnatal history suggestive of CHD?
- Weight (delayed)
2. Feeding pattern (fatigue and dyspnea while feeding)
Signs of CHF (4)?
- Tachypnea/dyspnea
- Frequent respiratory infections
- Delayed developmental milestones
- Change in activity level
Which is not part of the inspection portion of the physical exam?
A. general appearance and nutritional state?
B. Color
C. Bruising
D. Respiratory Rate/Retractions
E. Cold sweat on forehad
F. Signs of diminished myocardial performance (precordial bulge, hyperdynamic precordium)
C. Bruising
What do you note when palpating during the physical exam (3)?
Peripheral pulses
- count and note rate
- weak or strong pulse
- systemic congestion? (hepatomegaly, peripheral edema)
What do you note when auscultating during the physical exam (2)?
- Heart rate (tachycardia) and regularity
2. heart murmurs
What do you see on CXR of a child with CHD/CHF?
- heart size/silhouette is enlarged
2. Pulmonary vascular markings are increased
