Lecture 5 (Peds Cardio)-Exam 2 Flashcards
What is congenital heart disease? What is it also known as?
- A malformation of theheart, aorta, or other large blood vessels that change the normal flow of blood through the heart.
- Also known ascongenital heart defect, congenital heart malformation, congenitalcardiovascular disease, congenital cardiovascular defect, & congenital cardiovascular malformation.
Congenital Heart Disease (CHD)
* Most frequent form of what?
* Born with what?
* Affects how many kids?
- CHD is the most frequent form of major birth defect in newborns.
- Born with the defect but can present at all ages
- Affects ~ 8 out of every 1,000 newborns
- Each year more than 35,000 babies in the US are born with CHD
Congenital Heart Disease (CHD)
* What are the sxs?
* What is the spectrum?
- Signs & symptoms – depend on the type and severity of the defect, can include: asymptomatic, cyanosis, CV collapse, CHF
- Benign -> Life threatening
Causes of CHD
* What is the mcc?
* Maternal exposures?
* Family history?
* Prematurity?
- Most congenital heart defects have no known cause
- Maternal Exposures: Medications, Viruses, Diseases
- Family History: 3 x increased risk when a first-degree relative has CHD
- Prematurity: 2 to 3x higher in preterm= gestational age <37 weeks
Causes of CHD
* Genetic? (3)
- Genetic syndromes -Chromosome abnormalities (trisomy)
- Genetic syndromes -Single Gene Mutation (marfan’s)
- Genetic syndromes -Other: CHARGE syndrome, VACTERL association
Three common classifications of congenital heart disease, according to the American Heart Association.
- Septal defects
- Obstructive defects
- Cyanotic defects
What are all the different septal defects?
- Patent Ductus Arteriosus (PDA)
- Atrial Septal Defect (ASD)
- Ventricular Septal Defect (VSD)
- Atrioventricular Canal Defxect (AV canal)
Patent Ductus Arteriosus (PDA)
* Communication between what?
* Shunt?
- Persistent communication between descending thoracic aorta & pulmonary artery
- Left to right shunting (acyanotic aka no blue blood)
* Left to right meaning Aortic blood is being shunted into pulmonary artery which leads to increase blood/dilation of left atrium/ventricule
- Occurs in 3-8 of every 10,000 full-term births,
- 2:1 female-to-male ratio
What are the risks that can cause PDA?(5)
- Risks: prematurity (~8 in 1,000), perinatal distress, hypoxia, Down syndrome, Rubella in first trimester
PDA clinical manifestations:
* May be what into adulthood?
* What are some common signs in babies?(5)
- May be asymptomatic (into adulthood)
- Poor feeding and growth
- Sweating while feeding or crying
- Fast breathing
- Rapid pulse
- Tiring very easily
PDA clinical manifestations:
* What does the exam show?
- Continuous Machinery Murmur (classic sign)
- Bounding peripheral pulses
PDA-Diagnosis
* What imaging can be done? What are the results?
* What is gold standard?
- CXR- normal; may have cardiomegaly (if severe)
- ECG – normal; LVH and left atrial abnormality
- ECHO – Gold Standard test
PDA-Treatment
* What is the treatment?
- Observation (often resolves without intervention)
- IV Indomethacin (preterm infants-28 weeks)-> CLOSE PDA
- Surgical intervention if doesn’t close with Indomethacin
* Surgical ligation <6kg; Percutaneous occlusion >6kg or in adolescents &adults
Atrial Septal Defect (ASD)
* What is it?
* Shunt?
* Difficult to differentiate between what?
- Hole in the septum between the two atria - “hole in the heart”
- One of the most common etiologies of right heart dilation due to L->R Shunting
- Difficult to differentiate a PFO from an ASD
Atrial Septal Defect (ASD)
* How many causes of all congenital heart diease?
* Occurs in how many births in the US?
- 10% - 15% of all congenital heart disease
- Occurs 1-2 in 1,000 live births in the US
What are the risks of ASD?
family history, genetic disorders, drugs/alcohol
ASD
* Most common congenital lesion in adults after what?
Most common congenital lesion in adults after bicuspid aortic valves (Second most common congenital heart defect in adults)
ASD clinical presentation:
* Small ASD=
* Large ASD=
- Small ASD= no symptoms until adulthood, usually >30 years
- Large ASD= infants and children symptomatic
* recurrent respiratory infections, difficulty breathing, tiring when feeding (infants), dyspnea on exertion, fatigue, palpitations, arrhythmias, rarely heart failure
All depends on size of defect
ASD- Clinical Presentation
* Adults manifest what?
* What does the exam show?
Adults manifest same symptoms + increased risk of heart failure
* recurrent respiratory infections, difficulty breathing, tiring when feeding (infants), dyspnea on exertion, fatigue, palpitations, arrhythmias, rarely heart failure
Exam-
* Wide fixed split S2, systolic ejection murmur – left upper sternal border
* Right ventricular heave (at LSB)
ASD patho
* How is the blood moving and why?
* What does the moving of blood cause?
- Difference in compliance between the Right Atrium + Right Ventricle as compared to Left Atrium + Left Ventricle + the size of defect = shunting of oxygenated from left side of heart to right side
- Increased pulmonary blood flow from L->R shunting= increased pulmonary artery pressure = Pulmonary HTN
- Increased blood flow from L->R shunting= increased volume to R Atria = R Ventricle enlargement
What is the MC place for ASD? What are the other places?
ASD diagnosis:
* What are the different tests and results?
* What is the gold standard?
CXR – Normal; may have cardiomegaly with increased pulmonary vascularity (dt increase pHTN)
ECG – Normal; Incomplete RBBB
* Crochetage sign – notching of the peak of the R wave
ECHO- Gold standard test
ASD treatmetn:
* What is the treatment?
- Observation-small ASDs typically resolve by age 5
- Surgical correction for moderate/large ASDs typically > 2 yrs or persistent small ASDs in adults having significant symptoms
What does ASD lead to?
RIGHT Heart Dilatation
* This is because right side is more compliant