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cardio > neonate and pediatric CP conditions > Flashcards

neonate and pediatric CP conditions Flashcards

1
Q

(slide 4)

The lungs of a fetus develop over 3 periods; what are they?

A

-embryonic period
-fetal period
-birth and postnatal growth

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2
Q

(slide 4)

name the different stages of fetal lung development (there are 5 stages)

A

-embryonic
-pseudoglandular
-canalicular
-saccular
-alveolar

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3
Q

(slide 4)

the stages of fetal lung development are divided into 2 parts; name them

A

-organogenesis
-differentiation

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4
Q

(slide 4)

What happens during the embryonic stage (1st stage) of fetal lung development?

A

-lung bud formation
-trachea and bronchi differentiation

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5
Q

(slide 4)

What happens during the pseudoglandular stage (2nd stage) of fetal lung development?

A

-conducting airways formation
-terminal bronchioles

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6
Q

(slide 4)

What happens during the canalicular stage (3rd stage) of fetal lung development?

A

-increased vascularization
-formation of air-blood interface

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7
Q

(slide 4)

What happens during the saccular stage (4th stage) of fetal lung development?

A

-amino fluid will have detectable surfactant in it

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8
Q

(slide 4)

What happens during the alveolar stage (5th stage of fetal lung development)?

A

-mature alveoli formation
-prolifration and expansion of capillaries, nerve, and gas exchange areas

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9
Q

(slide 4)

The embryonic stage occurs from week … to week ….

A

3-7

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10
Q

(slide 4)

The pseudoglandular stage occurs from week … to week ….

A

7-17

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11
Q

(slide 4)

The canalicular stage occurs from week … to week ….

A

17-27

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12
Q

(slide 4)

The saccular stage occurs from week … to week ….

A

27-36

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13
Q

(slide 4)

The alveolar stage occurs from week … to week ….

A

36- 7-10 years

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14
Q

(slide 5)

The first functional organ, which starts by the 3rd week of gestation, is…

A

the heart

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15
Q

(slide 5)

Explain how the heart starts during the third week of gestation

A

it starts as two endocrdial tubes merge to form primitive heart tube, know as the tubular heart

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16
Q

(slide 5)

By which week is the heart completed?

A

by the 4th week, where it starts to beat and blood circulation begins

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17
Q

(slide 5)

What is the heart rate during the start of the 4th week of gestation, and what rate does it eventually reach?

A

it starts with a rate of 75–80 bpm and accelerates to reach 165–185 bpm (approx. 3.3 bpm/day)

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18
Q

(slide 5)

By which week do the heart chambers, septa, and valves develop?

A

9th week

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19
Q

(slide 5)

What happens to the heart rate by week 12?

A

it starts to decrease to 120–160 bpm

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20
Q

(slide 6)

Look at the table below. What can you observe?

A

Both respiratory rate and heart rate decrease as a new born reaches adolescence, whereas the systolic bp increases

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21
Q

(slide “7”)
Looking at the picture below, explain fetal circulation

A
  1. Blood rich in nutrients and oxygen flows from the placenta to through the umbilical vein
  2. Blood flows from the umbilical vein to ductus venosus
  3. Blood flows from ductus venosus into the right atrium via inferior vena cava, and some blood flows from superior vena cava into the right atrium as well
  4. Some of the blood in the RA will flow to the RV and some will flow to the LA via foramen ovale
  5. The blood in the LA then flows to the LV
  6. Then from the LV to the aorta and into the body
  7. Blood that was pumped into the RV flows through the pulmonary artery to reach ductus arteriosus, where it is mostly pumped into the aorta and some goes to the lungs
  8. Deoxygenated blood flows from the umbilical arteries back into the placenta to get oxygenated
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22
Q

(slide 8)

What happens during the transision of fetal circulation to the extrauterine world? (only some are mentioned in this card)

A

-clearance of fetal lung fluid and filling with air instead
-decrease in pulmonary vascular resistance
-functional closure of two fetal channels (foramen ovale, ductus arteriosus)

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23
Q

(slide 8)

What are the two fetal channels that close when the fetus is born?

A

-foramen ovale
-ductus arteriosus

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24
Q

what are the two categories of neonatal heart defects?

A

-acyanotic heart defects
-cyanotic heart defects

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25
Q

(slide 11)

What do acyanotic heart defects refer to?

A

they refer to any structural abnormality in the heart that does not cause right-to-left intracardiac shunting

(deoxygenated blood from the right side of the heart does not mix with oxygenated blood in the left, thus no signs appear on the pt)

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26
Q

(slide 8)

Acyanosis (acyanotic heart defects) indicates that the patient should have normal oxygen
saturations, explain.

A

because deoxygenated blood from the right side of the heart does not mix with oxygenated blood on the left, thus the pt has normal O2 saturation and no signs appear on them

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27
Q

(slide 8)

What are the most common types of congenital heart disease?

A

-Atrail Sepatl Defects (ASD)
-Ventricular Septal Defects (VSD)

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28
Q

(slide12)

In ASD, where does the defect (opening) occur?

A

in the intra-atrial septum,which creates an anatomical connection between
the two uppermost chambers of the heart (the two atria).

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29
Q

(slide 12)

What is a shunt?

A

it is when there is an opening between the two atria does not close; therefore, blood continues to flow between them

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30
Q

(slide 12)

What health problems could a shunt in the heart lead to?

A

pulmonary edema, due to the pressure build up in the lungs, which causes less O2 in the blood that goes to the body

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31
Q

(slide 12)
how long doesit take for a small ASD (> 6mm) to close compare to a ASD (< 6mm)

A

ASD > 6mm spontaneusly close by the age of 2, where as ASD < 6mm closes prior to starting school

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32
Q

(slide 13)

What is the most common congenital HEART LESION?

A
  • ventricular septal defect (VSD)
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33
Q

(slide 13)

VSD causes a connection between….

A

-the right and left ventricles

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34
Q

(slide13)

What are the symptoms of a small VSD?

A

Small defects with little intracardiac shunting will usually remain asymptomatic.

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35
Q

(slide 13)

A large VSD can result in increased pulmonary blood flow and increased pulmonary venous return to the left side of the heart. What will this lead to?

A

left ventricular volume overload

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36
Q

(slide 14)

What does AVCD stand for?

A

atrioventricualr canal defect

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37
Q

(slide 14)

What is AVCD characterized by?

A

a deficiency of the atrioventricular septum of the heart

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38
Q

(slide 14)

What are the defects included in AVCD?

A
  • ASD
  • VSD
  • Abmortalities of the artioventricular valves (usually the mirtal and tricuspid)
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39
Q

(slide 14)

AVCD is most common in?

A

children with down syndrome

40
Q

(slide 14)

Should AVCD be left to close alone?

A

no, surgery in the first 6 months of life is often necessary to correct defects

41
Q

(slide 15)

What is the blood vessel that connects the pulmonary artery and the aorta called?

A

ductus arteriosus

42
Q

(slide 15)

What is the importance of the patent ductus arteriosus in the utero?

A

it facilitates the appropriate blood flow from the placenta to the organs to deliver oxygen and nutrients

43
Q

(slide 15)

When a child is born and the ductus arteriosus is still patent (open), it causes the heart to perform extra work to deliver the same amount of oxygen to the organs. Why is that?

A

because blood travels through the pulmonary system unnecessarily instead of going directly to the organs to deliver oxygen.

44
Q

(slide 16)

What is the most common congenital heart defect found in PRETERM NEONATES?

A

patent ductus arteriosus (PDA)

45
Q

(slide 16)

What are the respiratory complications that PDA is usually associated with?

A

they are associated with pulmonary edema that results from pulmonary overcerculation

46
Q

(slide 16)

What can be used to alleviate capillary leakage due to PDA?

A

continuous positive pressure in the lungs, by the application of PEEP

47
Q

(slide 17)

What are the four most common types of LEFT-TO-RIGHT cardiac shunts?

A

-Atrial septal defect (ASD)
-Ventricular septal defect (VSD)
-Atrioventricular septal/canal defect
(AVCD or AVSD)
-Patent ductus arteriosus (PDA)

48
Q

(slide18)

What is meant by cyanotic heart defects?

A

structural abnormalities that lead to significant mixing of oxygenated and deoxygenated blood and cause oxygen saturations to be less than 85%.

(meaning the blood flows from the right side of the heart to the left, unlike acyanotic heart defects)

49
Q

(slide 19)

Why should any neonate presenting with oxygen saturations of 85% to 90% be assessed?

A

to determine whether the cause of hypoxemia is lung disease or congenital heart disease

50
Q

(slide 20)

What are the classic cyanotic congenital heart lesions referred to as?

A

the 5 Ts

51
Q

(slide 20)

name the 5 Ts

A

1-Tetralogy of Fallot (TOF)
2-Transposition of the great arteries
3-Truncus arteriosus
4-Tricuspid atresia
5-Total anomalous venous return

52
Q

(slide 21)

What is the most common form of cyanotic congenital heart disease?

A

TOF

53
Q

(slide 21)

TOF is caused by a combination of four condictions. What are they?

A

1-VSD
2-Pulmonary stenosis
3-Right ventricular hypertrophy
4-overriding aorta
(1+2 lead to 3+4)

54
Q

knowledge!

What is pulmonary stenosis?

A

the narrowing of the pulmonary valve, which controls the flow of blood from the heart’s right ventricle into the pulmonary artery to carry blood to the lungs.

55
Q

knowledge!

What is right ventricular hypertrophy?

A

an abnormal enlargement or pathologic increase in muscle mass of the right ventricle, in response to pressure overload (due to pulmonary stenosis)

56
Q

knowledge!

What is an overriding aorta?

A

a congenital heart defect where the aorta is positioned directly over a ventricular septal defect (VSD), instead of over the left ventricle

57
Q

(slide 22)

children with TOF exhibit bluish skin during episodes of crying or feeding, explain why?

A

due to “Tet spells” where at 2-3 yo, a child becomes cyanotic and experiences syncope (SOB)

58
Q

(slide 24)

what is the condition in which a single great vessel leaves the heart and supplies the systemic and pulmonary circulation called?

A

truncus arteriosus

59
Q

(slide 24)

truncus arteriosus is usually diagnosed prenatally via ultrasound, if not, what may neonates present with?

A

asymptomatic cyanosis, meaning they may be blue with saturations in the 75% to 85% range without respiratory distress.

60
Q

(slide 24)

Does a child with truncus arteriosus have a high chance of surviving without surgical intervention?

A

no, without surgical intervention, the chance of mortality with truncus arteriosus is high

61
Q

(slide 25)

What causes transposition of the great arteries (TGA) to occur?

A

It occurs when the two main arteries leaving the heart change places, so that the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle.

62
Q

(slide 25)

What is the PERMANEMT treatment (fixation) for TGA?

A

a surgical intervention known as arterial switch operation

63
Q

(slide 26)

What is the condition called when pulmonary vessels carrying oxygenated blood are not connected to the left atrium?

A

Total Anomalous Venous Return

64
Q

(slide 26)

In which cyanotic congenital heart defect are the pulmonary and systemic circulations not connected?

A

Total anomalous venous return

65
Q

(slide 26)

What anatomical structure must be present in order for a total anomalous return to not be fetal?

A

either a septal defect or patent foramen ovale

66
Q

(slide 28)

what is the most common and most serious VALVE disease?

A

Aortic Stenosis

67
Q

(slide 29)

What does pulmonary stenosis refer to?

A

a narrowing/ obstruction in the right ventricular outflow tract between the right ventricle and the main pulmonary artery.

68
Q

(slide 29)

Which common heart defect has an unknown cause?

A

pulmonic stenosis

69
Q

(slide 29)

What is the affect of pulmonic stenosis on the heart?

A

it causes increased workload on the right ventricle, which leads to right ventricular hypertrophy

70
Q

(slide 30)
a condition where there is a discrete narrowing of the descending thoracic aorta

A

Coarctation of the aorta

71
Q

(slide 30)

what is the rare congenital heart defect in which the left side of the heart is severely underdeveloped called?

A

Hypoplastic left heart syndrome (HLHS)

72
Q

(slide 32)

What is repiratory distress syndrome characterized by?

A

-lack of surfactant, which leads to –>
-immaturity of the lungs and this leads to –>
- severe impairment of the respiratory function

73
Q

(slide 32)

A disease that was first (in the early 20th century) thought to be a rare form of penumonia

A

respiratory distress syndrome

74
Q

hyaline membrane disease is another name for? (called that because of the unique cellular characteristics of the lung)

A

respiratory distress syndrome

75
Q

(slide 33)

what are the three features of RDS pathophysiology?

A

1-A decrease in surfactant production
2-Increased distance between alveolar spaces and capillaries
3-Lung hypoplasia (lung tissue underdevelopment)

76
Q

(slide 33)

what does a decrease in surfactant production cause?

A

low alveolar compliance

77
Q

(slide 33)

What does the increased distance between alveolar spaces and cappilaries do?

A

It worsens gas exchange along with a thick alveolar-capillary (A-C) membrane.

78
Q

(slide 33)

What is the primary cause of respiratory distress?

A

lung hypoplasia

79
Q

(slide 34)

What are some symptoms that could indicate an infant has RDS? (only 2 are mentioned is this card)

A

-see-saw breathing pattern
-hypercarbia (increased CO2 “hypercapnea”)

80
Q

(slide 35)

a sudden cessation of breathing that lasts for at least 20 seconds and is accompanied by bradycardia or oxygen desaturation in an infant younger than 37 weeks’ gestation, what is this condition called?

A

apnea of prematurity (AOP)

81
Q

(slide 35)

What is the classification of AOP?

A

-central apnea
-obstructive apnea
-mixed apnea

82
Q

(slide 36)

What are the causes of brochcopulmonary dysplasia? (there are 4)

A

-mechanical ventilation
-high FiO2
-infections
-heredity

83
Q

(slide 36)

What type of care does a newborn with bronchopulmonary dysplasia need?

A

-supplimental O2 for at least 28 days after birth
-assistance at discharge or until they reach full term gestation

84
Q

(slide 36)

When is an infant susceptible to bronchopulmonary dysplasia?

A

If they’re preterm (born at 30-34 weeks gestation) with a history of severe respiratory distress that requires high levels of ventilatory support and O2 exposure for a prolonged period

85
Q

(slide 38)

What does (PPHN) stand for?

A

presistant pulmonary hypertension of the newborn

86
Q

(slide 38)

What is PPHN characterized by?

A

-severe hypoxmia
-high pulmonary artery pressure

87
Q

(slide 38)

Why do infants with PPHN have severe hypoxemia and high pulmonary artery pressure?

A

because the pulmonary vascular resistance (PVR), which is normally high in utero, fails to decrease at birth

88
Q

(slide 38)

In PPHN, pulmonary pressure is higher than arterial pressure, what does this cause?

A

Right to left shunt either in the foramen ovale or ductus arteriosus

89
Q

(slide 38)

What conditions does PPHN result in?

A

-systemic hypoxmia and cyanosis

90
Q

(slide 39)

what a baby’s first bowls movement called?

A

meconium

91
Q

(slide 39)

A respiratory distress occurring soon after delivery in a meconium-stained infant, what is it called?

A

Meconium aspiration syndrome (MAS)

92
Q

(slide 39)

Who are affected by Meconium aspiration syndrome (MAS)?

A

primarily term and post-term infants

93
Q

(slide 40)

A condition of term or near-term infants, characterized by mild respiratory distress during the first few hours of life

A

Transient tachypnea of the newborn (TTN)

94
Q

(slide 40)

What causes transient tachypnea of the newborn (TTN)?

A

failure to clear fetal lung fluid

95
Q

(slide 40)

How long does it take for (TTN) to be resolved?

A

typically resolves within 48 to 72 hours of life

96
Q

(slide 40)

What are the clinical features of TTN? (5 features)

A
  • Respiratory distress within 6 hours of birth
  • Tachypnea: RR > 60 breaths/min
  • Grunting
  • Nasal flaring
  • Retractions

cardio (5 decks)

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