Pediatric Cardiac Abnormalities

Question 1

Acyanotic defects + list

Answer 1

Patent ductus arteriosus (PDA), Atrial septal defect (ASD), Ventricular septal defect (VSD)

allow shunting from high-pressure left heart to lower pressure right heart

if left untreated can cause CHF sx - untreated leads to pulmonary HTN

Question 2

Patent ductus arteriosus (PDA) is considered what kind of defect? What is it?

Answer 2

acyanotic defect

vessel located b/w junction of main and left pulmonary arteries

failure of ductus arteriosus to close results in persistent patency – allows blood to shunt from aorta to pulmonary artery causing left to right shunt

Question 3

what does PDA result in? s/s and what type of murmur?

Answer 3

increased pulmonary blood flow resulting in increased pulmonary venous return to the LA and LV with increased workload on the left side of the heart

INCREASE IN LEFT SIDE WORKLOAD

s/s: dyspnea, fatigue, poor feeding, continuous machinery-type murmur; risk for bacterial endocarditis

Question 4

Atrial septal defect (ASD)

s/s?

Answer 4

acyanotic

abnormal opening b/w the atria – blood flows from high pressure left atria to low pressure right atria – leads to right atrial and ventricular enlargement

s/s: often asymptomatic, dx by murmur; pulmonary symptoms on exertion at later age

Question 5

Ventricular septal defect - what is it? s/s? common what?

Answer 5

acyanotic

abnormal connection b/w ventricles - shunting from high pressure left ventricle to low pressure right ventricle

common congenital heart lesion (25-33%); depends on size and degree of PVR

pulmonary over circulation accounts for symptoms in large VSD

s/s: heart failure, poor weight gain, murmur and systolic thrill

Question 6

cyanotic defects:

Answer 6

complex with right to left shunting and cyanosis – obstruction causes increased right sided pressure – still moves from high to low

Question 7

cyanotic defects: mild, severe, chronic

Answer 7

mild hypoxemia: occasional cyanosis

severe hypoxemia: feeding intolerance, poor weight gain, tachypnea, dyspnea

chronic hypoxemia: small for age, cognitive/motor delays, polycythemia, exertional dyspnea, easily fatigued, exercise intolerance, nail bed clubbing

Question 8

tetralogy of fallot - what is it? s/s?

Answer 8

syndrome represented by four defects: VSD, overriding aorta, pulmonary valve stenosis, right ventricle hypertrophy

s/s: cyanosis and clubbing, feeding difficulty, squatting
*hypercyanotic spell or “tet spell” that generally occurs with crying and exertion

Question 9

hypoplastic left heart syndrome

Answer 9

see pt 2 pg 5

Question 10

transposition of the great arteries

Answer 10

see pt 2 pg 6

Question 11

Acquired cardiovascular disorders in childhood - list

Answer 11

systemic HTN - often underlying renal disease or coarctation of the aorta (can cause HTN or hypo)

kawasaki disease

childhood obesity

Question 12

Kawasaki disease - timeline and processes (stage 1-4) + clinical manifestations during acute, subacute, convalescent

Answer 12

pt 2 pg 6

Question 13

s/s of Kawasaki disease in the acute phase

Answer 13

fever, conjunctivitis, oral changes (strawberry tongue), rash, and lymphadenopathy, irritability

Question 14

clinical manifestations of Kawasaki disease in the subacute phase

Answer 14

begins when fever ends; continues until clinical signs resolve

child is most at risk for coronary artery aneurysm development

desquamation of palms and soles occurs (peeling skin)

marked thrombocytosis

Question 15

clinical manifestations of Kawasaki disease convalescent

Answer 15

continued elevation of ESR and platelet count

arthritis may still be present, continues until all lab values return to normal at 6-8 wks