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Cardiology Technology > Pediatric Cardiology > Flashcards

Pediatric Cardiology Flashcards

1
Q

Where does the baby get its oxygen source in-utero?

A

From the placenta

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2
Q
  • Explain the process of hypoxic vasoconstriction in the unborn baby.
A

Alveoli of baby’s lungs has extremely low oxygen relative to nearby blood vessels
2. Hypoxia causes vasoconstriction in that artery. The hypoxia will ripple to the pulmonary artery

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3
Q

Which two points does the umbilical vein meet with in the liver?

A
  1. inferior vena cava via the ductus venosus

2. sinusoids of the liver

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4
Q

Describe the two pathways of fetal circulation.

A
  1. umbilical vein –> ductus venosus –> inferior vena cava –> right atrium –>
    2a. foramen ovale –> left atrium –> left ventricle –> semilunar valve –>
    2b. right ventricle –> pulmonary semilunar valve –> pulmonary trunk –> ductus arteriosus –>
  2. aortic arch –> descending aorta –> common external iliac arteries –> internal iliac arteries –> umbilical arteries –> placenta (reoxygenation point)
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5
Q

Why shouldn’t there be high pulmonary pressures once the baby is born?

A

The alveoli are now working, and have high oxygen levels relative to the nearby blood vessels, so shunting of the blood shouldn’t be necessary. If shunting isn’t necessary, then the pulmonary arteries shouldn’t need to constrict.

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6
Q

What three things happen after birth that signals the ductus arteriosus to close?

A
  1. decreased prostaglandins
  2. increased oxygen level
  3. increased bradykinins
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7
Q

What do the 6 fetus-specific circulatory structures turn into in the “adult”?

A
  1. ductus venosus –> ligamentum venosum
  2. foramen ovale –> fossa ovalis
  3. ductus arteriosus –> ligamentum arteriosum
  4. umbilical vein –> ligamentum teres
  5. umbilical artery - medial umbilical ligament or superior vesicle artery.
  6. allantois/vitalin duct –> median umbilical ligament
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8
Q

What is a paradoxical embolus?

A

Happens in a person with a foramen ovale. If a clot were to form in the lower body, it could travel through the patent foramen ovale. It will pass through the left ventricle, that clot can get lodged in the circulatory pathway to the brain, blocking blood flow to the brain. The resulting necrosis will lead to a stroke.

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9
Q

What is the jelly-like substance in the placenta called?

A

Wharton’s jelly

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10
Q

Which two fetal circulaltory structures will have the highest oxygens saturation, and what is the saturation level in these two structures?

A
  1. Umbilical vein
  2. Foramen ovale

Both are 85% O2.

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11
Q

Where is the ductus venosus?

A

between umbilical vein and inferior vena cava

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12
Q

When should the foramen ovale stop working and when should the hole fill up with fibrotic tissue?

A

during baby’s first breath; one year after birth

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13
Q

What medications are used to stimulate the closure of a patent ductus arteriosus, and why?

A

NSAIDs, these inhibit prostaglandin synthesis, which will in turn signal the ductus arteriosus to close functionally.

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14
Q

When should the two closures of the ductus arteriosus happen?

A

functionally, 10-15h after after birth; anatomically 2-3 weeks after birth

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15
Q

What are the three vascular shunts found in fetal circulation?

A
  1. ductus venosus
  2. foramen ovale
  3. ductus arteriosus
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16
Q

Which extra ECGs would you do for a baby?

A

V3R and V4R rhythm strips

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17
Q

Where are V3R and V4?

A

V3R - halfway between V1 and V4R

V4 - midclavicular line, 5th ICS on each respective side

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18
Q

At what stage is the heart rate highest, and what is the maximum possible HR at that stage?

A

1-3 months, the max can be 185bpm

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19
Q

What is the normal axis by one year of age?

A

+30 - +100

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20
Q

What is left axis deviation associated with in babies (4 conditions)?

A

ASD, perimembranous inlet VSD, tricuspid atresia, single ventricle

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21
Q

What is the Katz-Wachtel phenomenon (2 criteria)?

A

BVH, large equiphasic QRS in >= limb leads and from V2-V5

22
Q

What ECG finding could indicate RBBB and/or RVH?

A

RSR’ in V1 and/or V3R

23
Q

What is the normal PRI duration for a child?

A

0.08s-0.18s

24
Q

What is the maximum normal QRS duration for a pediatric ECG?

A

0.10s

25
Q

What relevance does QTc have?

A

QTc represents the length of the QTI in comparison to the expected QTI for a given heart rate, since QTI changes in inverse proportion to heart rate

26
Q

Where should the end of a ST segment lie in relation to the peaks of R-waves on either side of it?

A

-about halfway between either R-wave peak

27
Q

How do the right precordial T-waves’ direction change throughout the development stages of life?

A

During the first week of life, T-waves are upright.

After that, all the way up to post-puberty, the T-wave should be inverted.

28
Q

At what point in time throughout the life stages should the left ventricle get bigger than the right?

A

1 month

29
Q

In the neonate, their ECG characteristics can mimic what conditions?

A

RVH, RBBB

30
Q

What changes could you possibly need to make to the ECG settings for a pediatric ECG?

A
  • decrease standardization/gain (QRS in babies’ ECGs tend to be very high-amplitude, and can run into one another)
  • increase paper speed (babies’ hearts tend to beat faster, so to prevent the morphologies from being squished together, the paper speed has to go in proportion)
  • add extra leads (V7, V3R, V4R)
  • leads need to be closer to the midline of the body than usual (not only because the RV tends to be more active anyway, but to reduce artifact from limb movement)
31
Q

What percentage of people with congenital heart disease have ASD?

A

atrial septal defect, 5-10%

32
Q

Which way does the shunting go in ASD?

A

left –> right

33
Q

What is the name of the disorder where left-to-right intracardiac shunting leads to a change in intracardiac pressures and eventual reversal of the direction of shunting?

A

Eisenmenger’s syndrome

34
Q

In L–>R shunting, what could you see in the ECG?

A

RAE, RVH, RSR’ in V1-V3 (looks like RBBB), first-degree heart block

35
Q

Which is the most common type of congenital heart disease, and what percentage of all congenital heart defects does it make up?

A

VSD, 20-30%

36
Q

What percentage of people with congenital heart disease have PS?

A

5-8%

37
Q

What aortic pressure gradients ranges represent mild, moderate, and severe aortic stenosis?

A

<40 mmHg = mild
40-75 mmHg = moderate
>75 mmHg = severe

38
Q

Which of the congenital heart defects can produce LVH if severe enough

A

aortic stenosis, pulmonary stenosis, patent ductus arteriosus, ventricular septal defect

39
Q

In what percentage of aortic coarctation cases does bicuspid aortic valve occur?

A

85%

40
Q

How is coarctation, pulmonary stenosis resolved in a lot of cases?

A

balloon valvuloplasty

41
Q

How are septal defects often resolved?

A

plug the hole with a catheter, patch of Teflon

42
Q

Which surgical procedure is like creating a reverse ductus arteriosus, and which defect is it used for?

A

Blalock-Taussig shunt, which is used to remedy the Tetralogy of Fallot

43
Q

What are the two major defects involved in EBstein’s anomaly?

A
  1. a misshapen tricuspid valve
  2. atrial septal defect, so that blood can move from the right side of the heart to the left side of the heart without the normal pathways
44
Q

Which of the congenital heart defects will give you large p-waves on the ECG?

A

Ebstein’s anomaly

45
Q

Which of the congenital heart defects can cause extreme axis deviation?

A

atrioventricular canal defect

46
Q

Which 3 surgeries are used to treat Transposition of the Great Arteries?

A
  1. Mustard-Senning atrial shunt
  2. Jatenne arterial switch
  3. Rastelli procedure
47
Q

Which type of pediatric cardiology disorder makes up 75% of all pediatric cardiology disorders?

A

Acyanotic, aka red, disorders.

48
Q

Which type of pediatric cardiology disorder makes up 275% of all pediatric cardiology disorders?

A

Cyanotic, aka blue, disorders.

49
Q

What are the acyanotic disorders (6)?

A
  1. CoA (coarctation of the aorta)
  2. VSD (ventricular septal defect)
  3. PDA (patent ductus arteriosus)
  4. AS (aortic stenosis)
  5. ASD (atrial septal defect)
  6. PS (pulmonary stenosis)
50
Q

What are the cyanotic disorders (6)?

A
  1. ES (Eisenmenger’s syndrome)
  2. ToF (tetralogy of Fallot)
  3. TGA (transposition of the great arteries)
  4. TA (tricuspid atresia)
  5. TAPVR (total anomalous pulmonary venous return)
  6. EA (Ebstein’s anomaly)
51
Q

What are 4 causes of short PRI in pediatric cardiology?

A
  1. Duchenne’s
  2. WPW
  3. accessory pathways
  4. Friedrich’s ataxia
52
Q

What are 2 causes of short QTI in pediatric cardiology?

A
  1. digoxin use

2. hypercalcemia

Cardiology Technology (20 decks)

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