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Pathophysiology > Pediatric Cardiology > Flashcards

Pediatric Cardiology Flashcards

1
Q

What congenital heart defect does PDA stand for?

A

Patent Ductus Arterious

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2
Q

What congenital heart defect does ASD stand for?

A

Atrial Septal Defect

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3
Q

What congenital heart defect does VSD stand for?

A

Ventricular Septal Defect

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4
Q

What congenital heart defect does TET stand for?

A

Tetrology of Fallot

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5
Q

What congenital heart defect does Coarc stand for?

A

Coarctation of the Aorta

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6
Q

A ____ heart defect is defined as a defect that occurs as a result of abnormal development of the heart and related structures during development

A

Congenital

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7
Q

Congenital heart defects affect between __-__ babies per 1000 live births

A

4-10

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8
Q

Congenital heart defects are the leading cause of ___ (excluding prematurity) during the first year of life

A

Death

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9
Q

During the first year of life, ___% of infants with heart defects require treatment or diet within the first year

A

35

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10
Q

The cause of the heart defects is only known in about ___% of cases

A

10

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11
Q

In the United States, there seems to be an ____ in cases of congenital heart defects; the cause is not known but it is thought that we just have better detection methods today

A

Increase

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12
Q

The risk for development of congenital heart disease increases when there is an increase in the number of ___ ___ relatives affected

A

First degree

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13
Q

What heart defects can be caused by trisomy 13?

A

-VSD
-PDA
-ASD

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14
Q

What heart defects can be caused by trisomy 21?

A

-Endocardial cushion defect
-VSD
-PDA
-ASD
-TET
-Transportation of great vessels
-Coarctation of the aorta

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15
Q

What types of heart defects might be caused by Turner’s Syndrome?

A

-Coarctation of the aorta
-PDA
-Pulmonary stenosis
-Septal defects

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16
Q

What types of heart defects might be caused by Cru du chat Syndrome?

A

-PDA
-Mixed defects

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17
Q

About ___% of congenital heart defects are thought to be caused by a combination of genetic and environmental factors

A

90

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18
Q

Because of the improved treatment methods, many children are growing up and having children; the risk of a child having a congenital defect is ___-___%

A

5-15%

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19
Q

If two siblings have cardiac anomalies, the risk is about ___% for the next child, but if three children are affected, the risk jumps to ____%

A

9; 50

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20
Q

Intrauterine infections, along with viral infections and Rubella, may cause what types of heart defects?

A

-PDA
-Pulmonary stenosis
-Coarctation of aorta

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21
Q

___ ____ can infect endothelial cells, but the specific cardiac effects are unknown

A

Herpesvirus cytomegalovirus

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22
Q

Diabetes might cause what types of heart defects?

A

-VSD
-Cardiomegaly
-Transposition of great vessels

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23
Q

What types of heart defects might be caused by PKU?

A

-PDA
-Coarctation of the aorta

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24
Q

Hypercalcemia may cause what types of heart defects?

A

-Supravalvular aortic stenosis
-Pulmonary stenosis

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25
Q

Alcohol abuse may cause what heart defects?

A

-TET
-ASD
-VDS

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26
Q

Warfarin use may cause what heart defects?

A

-ASD
-PDA

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27
Q

Increased maternal age increased risk for what cardiac defects?

A

-VSD
-TET

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28
Q

Prematurity increases risk of what heart defects?

A

-PDA
-VSD

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29
Q

Living at a high altitude increase risk for what heart defects?

A

-PDA
-ASD

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30
Q

Approximately the ___-___ day of fetal life, two lateral endothelial heart tubes fuse to form a single endocardial tube

A

21st-22nd

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31
Q

By the ___ day, the tube thickens and the first fetal heart contractions occur

A

28th

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32
Q

The tube them coils to the right and by the end of the ___ week, the tube is completely coiled and the major chambers are identified

A

4th

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33
Q

By the 22/23rd day, what structures can be identified in the heart?

A

-1st aortic arch
-Bulbus cordis
-Ventricle
-Atrium

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34
Q

By the 23/24th day, what structures can be identified in the heart?

A

-Truncus arteriosus
-Bulbus cordis
-Ventricle
-Atrium
-Sinus venosus

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35
Q

By the 24/25th day, what structures can be identified in the heart?

A

-1st and 2nd aortic arches
-Truncus arteriosus
-Ventricle
-Premature left atrium

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36
Q

The cranial end of this primitive heart is known as the ___ ___ which will further divide into the great vessels

A

Truncus arteriosus

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37
Q

The caudal end of the primitive heart will become the…

A

Superior and inferior cava

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38
Q

____ is also occuring at this time which creates the beginning of the heart valves

A

Septation

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39
Q

The heart is completed by __ __ after conception, therefor some congenital defects are formed before the pregnancy is recognized

A

6 weeks

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40
Q

Fetal ____ is anatomically and physiologically different from postnatal

A

Circulation

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41
Q

Oxygenation occurs in the ____ and not in the lungs

A

Placenta

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42
Q

Fetal lungs are filled with fluid and have low ___ ___ tension which produces pulmonary vasoconstriction

A

Arterial O2

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43
Q

There is ___ resistance to pump blood into the fetal lungs, but we don’t want much in there anyway

A

High

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44
Q

Because of the pulmonary constriction, only ___% of the fetal cardiac output is received by the pulmonary circulation

A

8

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45
Q

Fetal systemic vascular resistance is low, and nearly half of the blood flow enters the ____ which provides low resistance to flow

A

Placenta

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46
Q

The fetus is ____ with an O2 saturation of approximately 60-70%; however the fetus is not hypoxic because of the extremely high cardiac output

A

Hypoxemic

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47
Q

The cardiac output of a fetus averages about ___-__ ml/kg/min

A

400-500

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48
Q

The best oxygenated blood from the placenta travels to the fetal ___

A

Brain

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49
Q

The fetal blood is oxygenated in the placenta, which is a less efficient oxygenator than the ___

A

Lungs

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50
Q

The oxygenated blood enters the fetus through the ___ ___ to the liver

A

Umbilical vein

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51
Q

About 50% of oxygenated blood enters the ___ ___, bypassing the hepatic circulation and flowing into the inferior vena cava

A

Ductus venosis

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52
Q

When this blood reaches the right atrium, it is diverted by the ___ ___ toward the atrial septum, and flows through the foramen ovale into the left atrium

A

Crista dividens

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53
Q

The blood then passes through the left ventricle and ___ ___ to perfuse the head and upper extremities

A

Ascending aorta

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54
Q

This pathway allows the best-oxygenated blood from the placenta to perfuse the ___ ___

A

Fetal brain

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55
Q

Venous blood from the heat and upper extremities results to the fetal heart through the ___ ___ ___, enters the right atrium and ventricle, and flows into the pulmonary artery

A

Superior vena cava

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56
Q

Since pulmonary vascular resistance is high, this blood is diverted through the ductus arteriosus into the ___ ____

A

Descending aorta

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57
Q

Ultimately, much of this blood will return to the ____ through the umbilical cord to be reoxygenated

A

Placenta

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58
Q

Within the first few breaths, the lungs are filled with air and it becomes a more efficient ____

A

Oxygenator

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59
Q

With this in increase in O2 and decrease in CO2, the ___ ___ ___ starts to drop

A

Pulmonary vascular resistance

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60
Q

As the peripheral vascular resistance starts to decrease, right atrium and right ventricle pressures ____

A

Decrease

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61
Q

Systemic vascular resistance increases due to the elimination of the placenta, therefore increasing ___ ___ and ___ ___ pressure

A

Left atrium, left ventricle

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62
Q

This change in pressure gradient functionally closes the ___ ___

A

Foramen ovale

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63
Q

Anatomic closure, due to ___ deposits, is completed within the first few months of life

A

Fibrin

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64
Q

The change in O2 and CO2 levels is caused by constriction of the ___ ___

A

Ductus arteriosus

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65
Q

Another factor in constriction of the ductus arteriosus is the sudden drop in ____

A

PGE1

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66
Q

The ductus is usually functionally closed by ___ to ___ hours after birth with anatomical closure within ___-___ days of life

A

15-18 hours; 10-21 days

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67
Q

If a defect is present, the duct can stay open or be reopened with medications like _____

A

Prostaglandin

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68
Q

Due to the vasoconstriction of the umbilical arteries and the elimination of blood flow through the ___ ___, by 7 days post-natal, there is no flow through the duct

A

Ductus venosus

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69
Q

The ductus venosus because then becomes the ___ ___

A

Ligamentum venosum

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70
Q

There is marked change in ___ ___ after birth

A

Pulmonary resistance

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71
Q

The change in pulmonary resistance in a neonate is ___ and related to the infant’s condition

A

Variable

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72
Q

Problems with increased peripheral vascular resistance that occur are related to factors that cause constriction of the ___ ___

A

Pulmonary bed

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73
Q

Constriction of the pulmonary bed can result in ___ ___ (2/1000 live births- children may be very sick)

A

Pulmonary hypertension

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74
Q

With a ____ lesion, there is usually an obstruction to pulmonary blood flow

A

Cyanotic

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75
Q

With a cyanotic lesion, blood shunts from ___ to ___, decreasing blood flow to the pulmonary circulation

A

Right to left

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76
Q

Cyanotic lesions cause a mixing of ____ and ___ blood

A

Oxygenated and deoxygenated

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77
Q

With an ____ lesion, blood usually shunts from left to right

A

Acyanotic

78
Q

With acyanotic lesions, blood moves from ____ pressure to ___ pressure

A

High to low

79
Q

Usually, acyanotic lesions cause ___ ___ of pulmonary blood flow

A

Over circulation

80
Q

____ lesions are a stenotic area with restrictive blood flow

A

Obstructive

81
Q

With obstructive lesions, there is hypertension ___ to obstruction

A

Proximally

82
Q

With obstructive lesions, there is hypoperfusion ____ from obstruction

A

Distally

83
Q

A patent ductus arteriosus (PDA) is caused by…

A

Failure of ductus arterious to close

84
Q

With PDA, blood shunts normally from ___ to ___

A

Left to right

85
Q

Is a PDA a cyanotic or acyanotic defect?

A

Acyanotic

86
Q

A PDA can be part of a ____ defect

A

Complex

87
Q

A PDA can be ___ ___ is more complex defects

A

Medically necessary

88
Q

With a PDA, there is increased blood flow to the ____, resulting in increased workload on the left side of the heart

A

Lungs

89
Q

Clinical manifestations of PDA:

A

-Continuous machinery-type murmur heart beat at the upper left sternal border through systole and diastole (aortic area)
-If the lesion is significant, infants will also have bounding pulses, and active precordium (you can see their heart beating), a thrill upon palpation, and signs and symptoms of CHF from the pulmonary overcirculation

90
Q

A small PDA is usually ____

A

Asymptomatic

91
Q

Atrial septal defects (ASD) are caused by…

A

Improper formation of the septal wall

92
Q

Is an ASD cyanotic or acyanotic?

A

Acyanotic

93
Q

An ASD causes a failure of the ___ ___ to close

A

Foramen Ovale

94
Q

ASD is the ___ most common congenital heart defect

A

4th

95
Q

___ ___ ___ is an opening found low in the septum that may be associated with AV valve abnormality

A

Ostium primum defect

96
Q

___ ___ ___ is an opening in the center of the septum and is the most common

A

Ostium secundum defect

97
Q

___ ___ ___ is an opening high up in the atrial septum near the superior vena cava and right atrium junction

A

Sinus venosus defect

98
Q

With ASD, blood is shunted ___ to ___ because of the higher pressure of the left atrial chamber

A

Left to right

99
Q

ASD might cause right atrium and right ventricle ___

A

Enlargement

100
Q

Children with ASD are usually ____

A

Asymptomatic

101
Q

With an ASD, you will hear a ____-____ systolic ejection murmur due to increase blood flow the pulmonary valves

A

Crescendo-decrescendo

102
Q

Erb’s point is…

A

2nd-3rd intercostal space, left sternal border

103
Q

With an ASD, you might also hear a wide fixed splitting of the ____ heart sound due to volume overload in the right ventricle

A

Second

104
Q

Volume overload causes a prolonged ___ ___ and delay of pulmonic valve closure resulting in the splitting sound

A

Ejection time

105
Q

Small ASD might go undetected until adulthood when ____-like symptoms appear

A

Stroke

106
Q

A ventricular septal defect (VDS) is a defect in the ___ ___

A

Septal wall

107
Q

Is a VSD cyanotic or acyanotic?

A

Acyanotic

108
Q

Those with VSD are usually asymptomatic until there is a fall in ___ ___ ___ at 2-4 weeks of age

A

Peripheral vascular resistance

109
Q

A VSD is the most common congenital heart defect, accounting for approximately ___-___% of all defects

A

25-33%

110
Q

With VSD, blood is shunted from ___ to ___

A

Left to right

111
Q

The amount of shunting with VSD is dependent on the size of the defect as well as the degree of ___ ___

A

Pulmonary resistance

112
Q

With VSD, blood is shunted on ____, so blood goes right out the pulmonary artery into pulmonary circulation

A

Systole

113
Q

With VSD, you will see ____ of the main pulmonary artery, left atrium, and left ventricle

A

Enlargement

114
Q

With VSD, ___ ___ hypertrophy occurs to effectively pump the additional volume

A

Left ventricle

115
Q

With VSD, eventually the heart can’t handle the increased volume and ___ ___ ____ develops

A

Congestive heart failure

116
Q

Clinical manifestations in children with VSDs depend on…

A

-Age of the child
-Size of the defect
-Level of pulmonary resistance

117
Q

Newborns with VSD are relatively ___

A

Asymptomatic

118
Q

The high ___ ___ ___ equalizes pressure in the ventricles

A

Peripheral vascular resistance

119
Q

Once peripheral vascular resistance drops, left-right shunting occurs resulting in…

A

Murmur (load, holosystolic left sternal border

120
Q

Large VSDs lead to symptoms like…

A

-Symptoms of congestive heart failure
-Poor weight gain
-Loud, harsh, holosystolic murmur
-Systolic thrill at left lower sternal border

121
Q

Adults with unrepaired VSD may develop ___ ___ ___ ___ which may cause cyanosis and clubbing

A

Pulmonary vascular obstructive disease

122
Q

Tetralogy of fallot (TET) is the most common ____ defect

A

Cyanotic

123
Q

TET is what four defects in one?

A

-VSD
-Pulmonary stenosis
-Right ventricular hypertrophy
-Overriding aorta

124
Q

TET occurs __-__% of the time

A

9-14%

125
Q

Pathophysiology of TET varies widely based on…

A

-Degree of pulmonary stenosis
-Size of the VSD
-Pulmonary and systemic resistance to flow

126
Q

If pulmonary resistance is high with TET, you will see a ___ to ___ shunt

A

Right to left

127
Q

If pulmonary stenosis is minor and pressure is lower, you will see a ___ to ___ shunt

A

Left to right

128
Q

Pulmonary stenosis decreases the amount of blood flow to the ____

A

Lungs

129
Q

Pulmonary stenosis causes an increase in pressure which results in a __ to ___ shunt

A

Right to left

130
Q

People with pulmonary stenosis have a mixing of deoxygenated blood with a decreased amount of oxygenated blood from the lungs; the body compensates by increased the amount of ___ ___ ___ (polycethmia)

A

Red blood cells

131
Q

Clinical manifestations of tetralogy of fallot:

A

-While the PDA is open, the newborn has adequate pulmonary blood flow
-Once the duct closes, cyanosis occurs
-Over time, you may see clubbing of fingers and toes

132
Q

A tet spell might cause…

A

Sudden onset of dyspnea, cyanosis, and restlessness which occurs with crying or exertion

133
Q

One theory about tet spells is that right ventricle outflow tract goes into spasm, increasing pulmonary resistance and __-__ shunting

A

Right-left

134
Q

A compensatory mechanism for older children with tet spell is to ___, which increases systemic vascular resistance while decreasing venous return to the heart

A

Squat

135
Q

The decrease in venous return that happens when squatting allows for more ___ ___ to be available and the increase in systemic vascular resistance helps reverse the shunt to more left-right

A

Oxygenated blood

136
Q

Coarctation of the aorta (Coarc) is severe ____ of the arch of the aorta

A

Narrowing

137
Q

The ____ and ____ of the coarc predict presentation

A

Location and narrowing

138
Q

Coarc commonly occurs because of an abnormal ___ ___ ___ that constricts at the time of ductal closure

A

Contractile ductal tissue

139
Q

Coarc causes ___ pressures above the site of stenosis and ____ pressures below the site

A

Higher; lower

140
Q

You may see ___ ___ ___ is the coarc is pre-ductal

A

Congestive heart failure

141
Q

The high pressure above the coarc are seen in the ___ ___ served by the arteries where the pressure is higher

A

Systemic circulation

142
Q

Clinical manifestations of coarc in newborns:

A

-Usually present with signs of congestive heart failure
-Once the ductus closes, infants deteriorate rapidly with the development of hypotension, acidosis, and shock

143
Q

Older children with coarc might not be diagnosed until ____ is noted

A

Hypertension

144
Q

In older children with coarc, you would see ____ in upper extremities and ____ in lower extremities

A

Hypertension; hypotension

145
Q

If pulses are affected by the coarc, we will see…

A

-Mottled skin
-Leg cramps during exercise from anorexia

146
Q

Hypertension may cause…

A

-Dizziness
-Headache
-Fainting
-Epistaxis

147
Q

___ ___ is a narrowing of the right ventricle outflow tract

A

Pulmonary stenosis

148
Q

There is a decrease in ____ blood flow with pulmonary stenosis

A

Pulmonary

149
Q

Pulmonary stenosis can be…

A

-Supravalvular
-Subvalvular
-Valvular

150
Q

___ ___ ___ is a result of the stenosis

A

Right ventricular hypertrophy

151
Q

If the backup into the right atrium is severe with pulmonary stenosis, you may see reopening of the __ __, causing ASD

A

Foramen ovale

152
Q

Clinical manifestations of pulmonary stenosis depends on ___

A

Severity

153
Q

Systolic ejection murmur at the __ ___ ___ ___ reflects obstruction to flow

A

Left upper sternal border

154
Q

With pulmonary stenosis, you might palpate a ___

A

Thrill

155
Q

If child has moderate stenosis, they may have ___ ___ because of insufficient pulmonary blood flow

A

Exertional dyspnea

156
Q

Severe pulmonary stenosis results in…

A

-Cyanosis
-Right sided failure

157
Q

Is a transposition of the great arteries cyanotic or acyanotic?

A

Cyanotic

158
Q

With a transposition of the great arteries, the ___ and ___ ___ are switched

A

Aorta and pulmonary artery

159
Q

Transposition of the great arteries is called a ___ defect because of the dependence upon mixing of the pulmonary and systemic circulation for survival

A

Mixing

160
Q

Patients with transposition of the great arteries must have one of these things to survive:

A

-Patent ductus arteriosus
-ASD
-VSD

161
Q

With transposition of the great arteries, there is mild cyanosis shortly after birth which worsens during the first day when the ___ ____ closes

A

Ductus arteriosus

162
Q

When the ductus arteriosus closes, it causes hypoxemia which causes symptoms like…

A

-Metabolic acidosis
-Tachycardia
-Tachypnea

163
Q

The presence of a ___ or ___ ___ allows for more mixing with transposition of the great arteries

A

PDA or septal defect

164
Q

If someone with transposition of the great arteries has an intact septum, you will not hear a ____

A

Murmur

165
Q

Fixing a transposition of the great arteries is a tricky procedure because the __ __ must be moved along with the ___

A

Coronary arteries, aorta

166
Q

___ ___ is also known as mucocutaneous lymph node syndrome

A

Kawasaki Disease

167
Q

Kawasaki disease is acute self-limiting ____ that may result in cardiac complications

A

Vasculitis

168
Q

Are males or females more affected by Kawasaki disease?

A

Males (slightly)

169
Q

Peak incidence of Kawasaki disease is in what seasons?

A

-Winter
-Spring

170
Q

Kawasaki disease is a primary disease of ___ ___

A

Young children

171
Q

___% of cases of Kawasaki disease are in children less than 5 years of age

A

80%

172
Q

The first reported cause of Kawasaki was reported in ___ by Dr. Thomisakyu Kawasaki

A

1967

173
Q

Kawasaki occurs throughout the world but the greatest number of cases are reported in ____

A

Japan

174
Q

What U.S state has the highest incidence of Kawasaki?

A

Hawaii

175
Q

Kawasaki disease occurs in ___ stages

A

4

176
Q

What happens in stage I of Kawasaki disease (0-12 days)?

A

Small capillaries, arterioles, venules, and the heart become inflamed

177
Q

What happens in stage 2 of Kawasaki disease (12-25 days)?

A

Inflammation spreads to larger vessels

178
Q

What happens in stage 3 of Kawasaki disease (26-40 days)?

A

Coronary arteries begin to thicken and inflammation resolves

179
Q

What happens in stage 4 of Kawasaki disease (40 days and beyond)?

A

Vessels develop scarring, calcification, and stenosis of coronaries

180
Q

Symptoms of the acute phase of Kawasaki:

A

-Fever (most common)
-Conjuntivitis (begins within days of fever onset)
-Strawberry tongue
-Rash
-Lymphadenopathy (occurs in 50-70%)
-Irritability

181
Q

Symptoms of the subacute phase of Kawasaki:

A

-Fever ends
-Clinical signs resolve
-Desquamation of palms and soles
-Thrombocytosis (high platelet count)

182
Q

During the subacute phase, the child is at the highest risk for developing ___ ___

A

Coronary aneurysm

183
Q

Symptoms of the convalescent phase of Kawasaki:

A

-Elevation of erythrocyte sedimentation rate and platelet count
-Possible arthritis

184
Q

The convalescent phase lasts until all ____ return to normal

A

Labs

185
Q

Eisenmenger’s Syndrome is a defect of the ___ ___ (ASD or VSD) with severe pulmonary hypertension, hypertrophy of the right ventricle, and latent or overt cyanosis

A

Interventricular septum

186
Q

Because of the VSD with Eisenmenger’s, there is an ___ in blood flow to the lungs and an ___ in blood pressure in the lungs

A

Increase; increase

187
Q

When the high blood pressure becomes an irreversible problems on its own, the direction of blood through the ___ in the heart is reversed

A

Hole

188
Q

The reversal of the direction of shunting ____ pressure resulting in a narrowing of the arteries

A

Increases

189
Q

Over time, these changes are irreversible due to ___ of the arteries

A

Inflammation

190
Q

Much of the lung arteries become ___, leading to increase in pulmonary blood vessel resistance

A

Occluded

191
Q

Once the resistance is so high, the shunt reverses to ___ to ___

A

Right to left

192
Q

Symptoms of Eisenmenger’s syndrome:

A

-Cyanosis
-Clubbing
-Dyspnea and SOB
-Hemoptysis
-Activity intolerance
-Palpitations
-Syncope
-Erythrocytosis
-Sudden death
-Symptoms of pulmonary hypertension
-Symptoms of heart failure

Pathophysiology (18 decks)

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