Pediatric Cardiology Flashcards
What does heart failure look like in a neonate?
- Respiratory distress, especially with feeding
- Poor feeding
- Poor growth
- Hepatomegaly and rales
What is the anatomic location of the foramen ovale?
Right atrium to left atrium
Where is the ductus arteriousus located anatomically?
pulmonary artery to aorta
What physiologically occurs with the infants first breath?
High surge in pressure that causes lungs to expand to clear fluid and surge of surfactant release
What circulatory changes occur once the neonate takes their first breath?
- Pressure changes help to close bypass tracts
- Decreased levels of prostoglandin E2 leads to closure of ductus arteriosus
What are the three types of critical congenital heart disease (CCHD)?
- Acyanotic heart disease (left to right shunt)
- Obstructive lesions
- Cyanotic heart disease (right to left shunt)
What are the risk factors for congenital heart disorders?
- ** Prematurity
- Family history
- Genetic syndromes
- Maternal factors: DM, HTN, obesity, PKU, thyroid disorders, smoking, and alcohol use
- TORCH infections
What are the TORCH infections?
- Rubella
- Flu-like illnesses
- CMV
- HHV6
- HSV
- Parvovirus
- Toxoplasmosis
What are signs and symptoms concerning for CHD in the outpatient setting?
- Cyanosis
- Respiratory symptoms
- Difficulty feeding
- Sweating with feeds
- Poor weight gain
What is acyanotic heart disease and what are common causes?
L > R shunts
- PDA
- VSD
- ASD
PDA’s are more common in whom?
Babies with a birth GA < 30 weeks
What are the common osculatory sounds of a PDA?
Continuous machine-like murmurs LUSB or left infra-clavicular area
Can you give prostaglandin inhibitors to older and term infants?
No
What prostaglandin inhibitors can be given to preterm infants with a symptomatic PDA?
- Indomethacin
- Ibuprofen
Once medical treatment fails, how should a moderate-severe PDA be treated?
Surgical or percutaneous closure
What percentage of all congenital heart disease have a VSD as a component?
50%
What is the number one sign of a VSD?
Failure to thrive, not regaining to birthweight
What are the symptoms of a VSD?
- Diaphoresis, particularly with feeds
- Difficulty feeding
- Failure to thrive
- CHF
- Irreversible pulmonary vascular changes within 6-12 months
How is a VSD murmur characterized?
Holosystolic murmur heard best at the mid to LLSB
How is a VSD diagnosis confirmed?
ECHO
What is the treatment for a small VSD (< 4mm)?
- 75% will close spontaneously by age 2, most by age 6 months
- Benign if they persist into adulthood
- Regular evaluation for clinics signs of PHN, CHF with ECHO
What is the treatment for moderate (4-6 mm) or large (> 6 mm) VSDs?
- Asymptomatic: regular f/u x 1 year, then q2 years
- Symptomatic: mild to moderate treated with oral diuretics and nutritional support. Severe need to stabalize with IV diuretics and nutrition in anticipation for surgical repair
What are the classic findings on auscultation in an ASD?
- Wide, fixed split S2
- Mid-systolic ejection murmur
What genetic disorder has a high association with coarctation of aorta?
Turnor’s Syndrome
