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Summer 2020 - Advanced Anesthesia - Pediatrics > Pediatric Cardiology & Congenital Heart Disease - Quiz 5 > Flashcards

Pediatric Cardiology & Congenital Heart Disease - Quiz 5 Flashcards

1
Q

What are the most common Congenital Heart Defects?

A

Bicuspid Aortic Valve

Ventricular Septal Defect (VSD)

Atrial Septal Defect (Secundum)

Cyanotic Lesions

TOF

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2
Q

What are some Environmental Factors that contribute to Congenital Heart Defects?

A

Chronic Maternal Disease

Maternal Meds, Drug, & ETOH Abuse

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3
Q

What is Retinoic Acid?

A

Found in cosmetics to treat skin problems, but has teratogenic properties, so preggos should avoid

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4
Q

What is the result of the Recirculation of Pulmonary Venous Blood?

A

L –> R Shunt

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5
Q

What results with the Recirculation of Systemic Venous Blood?

A

R –> L Shunt

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6
Q

What happens w/ Single-Ventricular Physiology?

A

Ventricle pumps out Mix of Pulm. & Systemic Blood

Distribution depends on Intra/Extracardiac Resistance in 2 parallel circuits

O2 Sat is the same in both Aorta & Pulm. Artery

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7
Q

Life is not compatible w/ Parallel Blood Flow Circuits w/ Transposition of the Great Vessels (TGA). How is this problem solved?

A

Intercirculatory Mixing provided by communication via a ASD, VSD, PFO, or PDA.

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8
Q

In regards to Intercirculatory Mixing, what determines the Arterial Saturation?

A

Volumes & Sats of Recirculated Systemic & Effective Systemic Venous Blood reaching the Aorta

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9
Q

What is Fontan Physiology?

A

When Systemic Venous Blood passively flows directly into the Pulmonary Circulation, then returns to a common atrium and single venticle.

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10
Q

Which heart conditions cause Cyanotic Heart Disease w/ Decreased Pulmonary Flow?

A

TOF

Tricuspid Atresia

Univentricular Heart w/ Pulm. Stenosis

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11
Q

Which heart conditions cause Cyanotic Heart Disease w/ Increased Pulmonary Flow?

A

Transposition of Great Arteries (TGA)

&

Total Anomalous Pulmonary Venous Return

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12
Q

Which heart conditions cause Acyanotic Heart Disease d/t a L–>R Shunt Lesion?

A

VSD

ASD

AVSD

PDA

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13
Q

Which heart conditions cause Acyanotic Heart Disease d/t an Obstructive Lesion?

A

Aortic Stenosis

Pulm. Valve Stenosis

Coarctation of Aorta

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14
Q

What are the One-Ventricle Lesion heart conditions?

A

Hypoplastic Left Heart Syndrome

Tricuspid Atresia

Double Inlet LV

Unbalance AVSD

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15
Q

What are the Two-Ventricle heart conditions?

A

Truncus Arteriosus

TOF w/ Pulm. Atresia

Severe Neonatal Aortic Stenosis

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16
Q

What are the LV Obstructive Lesion heart conditions?

A

Mitral Stenosis

Aortic Stenosis

Coarctation

Mixing of Systemic & Pulm. Venous Blood

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17
Q

What is the PO2 & O2 Sat in the Placenta?

A

PO2: 32-35 mmHg

O2 Sat: 80%

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18
Q

In Fetal Circulation, what is the PO2 & O2 Sat when the blood in the IVC joins the SVC Drainage?

A

PO2: 12-14 mmHg

O2 Sat: 40%

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19
Q

In Fetal Circulation what is the PO2 & O2 Sat of the blood traveling from the Ascending Aorta to the Brain, Coronary Arteries & Upper Limbs?

A

PO2: 20-22 mmHg

O2 Sat: 65%

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20
Q

What is the PO2 & O2 Sat for the Blood in the Descending Aorta in regards to Fetal Circulation?

A

PO2: 20-22 mmHg

O2 Sat: 55%

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21
Q

Why is the P50 Lower in Fetal Hgb?

A

To help w/ O2 Uptake in the Placenta

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22
Q

With Fetal Circulation, How does the RV compare to the LV?

A

Same Size & Thickness

RV has Higher Output @ 1.3 : 1

Pumps 450 mL/kg/min

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23
Q

What causes the Foramen Ovale to close?

A

When LA pressure is more than RA Pressure causing the FO’s Flap Valve to close against the Septum Secundum

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24
Q

Functional Closure of the Ductus Arteriosus happens in 10-72 hrs after birth. What else happens at this time?

A

↑Arterial O2 Tension

↓Prostaglandins

Lung Expansion releases Bradykinin

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25
Q

What happens to Cardiac Output after Birth?

A

Increases 30-80%

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26
Q

What is the Main Purpose of Transitional Circulation?

A

Separate Systemic & Pulm Circulation

Close FO & DA (Reversible for a few days)

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27
Q

What can cause the FO to Reopen?

A

Crying & Pain

Hypoxia

Hypercarbia

Acidosis

Lung Disease

Sepsis

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28
Q

How long does it take for the Anatomic Closure of the FO?

A

3 months & 1 year when the Septum Primum & Secundum adhese

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29
Q

How long does it take for the Anatomic Closure of the DA?

A

1 - 3 months when the Ligamentum Arteriosum forms

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30
Q

What can cause the Ductus Arteriosus to Reopen?

A

Decrease in O2 Tension

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31
Q

What is Alprostadil used for?

A

Prostalglandin E1 - used to open the DA

(and also to treat ED)

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32
Q

What are signs of a PDA?

A

Hyperactive Precordium

Bounding Pulse

Wide Pulse Pressure

Hepatomegaly

Tachypnea

Tachycardia

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33
Q

What med can be given to close a PDA?

A

Indomethacin - prostaglandin inhibitor

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34
Q

What is the Blood Volume of a Premi?

A

100 mL/kg

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35
Q

What is the Blood Volume for a < 3 month old?

A

90 mL/kg

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36
Q

What is the Blood Volume for a baby older than 12 months?

A

Same as Adult 70 mL/kg

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37
Q

What is the Blood Volume for a 3-12 month old baby?

A

80 mL/kg

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38
Q

With Fetal & Newborn hearts, how is Cardiac Output increased?

A

By Increasing HR b/c increasing preload has little effect

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39
Q

What is the Normal Respiratory Rate & Heart Rate for an Infant?

A

RR: 30 - 60

HR: 120 - 160

40
Q

What is the Normal BP for a Premi vs. a Neonate?

A

Premi: 50/25

Neonate: 70/40

41
Q

PVR starts to fall at birth but does not reach adult level until ______

A

PVR starts to fall at birth but does not reach adult level until 6 MONTHS

42
Q

Why should Hypoxia & Pressors be avoided in babies?

A

To prevent R–>L Shutning & RV Dysfunction

43
Q

What type of Heart Defects are Volume Overload Lesions?

A

ASD

VSD

AVSD

PDA

Truncus Arteriosus

L–>R Shunting

44
Q

With Volume Overload Lesions, where would the Lesions need to be to cause Right Heart Dilatation?

A

Proximal to Mitral Valve

Distal = Left Heart Dilatation

45
Q

How are Volume Overload Lesions treated?

A

Diuretics

Afterload Reduction

Surgery

46
Q

What are the major types of ASD?

A
  • Secundum ASD - @ Fossa Ovalis - Most common
  • Primum ASD - Lower, Form of AVSD, MV Cleft
  • Sinus Venosus ASD - High, r/t Partial Anomalous Venous Return - Least Common
47
Q

What are signs of ASD?

A

Mostly Asymptomatic

Rarely CHF

Easily Fatigued

Mild Growth Failure

No Cyanosis unless Pulm. HTN

48
Q

How is an ASD fixed?

A

Surgery/Catheter Closure when kid is 2-5 y.o to avoid late complications

49
Q

When is Surgical Repair of an ASD indicated if the child is younger than 2 y.o?

A

When the kid has CHF or Severe Pulm. HTN

It’s too late when shunt is reversed while having Pulm. HTN

50
Q

What are the different types of VSDs?

A
  • Perimembranous - Most Common
  • Infundibular (Subpulmonary/Supracristal) - Involves RVOT
  • Muscular - single/multiple
  • AVSD - Inlet VSD, Involves AV Valve Abnormalities
51
Q

What causes the L–>R shunt w/ VSDs?

A

PVR is less than SVR, NOT Higher LV pressure

52
Q

At what size is it considered a Large VSD?

A

> 6 mm & will need repair

50% of Small VSDs close on their own

53
Q

What are symptoms of Large VSDs?

A

CHF

Failure to Thrive

Resp. Infections

Exercise Intolerance

Hyperactive Precordium

54
Q

What is the treatment for VSDs?

A

Small VSDs - No Surgery, just Endocarditis Prophylaxis

Large VSDs - Start w/ afterload reducers & diuretics, then surgery

55
Q

How does a AVSD develop?

A

Incomplete Endocardial Cushion Fusion

56
Q

What genetic disease is AVSD common seen in?

A

Trisomy 21 (Down’s)

57
Q

What are signs & symptoms of AVSD?

A

(Looks like ASD)

CHF

Pulm. Infections

Failure to Thrive

Easily Fatigued

58
Q

What is the treatment for AVSD?

A

Surgery Always

Treat CHF

Pulmonary Banding

59
Q

What is the Coarctation of the Aorta?

A

Narrowing of Aorta at any point from the Transverse Arch to Iliac Bifurcation

98% Juxtaductal

Commonly associated w/ Bicuspid Aortic Valve

60
Q

What genetic syndrome is Coarctation seen in?

A

Turner’s Syndrome

61
Q

What are signs & symptoms of Aorta Coarctation?

A

Weak or Absent Fem Pulses

Higher BP in Upper Extremities than Lower

Pulse Differences b/t R & L Arms

Cyanosis if Ductus is Open

Lower Extremity Hypoperfusion

Cardiomegaly & Rib Notching

62
Q

What is the treatment for Aorta Coarctation?

A

Maintain Ductus w/ Prostaglandin E

Surgery to prevent LV Dysfunction

Angioplasty

Balloon Angioplasty for Re-Coarctation

63
Q

What should be given for Pulmonary Blood Flow Obstruction?

A

Prostaglandin E1 to manage cyanosis

64
Q

What happens w/ Parallel Circulation?

A

RV ejects into Aorta

LV ejects into Pulm. Circulation

Mixing occurs at Atrial, Ventricle, or Ductal Levels

65
Q

What is needed to Maintain Ductal Patency and to Enlarge the Atrial Shunt?

A

Prostaglandin E1 to maintain Ductus Patency

&

Balloon Septostomy to Enlarge Atrial Shunt

66
Q

What happens w/ Double Inlet LV?

A

Both Atria empty into LV

67
Q

What Four critieria are needed to be considered a Tetrology of Fallot?

A

(Most common Cyanotic CHD)

VSD

Overriding Aorta

RVOT Obstruction

RV Hypertrophy

68
Q

What happens in a Tet Spell?

A

Dynamic Narrowing w/ Hypercyanotic Episodes

&

↑R–>L Shunt

69
Q

What can cause a Tet Spell?

A

Crying

Feeding

Anesthesia

Surgical Stimulation

Acidosis

70
Q

What is included in the Urgent Intervention for a Tet Spell?

A

Phenylephrine 0.5-1 mcg/kg

Norepinephrine 0.5 mcg/kg

100% O2

Fluid Bolus

Sedation

Bicarb

B-Blockers

71
Q

What syndromes are commonly associated with TOF?

A

DiGeorge & Trisomy 21

72
Q

For a PDA case, what might be given to the patient?

A

Blood

ABx

Vitamin K

73
Q

What are the complications associated w/ PDA surgery?

A

Difficulty Ventilation

Desaturation

Hemorrhage

Accidental Aorta/Pulm. Artery Ligation

74
Q

What monitoring devices should be included along with the standard monitors for a PDA?

A

Two Pulse Ox - One on Right Hand & Lower Limb

75
Q

During PDA surgery, what might be the cause if the Pulse Ox on the Lower limb is lost?

A

Clamping of the Aorta

76
Q

What signs would you see at birth for a kid with a Hypoplastic Left Heart?

A

Tachypnea

Tachycardia

Cyanosis

Systolic Murmur

77
Q

What is the Surgical Goal for a Hypoplastic Left Heart?

A

Transition to Single Ventricle Circulation where the Pulm. Blood Flow is supplied by the SVC & IVC

78
Q

What happens in the Norwood Stage 1 of Hypoplastic Left Heart Surgery?

A

Move the Aortic Arch so that it comes from the Pulm. Trunk

Pulm. Valve becomes Aortic Valve

BT Shunts blood from Subclavian Artery to PA

Sano Mod Shunts RV to PA

79
Q

What happens during the Norwood Stage 2 Hypoplastic Left Heart Surgery?

A

Disconnect BT Shunt

Make Glenn Shunt by connecting SVC to PA

80
Q

What happens during the Norwood Stage 3 Hypoplastic Left Heart Surgery?

A

Fontan

SVC & IVC connected to PA

81
Q

What the normal Saturation for a BT shunt?

82
Q

What’s the normal Saturation for a Glen Shunt?

83
Q

What’s the normal Saturation for a Fontan?

84
Q

How is Transposition of the Great Arteries fixed?

A

Arterial Switch Procedure - arterial trunk relocated to respective ventricles & coronary arteries relocated to aortic root

85
Q

How is a Truncus Arteriosus repaired?

A

Close the VSD w/ Homograft

86
Q

Which med is good for sick neonatal hearts?

A

Milrinone - PDE3 Inhibitor that increases cAMP & Calcium to relax smooth muscles and enhance both parts of the cardiac cycle

87
Q

A newborn has T-Waves upright in all leads, but gets inverted in V1-V4 by one week of age, then back upright at adolescence. What is indicated if they dont invert at one week?

A

Right Ventricular Hypertrophy

88
Q

How does the QRS axis appear at birth?

A

Right Sided QRS, then Left sided by 1 month of age

89
Q

How does an Infant’s Cardiac Output compare to an Adult’s?

A

Healthy Full Term Infant has 2-3x the Cardiac Output of an Adult

90
Q

How would an SVR Decrease or PVR Increase affect a R –> L shunt?

A

Increases the R –> L Shunt

91
Q

What is associated with Kawasaki Disease?

A

Mucocutaneous Lymph Node Syndrome

Vasculitis

Dilated Coronary Arteries

Aneurysm

MI

Covid-19

92
Q

What are signs and symptoms of Trisomy 21?

A

Small Size

Short Neck

Small & Low Ears

Macroglossia

Mandibular Hypoplasia

Narrow Nasopharyx

Hypotonia

93
Q

What conditions are commonly associated w/ Trisomy 21?

A

OSA

MR

Spine Disorders

Thyroid Disease

Subglottic Stenosis

94
Q

How does Trisomy 21 affect the CV system?

A

50% pts have CV Defects

ASD

VSD

TOF

PDA

Pulm. HTN

Bradycardia w/ Anesthesia

95
Q

What are the signs & symptoms of the X-Linked disorder Turner Syndrome?

A

Webbing

Micrognathia

Short Stature

Lymphedema

Ovarian Failure

96
Q

How does Turner Syndrome affect the CV System?

A

Aortic Coarctation

Biscuspid Aortic Valve

HTN

97
Q

What conditions are commonly associated w/ Turner Syndrome?

A

Obesity

DM

Hypothyroidism

Liver Disease

Summer 2020 - Advanced Anesthesia - Pediatrics (6 decks)

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