Pediatric Congenital Heart Flashcards
What is patent ductus arteriosus?
S/Sx?
Tx?
Failed closure of ductus arteriosus (from pulmonic artery to aortic arch)
This ductus should normally close 24-72 hours after birth. Failed closure results in mixture of deoxygenated and oxygenated blood
Most common birth defect. Called hole in the heart
S/sx: HF, murmur, widened pulse pressure, bounding pulse, cardiac enlargement
Tx: Prostaglandin inhibitor until surgical repair (indomethacin)
Nonsurgical occlusion with coil
Thoracotomy for ligation (tying) of DA
What is an atrial septal defect?
S/Sx?
Tx?
Abnormal opening between atria
Mixes oxygenated and deoxygenated blood and affects the pressure differential in the chambers
Right atrium can become enlarged
S/Sx: Usually asymptomatic until age 3-4, then can start with:
Fatigue, dyspnea, palpitations, atrial dysrhythmias, recurrent respiratory infections, murmur, risk for embolism
Tx: Spontaneous closure happens in 87% of kids so wait, watch, manage symptoms
Diuretics, antidysrhythmics
Occluder devices can be placed
Sutures or patch can be placed in open heart surgery
What is ventricular septal defect?
S/Sx?
Tx?
Abnormal opening in between R/L ventricles
Allows change in pressure gradients among ventricles, Increases pressure on R ventricle and lungs. Can lead to increase pulmonary HTN
S/sx: Murmur
palpable thrill
HF can occur
Tx: conservative. Wait, watch, manage symptoms. Some spontaneously close
Diuretics
Positive inotropics
HF tx
Occluder device
Suture or patch closure by open heart surgery
What is AV septal defect or canal?
S/Sx:
Tx:
Abnormal openings involving atria, ventricles and even the AV valves. Allows mixing of both types of blood.
Varying degrees
Results in increased pressure to lungs and HF
Often associated with Down syndrome
S/Sx: HF, murmur, intermittent cyanosis
Tx: Tx of symptoms
Will need surgical repair, valve replacements depending on the affected areas
What is pulmonary stenosis?
S/Sx?
Tx?
Narrowing of pulmonary artery from RV to lungs. Can prevent ductus arteriosus from closing. Causes increase pressure on RV and hypertrophy
S/Sx: Exercise intolerance, Right HF, cardiomegaly, cyanosis
Tx: Prostaglandin to keep ductus arteriosus open
Balloon valvuloplasty
Surgical valvulotomy
Shunt placement
What is aortic stenosis?
S/Sx?
Tx?
Narrowing of aorta from LV
Increases LV pressure and hypertrophy
S/Sx: Exercise intolerance, cardiomegaly, murmur with thrill, HF
Tx: Balloon valvuloplasty
Valvulotomy
Aortic valve replacement
What is coarctation of the aorta?
S/Sx?
Tx?
Aorta constricted at site of ductus arteriosus. Narrowing caused increased pressure in LV. Blood supply below heart decreased, above heart not affected.
S/Sx: Left sided HF
Poor lower extremity perfusion
Metabolic acidosis
Shock
Cyanotic in lower extremities, tingling, weak, cramps in LE
Tx: Prostaglandins to open ductus arteriosus until surgical repair
Balloon dilation
Tx for HF
Many types of surgery to open up and repair
What is Tetralogy of Fallot?
S/Sx?
Tx?
Combo of 4 heart defects
Ventricular septal defect
Overriding aorta (that means aorta is on top of ventricular septal defect)
Pulmonary stenosis
Ventricular hypertrophy
All of these mean that 2 type of blood mixing
S/Sx: Cyanosis, extreme fatigue, harsh systolic murmur, palpable thrill, boot shaped heart
Tx: Prostaglandins
Surgery ASAP, this will be done 3–12 months out
What is tricuspid atresia?
S/Sx?
Tx?
Severe and rare defect
Tricuspid valve is not there
Foramen ovale stays patent
Atrial septal defect
Ventricle septal defect
Pulmonary stenosis
Underdeveloped right ventricle
S/Sx: SEVERE cyanosis
Tx: Prostaglandins
Balloon atrial septostomy
3 Stage surgery
What is total anomalous pulmonary vein return?
S/Sx?
Tx?
Pulmonary veins don’t connect to LA but somewhere else. This means two blood types mix and systemic blood flow is crap
S/Sx: Cyanosis
Severe respiratory distress
Pulmonary HTN
Usually dies within 1 week if not treated
Hepatomegaly
Failure to thrive
Decreased peripheral pulses
Frequent pulmonary infection (if survive)
Tx: Treat HF and edema
ECMO
Surgery
What is truncus arteriosus?
S/Sx?
Tx?
Both ventricles pump into one outgoing vessel
Ventricles are under pressure and overloaded
Mixture of both bloods
S/Sx: HF, cyanosis
Murmur with thrill
Bounding pulse
Wide pulse pressure
Tx: ACE, diuretics
Prevent polycythemia
Prevent frequent infections
Surgery to repair
What is transposition of great vessels?
S/Sx?
Tx?
Aorta is attached to RV not LV and goes out into system with deoxygenated blood
Pulmonary artery attached to LV not RV and goes to lungs with oxygenated blood
(They have switched places)
S/sx: Cyanosis
Hypoxemia despite O2
Acidosis
HF
Tx: Prostaglandins
Ballon atrial septostomy
Surgical repair
