pediatric CV disorders. CHD Flashcards by Kathleen Rice

The force of blood in the arteries when the heart beats (when the heart muscle contracts)

Systolic BP

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The force of blood in the arteries when the heart is at rest

Diastolic BP

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In fetal circulation, oxygenation of the blood occurs in the _____. not the ____

placenta

lungs

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Fetal pulmonary resistance is ____

high

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The _____ the opening in the septum between the 2 atria, permits a portion of the blood to flow from the right atrium directly to the left atrium.

foramen ovale

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A ____ provides a connection between the pulmonary artery and the aorta that allows blood to flow from the pulmonary artery to the aorta and bypass fetal lungs.

patent ductus arterosus (PDA)

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_____ 2 parallel circuits with the left ventricle supplying blood to the upper extremites and the right ventricle supplying the lower extremities and placenta.

fetal circulation

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In neonatal circulation, the first breath the newborn takes, spurs the inflation of the lungs and increase in the o2 sat brings a dramatic fall in pulmonary vascular resistance, and increased pulmonary blood flow- that begins to constrict the _____.
As the pressures within the heart become higher on the left side and lower on the right the_____ closes

ductus arterosus

foramen ovale

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functional closure of the ductus arteriosus and foramen ovale usually occurs within ____.
the transition towards complete anatomic closure is more gradual over the first ____ of life

first hours to days of life

2 to 8 weeks

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at the time of ventricular contraction, the beginning of ____ , the mitral and tricuspid valves close and produce the 1st heart sound S1 “lubb”

systole

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After the blood has been ejected the _____ , the mitral vlave and tricuspid valve open and aortic and pulmononic valve close to keep blood from rushing back into ventricles— this closure results in the ____

heart relaxes

2nd heart sound S2 “dupp”

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The term _____ implies that a cardiovascular malformation at birth doesn’t mean its the cause of problem

congenital heart disease, (CHD)

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the heart is formed by ___ of fetal life

up to ____% of children with CHD also have non cardiac abnormalities

6 weeks

25%

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How should heart rate be obtained?

and what age??

by auscultation

younger than 10yrs

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pulses must be checked in upper and lower extremities.
A bounding pulse may indicate____ ______.
A weak or thread pulse may indicate___ ____

PDA or aortic insufficiency

CHF, obstructive lesion (such as severe aortic stenosis)

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Good brachial pulses and weak or absent femoral pulses may indicate ____________

Coarctation of aorta (COA)

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What age should BP’s be measured annually ?

can always do it younger children if suspicious of heart disease.

3 years old

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_____ is the difference between systolic and diastolic pressure

pulse pressure

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the normal pulse pressure is ______ thru out childhood

20 to 50 mm HG

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a respiratory rate above ___ in a young child or more than ___in an infant who is quiet , resting and afebrile warrants further evaluation

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obtain ____in new babies or new pts because cyanosis is often subtle and isn’t always visible

O2 saturation

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what % of children may have a murmur…..especially beginning at 3 to 4 years old

80%

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murmur-intensity —barely audible

Grade I

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murmur intensity—audible with stethoscope off chest

grade VI

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murmur intensity--- loud with a thrill

grade IV

murmur intensity ---soft but easily audible

grade II

murmur intensity---moderately loud without a thrill: roughly as loud as S1 /S2

grade III

murmur intensity--- audible with stethoscope barely on chest

grade V

A murmur in a pt with a genetic syndrome such as trisomy 21 needs __________

to be referred to pedi cardiology

what type of murmur always needs to be referred????

DIASTOLIC (on test)****** is a possible pathologic problem

what grade murmur always needs to be referred

grade III thru VI

what type of murmur occurs mid systolic, louder on inspiration and in supine position?

stills innnocent murmur

what type of murmur soft blowing , grade I or II, early to mid systolic, increases in supine position, disappears in standing position?

pulmonary flow of childhood innocent murmur

what murmur midsystolic ejection murmur, common in newborn period, espec. preterm infants, soft, middle to high pitch usually gone by 6 months, radiates from LSB to both axilla and back

pulmonary flow murmur of infancy-innocent murmur

What murmur has a constant swishing sound, disappears with head turning, supine position, compression of jugular veins, best heard upright below clavicles

venous hum- innocent murmur

what type of CHD defect is this? Hole is atrial septum, may be asymptomatic,, may have mild cardiomegaly, smaller defects may close on their own larger defects can be closed in cath lab with closure device, prognosis excellent

atrial septal defect (pink)

what type of CHD defect is this? hole in ventricular septum,4 types, most common type is ____. small defects may be asymptomatic, may close on its own by 4 y/o. murmur may not be heard immediately after birth may be later 2 to 8 weeks

ventricular sepal defect (pink) perimembraneous VSD

small defect- harsh, high pitched, grade II to IV/VI, murmur is at LLSB.....What type of defect?

small VSD

large defect, low pitched, grade II to V/VI, murmur is at LLSB, thrill may be heard at LSB, may show signs of CHF after first few weeks of life, may have S3 or S4 what type of defect is this??

large VSD

Murmurs that become____pitched over time mean that defect is getting smaller

higher

What will EKG look like with a small VSD? | large VSD?

normal | LVH

how are small VSD 's managed? with no CHF symptoms...

monitoring q 3 to 6 months thru 1 year them q 6 months after

how are large VSD managed with S/S of CHF?

surgical /or closure device in cath lab..... symptoms of CHF by lanoxin, diuretics, ace inhibitors, beta blockers

as a provider what is important to monitor of these babies to teach to parents?

nutritional intake, weight gain S/S of developing or progressing CHF

PDA happen more often in ____?

pre term infants

immediately after birth murmur may be soft, systolic and heard along LSB?

PDA

after the first few weeks of life the murmur is a grade II to V/VI, harsh, rumbling, machinery sound, pulmonic area?

PDA

in PDA what medication may given to pre term infants | to to help with closure of defect?

indomethacin or ibuprophen

In PDA EKG may show? | echo?

LVH | enlarged left atrium, patent ductus

what is the condition with a narrowing of a small or long segment of the aorta?

COA coarctation of the aorta

Pts with ____ have a 10 % incidence of COA

turner syndrome

What type of defect may this be? bounding brachial, radial, carotid pulses and weak/thready pulses to femoral and lower extremities?

COA on test

children with ____ may have complaints of leg pain especially with exercise and headaches?

COA

may have hypertension to upper extremites and hyptotension in lower extremities? what condition?

COA on test

In critical neonatal coarctation ____ is given to maintain or reopen the ductus?

prostaglandin E1 (PGE1)

condition with systolic ejection murmur, heard under left clavicle with transmission to back, ventricular heave at apex can be palpated

COA

In pulmonic stenosis, there is a narrowing that causes an increased right sided pressure that results in ____ occurs as a result of increased load.

RVH right ventricular hypertrophy

In _____, cyanosis from right to left shunting over the foramen ovale may be evident

pulmonic stenosis

grade II to VI harsh mid to late systolic ejection murmur is heard at ULSB over pulmonic area...what is condition. may hear intermittent systolic ejection click, thaat is louder on inspiration

pulmonic stenosis

Cyanosis and symptoms of right sided CHF can occur in severe ____ in the newborn

pulmonic stenosis

_____ causes increased pressure load on the left ventricle... leading to LVH and ultimately ventricular failure

Aortic stenosis

In this condition ____ BP may reveal a narrow pulse pressure, apical pulse may be louder with progressive stenosis

aortic stenosis

this condition has a grade III to VI loud, harsh systolic crescendo-decrescendo murmur is best heard at the URSB with radiation to neck, LLSB and apex, may hear S4, may hear a thrill at suprasternal notch

Aortic stenosis

____ is the most common cyanotic lesion, It is a combination of four cardiac defecrts resulting in right ventricular outflow tract obstruction

tetralogy of fallot

tetralogy of fallot includes these 4 anatomic defects

pulmonary valve stenosis RVH VSD an aorta that overrides the ventricular septum

Children with ____exhibit bluish skin during episodes of crying or feeding.

Tetralogy of fallot

This condition has a grade III to VI harsh systolic ejection murmur at the left mid to upper sternal border there may be a palpable thrill and holosystolic murmur at the LLSB, sternal lift due to RVH

Tetralogy of fallot,

For pts who have tetralogy of fallot and they are having hypercyanotic episodes the following intervention should take place....

child should be cradled in a knee-chest positon, soothed, given o2 and perhaps morphine SQ till spell subsides if it doesn't subside immediate intervention is required

what condition appears as a boot shape on CXR

tetralogy of fallot

in this type of condition there is functionally only one ventricle that is doing all the work of pumping blood to systemic and pulmonary circulation....oxygenated and deoxygenated blood mix in the ventricle and the child is cyanotic.

tricuspid atresia, hypoplastic left heart syndrome

in this condition, you may only hear a single S1 or S2 hepatomegaly may be present, cyanosis usually evident as soon as ductus arteriosus closes. child may have to have many surgeries including heart transplant

tricuspid atresia, hypoplastic left heart syndrome

___ results from incomplete septation and migration of the trunctus arteriosus during fetal development

TGA transposition of the great arteries

In___ the aorta arises from right ventricle and pulmonary arteries from left ventricle. The aorta receives deoxygenated blood and sends to the systemic circulation....pt will die without tx

TGA transposition of the great arteries

In this condtion, ____ cyanosis is immediately evident by 1 hour to 1 day of birth, may have CHF symptoms

TGA transposition of the great arteries

in what condition in the chest x ray the heart appears egg shaped?

TGA transposition of the great arteries