Quiz 2- Pediatric Cardiology (add On) Flashcards
What other cardiac anomaly is coarctation of the aorta associated with?
Bicuspid aortic valve (seen in 70% of all cases)
What genetic syndrome is coarctation of the aorta seen in?
Turner’s syndrome
What are the hemodynamics of coarctation of the aorta?
LV outflow—> pressure hypertrophy of the LV
What are clinical symptoms of coarctation of the aorta?
- ** CLASSIC SIGN IS DIMINUATION OR ABSENCE OF FEMORAL PULSES **
- cardiomegaly and rib notching on CXR
- higher BP in UE
- pulse discrepancy between left and right arms
- if ductus still open—> cyanosis
- with severe coarctation- LE hypoperfusion, acidosis, HF, shock
What is the treatment or coarctation of the aorta?
Severe—> maintain patent DA with prostaglandin E1
- surgery to prevent LV dysfunction
- balloon angioplasty if re-coarctation occurs
What is the treatment for obstruction to systemic flow, that may be caused by AS, coarctation, aortic arch interference, hypoplastic left heart syndrome?
- surgery or transcatheter approach in the first few days of life
- inotropes, mechanical ventilation, prostaglandin E
- with high Qp: Qs—> diuretics
How is obstruction to pulmonary flow treated? (Caused by ductal dependent lesion, critical pulmonary valve stenosis, pulmonary atresia with intact ventricular septum)
- prostaglandin E1 to manage cyanosis
What happens with D- transposition of the great arteries?
- RV ejects into the aorta while the LV ejects into the PAs
How is D- transposition of the great arteries treated?
Prostaglandin E, and balloon angioplasty to enlarge PFO
What are the various single ventricle lesions?
- tricuspid atresia
- double inlet left ventricle: both atria empt]y into LV, may have a right ventricle but is very tiny and non functional
- unbalanced AVSD—> complete mixing of systemic and pulmonary venous blood
What are intrinsic myocardial disorders?
Cardiomyopathy and myocarditis
T/F Shunts vary in direction and magnitude over time, even within the cardiac cycle.
True
What is the equation for flow (Q)?
Q= (PĎ€r^4)/8nL
When would you use endocarditis prophylaxis?
- prosthetic heart valve
- previous infective endocarditis
- heart transplant with valvulopathy
- CHD
- unrepaired CHD
- repaired CHD with prosthetic material during the 1st 6 months after procedure
- repaired CHD it’s residual defects at or near the site of prosthetic patch/device
Which antibiotics are used for endocarditis prophylaxis?
Amoxicillin
Ancef
Ampicillin
Clindamycin
What is Kawasaki’s disease?
- mucocutaneous lymph node syndrome
- effects infants and young children
- vasculitis, coronary artery dilation, aneurysm formation, MI
- present as red hands, soles of feet, mouth and body rash
How does trisomy 21 present?
- smaller for age
- short neck
- oblique palpebral fissures (opening between eyelids widened)
- small and low set ears
- macroglossia
- microdonia
- mandibular hypoplasia
- narrow nasopharynx
- hypertrophic lymphatic tissue
- generalized hypotonia
Regarding Trisomy 21, what are anesthetic considerations?
*** BRADYCARDIA UNDER ANESTHESIA—> within 30-60 seconds, have atropine ready- VERY sensitive to volatile anesthetics **** (if you know nothing else, know this!!!)
- pulmonary HTN CV defects in 40-50% - OSA - MR - C-spine disorders - thyroid disease - subglottic stenosis - large tongue
What is Turner Syndrome?
- x- linked
- webbed neck
- low set ears
- pigmented nevi (birthmark)
- short stature
- lymphadema
- HTN
- liver dz
- obesity
- DM
- hypothyroid
- aortic coarctation and bicuspid aortic valve **
What is most important regarding a patient with William’s Syndrome?
(Elfin faces)
*** with have narrowing of the aorta—> valvular and supravalvular aortic stenosis as well as aortic coarctation
- narrowing of abdominal and renal arteries
** can involve origin of coronary arteries as well as CA stenosis —> leading to myocardial ischemia and severe biventricular outflow obstruction
—> CV EVAL BEFORE ANESTHESIA IS A MUST !!!
What is the leading cause of cardiac arrest in the perioperative cardiac arrest registry?
William’s syndrome MI
What are the four characteristics of tetralogy of Fallot?
- pulmonary stenosis
- RVH
- VSD
- aorta overrides septal defect
A concern for paradoxical air embolism May occur in the neonate because of:
Patent foramen ovale
What are examples of a cyanotic shunt (right to left)?
- tetralogy of Fallot
- transposition of the great arteries
- tricuspid valve abnormality (ebsteins anomaly)
- truncus arteriosus
- total anomalous pulmonary venous connection
