Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APEX > Unit 11 - Congenital Heart Defects > Flashcards

Unit 11 - Congenital Heart Defects Flashcards

1
Q

where does fetal gas exchange occur

A

placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Carries oxygenated blood from the mother to the fetus

A

umbilical vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Carry deoxygenated blood from the fetus to the mother

A

umbilical artery (1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Shunts blood from the umbilical vein to the IVC (bypasses liver)

A

ductus venousus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Shunts blood from the RA to the LA (bypasses lungs)

A

foramen ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Shunts blood from the pulmonary artery to the aorta (bypasses lungs)

A

ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

6 ways fetal circulation differs from adult circulation

A
  1. placenta is organ of respiration
  2. circulation arranged in parallel
  3. R-L shunting across foramen ovale and ductus arteriosus
  4. SVR is low
  5. PVR is high
  6. minimal pulmonary blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

fetal organ of respiration

A

placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

purpose of foramen ovale

A

shunt blood from RA to LA

Oxygen-rich blood bypasses the lungs and is preferentially delivered to the heart and developing brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

purpose of foramen ovale

A

shunt blood from RA to LA

Oxygen-rich blood bypasses the lungs and is preferentially delivered to the heart and developing brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

purpose of ductus arteriosus

A

shunt blood from pulmonary trunk to aorta

Lower oxygen blood bypasses the lungs and is delivered to the lower body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

purpose of ductus venosus

A

allows oxygen-rich blood from placenta to bypass liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when does the foramen ovale close

A

functional closure: when LAP > RAP (cord clamping increases SVR)

anatomic closure: 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when does the ductus arteriosus close

A

functonal closure: SVR > PVR (increased PaO2 & decreased prostaglandins from placenta)

Anatomic closure: several weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

adult remnant of foramen ovale

A

fossa ovalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

adult remnant of ductus arteriosus

A

ligamentum arteriosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when does the ductus venosus close

A

anatomic closure when umbilical cord is clamped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

adult remnant of ductus venosus

A

Ligamentum venosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

% of adult population with PFO

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

complication of PFO

A

Increases risk of paradoxical air embolism (embolus travels to brain instead of lungs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

meds that can open or close PDA

A

opens: prostaglandin E1 (PGE1)
closes: indomethacin (prostaglandin synthesis inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

plays a key role in trauma, where a rapid deceleration tears the ligament & results in partial or complete aortic dissection

A

Ligamentum arteriosum

adult remnant of ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

plays a key role in trauma, where a rapid deceleration tears the ligament & results in partial or complete aortic dissection

A

Ligamentum arteriosum

adult remnant of ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

size and direction of shunt depends on what 3 factors

A
  1. Ratio of PVR to SVR
  2. Pressure gradients between cardiac chambers or arteries involved
  3. Compliances of cardac chambers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how does ratio of PVR to SVR affect direction of shunt

A

R - L shunt occurs when PVR is > SVR
L - R shunt occurs when SVR is > PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

causes of increased PVR

A
  • hypercarbia
  • hypoxemia
  • acidosis
  • collapsed alveoli
  • Trendelenburg
  • hypothermia
  • vasoconstrictors
  • increased SNS tone
  • light anesthesia
  • pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

causes of decreased PVR

A
  • hypocarbia
  • adequate oxygenation
  • alkalosis
  • hemodilution
  • vasodilators
  • nitric oxide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

causes of increased SVR

A
  • vasoconstrictors
  • fluid bolus
  • increased SNS tone
  • pain
  • anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

causes of decreased SVR

A
  • volatiles
  • propofol
  • decreased SNS tone
  • hemodilution
  • sepsis
  • anaphylaxis (histamine release, vasodilation, capillary leak)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

patho of cyanotic shunts

A

↓ pulmonary blood flow = hypoxemia, LV volume overload, LV dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

5 examples of R-L cardiac shunts (5 T’s)

A
  1. Tetralogy of Fallot (most common)
  2. Transposition of the great arteries
  3. Tricuspid valve abnormality (Ebstein’s anomaly)
  4. Truncus arteriosus
  5. Total anomalous pulmonary venous connection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

how do cyanotic shunts affect inhalation induction

A
  • shunted blood doesn’t pass through lungs to pick up volatile
  • shunted blood dilutes volatile in L heart
  • decreased FA/FI rise
  • slower inhalation induction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how does volatile solubility affect inhalation induction in cyanotic shunts

A

slower inhalation induction
* most profound with less soluble agents (N2O and Desflurane)
* less of an issue with more soluble agents (isoflurane)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how is IV induction affected by cyanotic shunts

A

R - L shunt allows IV medication to bypass lungs and directly enter systemic circulation.

The drug reaches the vessel-rich organs faster, resulting in a faster onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

HD goals with cyanotic shunts

A

maintain SVR
decrease PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

patho of acyanotic shunt

A

L-R shunt
* oxygenated pulmonary venous blood recirculates through R heart and lungs
* decreased systemic flow
* increased pulmonary flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

examples of acyanotic CHD

A
  • VSD (most common)
  • ASD
  • PDA
  • Coarctation of aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how do cyanotic shunts affect anesthesia induction

A

R  L shunt allows IV medication to bypass lungs and directly enter systemic circulation. The drug reaches the vessel-rich organs faster, resulting in a faster onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

HD goals with acyanotic shunt

A
  • avoid increased SVR
  • avoid decreased PVR by avoiding alkalosis, hypocapnia, high FiO2, and vasodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

complications of increased pulm blood that occurs in acyanotic shunts

A
  • Volume overload of both ventricles -› biventricular failure
  • Ventricular hypertrophy
  • Decreased lung compliance + increased airway resistance
  • Pulmonary hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is Eisenmenger’s syndrome

A

a patient with a left-to-right shunt develops pulmonary hypertension

Increased right heart pressures cause a flow reversal through the cardiac defect, ultimately leading to a right-to-left shunt, hypoxemia, and cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

most common cyanotic CHD

A

tetralogy of fallot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

4 assoc defects in ToF

A
  1. Right ventricular outflow tract obstruction
  2. Right ventricular hypertrophy
  3. Ventricular septal defect
  4. Overriding aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

strongly correlates with amount of shunt in ToF

A

degree of RVOT obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

which is assoc with pHTN - cyanotic or acyanotic shunts

A

acyanotic (L-R shunt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

effect of increased RVOT obstruction in ToF

A

more deoxygenated blood is shunted through the VSD and out into the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

how does the body compensate for RVOTO in ToF

A

erythropoiesis

leads to polycythemia and increases the risk of thromboembolism and stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what precipitates a Tet spell

A

increased sympathetic activity (crying, agitation, pain, defecation, fright, or trauma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

how does a Tet spell cause hypoxemia

A
  • ↑ SNS activity = ↑ contractility and ↑ RVOTO
  • ↑ resistance at level of RVOT favors flow through VSD
  • net effect: ↑ R-L shunting, hypoxemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

treatment of peri-op Tet spell

A
  • FiO2 100%
  • IVF
  • Increase SVR with phenylephrine
  • Reduce SNS stimulation (deepen anesthesia, beta-blockade with a short-acting agent - esmolol)
  • Avoid inotropes
  • Avoid excessive airway pressure
  • knee-chest position to
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

how does a child experiencing a Tet spell respond

A
  • hyperventilation with onset of hypoxemia
  • assumes squatting position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

why does a child experiencing a Tet spell squat

A

increased IAP compresses abdominal arteries
* increased RV preload
* increased SVR
* increased blood flow through RVOT

restores pulmonary blood flow, reduces the magnitude of the right-to-left shunt, and improves oxygenation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

medications to avoid in patients with unrepaired ToF

A

ephedrine
dobutamine
epinephrine
morphine
meperidine
atracurium

avoid inotropes and histamine-releasing drugs

54
Q

HD goals in pts with ToF

A

increase SVR
decrease PVR
maintain contractility & HR
increase preload

55
Q

best induction agent for pt with unrepaired ToF

A

Ketamine (1 - 2 mg/kg IV or 3 - 4 mg/kg IM)

increases SVR and reduces shunting

increased contractility is minor compared to benefit of increasing SVR

56
Q

best induction agent for pt with unrepaired ToF

A

Ketamine (1 - 2 mg/kg IV or 3 - 4 mg/kg IM)

increases SVR and reduces shunting

increased contractility is minor compared to benefit of increasing SVR

57
Q

CXR findings in pt with ToF

A

The heart may take on a “boot-shaped” appearance

58
Q

EKG changes in ToF

A

RVH can cause RAD

59
Q

best induction agent for a pt with ToF

A

ketamine

60
Q

why are some pts with ToF polycythemic

A

chronic hypoxemia stimulates RBC production

61
Q

failure of the fossa ovalis to close results in what type of atrial septal defect

A

secundum

62
Q

most common congenital cardiac anomaly in children

A

VSD

63
Q

the most common congenital cardiac defect in adults

A

bicuspid aortic valve.

64
Q

most common site of ASD

A

fossa ovalis

also called an ostium secundum ASD

65
Q

a significant number of VSDs close by what age

A

2 yrs old

66
Q

early s/s of ASD

A

poor exercise tolerance

67
Q

later s/s of ASD

A

include atrial flutter, atrial fibrillation, and CHF

68
Q

antibiotic prophylaxis for acyanotic CHD

A

only indicated within 6 months of valve repair

69
Q

common closure of ASD

A

percutaneous transcatheter device

70
Q

how are VSDs usually closed

A

open approach

71
Q

most common site of VSD

A

middle of the ventricular septum, just below the septal leaflet of the tricuspid valve

This is also called a perimembranous VSD

71
Q

most common site of VSD

A

middle of the ventricular septum, just below the septal leaflet of the tricuspid valve

This is also called a perimembranous VSD

72
Q

conditions assoc with VSD

A
  • trisomy 13, 18, 21
  • VACTERL
  • CHARGE
73
Q

The physiologic consequence of the VSD is a function of ?

A

the pressure gradients between the RV and LV, and in turn, these are dependent on PVR and SVR

74
Q

pulmonary blood flow in large vs. small VSD

A
  • small: marginal increase (tolerate GA well)
  • large: RV/LV pressures equalize, PVR and SVR determine direction of blood flow
75
Q

syndrome strongly assoc with CoA

A

turner syndrome

76
Q

where does CoA typically occur

A

just before or after the ductus arteriosus

in rare instances, it occurs proximal to the left subclavian artery

77
Q

where does CoA typically occur

A

just before or after the ductus arteriosus

in rare instances, it occurs proximal to the left subclavian artery

78
Q

what is CoA

A

narrowing of the thoracic aortic lumen

79
Q

presentation of preductal vs. postductal CoA

A
  • Preductal coarctation is less common and usually presents in the neonate
  • Postductal coarctation is more common and usually presents in the adult
80
Q

SBP in upper vs lower extremities in CoA

A

SBP is elevated in the upper extremities

SBP is reduced in the lower extremities

81
Q

CXR changes in CoA

A

Rib notching may be visible (due to increased vessel diameter)

82
Q

required for lower body perfusion in severe CoA

A

PDA

83
Q

what is differential cyanosis

A

pink, well-perfused upper body + blue, poorly-perfused lower body

may be seen in severe CoA

84
Q

what is differential cyanosis

A

pink, well-perfused upper body + blue, poorly-perfused lower body

may be seen in severe CoA

85
Q

administered to maintain ductus arteriosus patency in severe CoA

A

PGE1

temporary until surgery

86
Q

administered to maintain ductus arteriosus patency in severe CoA

A

PGE1

temporary until surgery

87
Q

surgical repair of CoA

A
  • often through left thoracotomy + end-to-end anastomosis
  • aortic cross clamp used - can cause paraplegia
88
Q

why do some surgeons cool the child 34-35 deg C during CoA repair

A

aortic-cross clamp used during an open procedure can cause paraplegia

89
Q

indications for CoA surgical repair

A
  • exercise intolerance
  • chest pain
  • headaches
  • lower extremity claudication
90
Q

presentation of CoA in adulthood

A

secondary HTN

91
Q

characterized by a downward (apical) displacement of the tricuspid valve

A

Ebstein’s anomaly

92
Q

what causes RA enlargement in Ebstein’s anomaly

A

part of the right ventricle becomes part of the right atrium (atrialization), and this causes right atrial enlargement

93
Q

septal defects often assoc with ebstein’s anomaly

A

ASD or PFO

94
Q

Most common congenital defect of the tricuspid valve

A

ebstein’s anomaly

95
Q

how does ebstein’s anomaly affect onset of IV drugs

A

onset of IV drugs may be prolonged due to the pooling of drugs in the enlarged RA

96
Q

arrythmia commonly assoc with ebstein’s anomaly

A

SVT

97
Q

common postop complication assoc with ebstein’s anomaly

A

RV failure

98
Q

critical to management of a pt with ebstein’s anomaly

A

Maintenance of RV function is critical (risk of congestive heart failure)

99
Q

what is transposition of the great arteries

A

each great vessel arises from the wrong ventricle
* RV gives rise to the aorta
* LV gives rise to the pulmonary artery

100
Q

RV circuit in TGA

A
  • Systemic venous (desaturated) blood → RV → aorta → repeat
  • This blood circulates through the systemic circulation but not the pulmonary circulation
101
Q

LV circuit in TGA

A
  • Pulmonary venous blood (well oxygenated) → LV → lungs → repeat
  • This blood circulates through the pulmonary circulation but not the systemic circulation
102
Q

required for extrauterine survival with TGA

A

depends on the mixing of blood through an ASD (best case scenario), VSD, or PFO

103
Q

management of TGA after birth

A

The PDA can be kept open with a prostaglandin infusion (this is a temporary fix)

104
Q

management of TGA after birth

A

The PDA can be kept open with a prostaglandin infusion (this is a temporary fix)

105
Q

TGA repair options

A
  • Rashkind procedure creates an interarterial pathway to allow some oxygenated blood to reach the systemic circulation
  • Definitive surgical correction includes intraatrial baffle and arterial switch procedures
106
Q

goal of surgical HLHS correction

A

separating the pulmonary and systemic circulations

107
Q

goal of surgical HLHS correction

A

separating the pulmonary and systemic circulations

108
Q

4 anatomic features of HLHS

A
  • Hypoplastic LV
  • Hypoplastic aortic arch
  • Mitral and aortic stenosis or atresia
  • Ductal-dependent circulation
109
Q

why should the RUE be used to monitor BP in CoA

A

rarely, obstruction can be proximal to L subclavian a. and reduce perfusion to LUE

110
Q

2 cardiac signs of CoA

A
  1. upper extremity SBP > lower
  2. differential cyanosis
111
Q

surgical goal of Norwood stage 1

A

Aortic reconstruction - aortic arch now arises from the pulmonary trunk

pulmonary arteries are disconnected from the pulmonary trunk and are used to create a shunt from the subclavian artery or the right ventricle

112
Q

surgical goal of Norwood stage 1

A

Aortic reconstruction - aortic arch now arises from the pulmonary trunk

pulmonary arteries are disconnected from the pulmonary trunk and are used to create a shunt from the subclavian artery or the right ventricle

113
Q

when is Norwood stage 1 completed in HLHS

A

neonatal period

114
Q

when is Norwood stage 2 completed

A

3-6 months old

115
Q

surgical goals of Norwood stage 2

A

The shunt from the first procedure is taken down and a new connection is made between the SVC and the pulmonary arteries.

116
Q

surgical goals of Fontan procedure

A

Conversion to Fontan circulation - The IVC is connected to the PA with a conduit

117
Q

when is Fontan surgery completed

A

2-4 yrs old

118
Q

circulation after Fontan completion

A
  • single ventricle pumps blood systemically
  • pulmonary blood flow is passive from SVC/IVC to PA
119
Q

what does pulmonary blood flow depen on after Fontan completion

A

completely dependent on negative intrathoracic pressure during spontaneous breathing

Increased PVR is detrimental to pulmonary blood flow

120
Q

what does pulmonary blood flow depend on after Fontan completion

A

completely dependent on negative intrathoracic pressure during spontaneous breathing

Increased PVR is detrimental to pulmonary blood flow

121
Q

ventilation after Fontan completion

A

Positive-pressure ventilation reduces pulmonary blood flow and should be avoided/ minimized. Spontaneous ventilation is preferred

122
Q

what is truncus arteriosus

A

single artery that gives rise to the pulmonary, systemic, and coronary circulations

no specific pathway for blood to enter the pulmonary circulation before being pumped into the systemic circulation

123
Q

CHD commonly seen with truncus arteriosus

A

VSD

124
Q

consequence of decreased PVR in truncus arteriosus

A

steals blood from the systemic and coronary circulations

125
Q

result of surgical correction of truncus arteriosus

A

can restore a two ventricle arrangement by separating the pulmonary from the systemic circulation with closure of the VSD

126
Q

CHDs assoc with prolonged inhalation induction

A

R-L shunts
* ToF
* ebstein’s anomaly

127
Q

hydration in HLHS patients

A

do not let them get dry - preload dependent

128
Q

shunt lesions with outflow tract obstruction

A
  • Tetralogy of Fallot
  • Ebstein’s anomaly
  • Pulmonary stenosis with atrial or ventricular septal defect
  • Eisenmenger’s syndrome
129
Q

fetal shunt unable to reopen after birth

A

ductus venosus

130
Q

inhaled anesthetic to avoid with ASD

A

N2O

APEX (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions