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25 Cards in this Set
- Front
- Back
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Pediatric CHF is most frequently what? What is it's most common cause?
Flow and resistance are ______ related for a given pressure. Pulmonary HTN is defined by _____ flow and/or _____ resistance. |
Pulmonary over-circulation;
Large L-->R shunt reciprocally increased, increased |
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Pulm over-circulation causes and increase ____ needs and _____ sympathetic activation. What is concurrently happening to CO?
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metabolic needs;
increased sym. atv. CO is decreasing. This combination is bad, mmkay? |
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Kid comes into the office, he looks sick - BP low, O2 sat low. You're concerned about bad cardiopulm stuff. What PE should be done?
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Palpate precordium
Auscultate, listen for murmurs, sound splitting, etc. **pulses: esp. lower extremities Lung exam **abd exam: look for hepatomegaly, which is a sign of Right Heart Failure. |
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Which test is better at assessing RV size and fx?
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Cardiac MRI > Echocardiogram.
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What are the Acyanotic ConHtDz categories? (4)
Cyanotic? (2) |
ASD, VSD, AVSD, Coarctation of Aorta
Tetralogy of Fallot TGA |
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Cyanotic Ht lesions can be caused by both decreased and increased pulm. blood flow. Explain.
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decreased:
pulm. obst. w/ intracardiac shunt - Tetralogy of Fallot increased: complete mixing lesions - TGA, really large atrial or ventricular defects. |
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What two classes of things can cause acyanotic ht lesions?
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Isolated shunts (L-->R shunt like a VSD)
Obstructions w/o shunt - pulm stenosis, AS. |
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What is the long-term risk of pulmonary vascular dz (htn)? What is our only option when that does occur?
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eventually will cause irreversible damage that we cannot correct surgically.
Palliation/transplant. |
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When do we tx these congenHtDfts?
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CHF when there is failure to thrive:
cacetix, breathing 100x a min, etc. When hypoxia/hypoxemia is causing end organ effects: brain, etc. When there is a risk of perm. pulm. damage. |
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What is the most common type of ASD?
Which type of ASD must be closed surgically, rather than with a cath. disc? Is ASD more common in F or M? What does a shunt in ASD depend on? When a shunt is present, what is seen on EKG? |
Secundum ASD.
Sinus Venosus ASD. F diff. in ventricular compliance. RAD, RVH, RAE |
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Pt presents as a healthy looking child. On auscultation, S1 is normal and a fixed split S2 is heard. A systolic ejection murmur is also heard. Pulses are normal. Upon palpation, the precordium is active w/ a prominent RV impulse.
Top of the Diff? Given that we heard a fixed split S2, is this child older or younger? What is the systolic ejection murmur from? Shunting is directly proportional to what PE findings? |
ASD
older NOT from shunt, actually from the higher than normal Volume traversing the PV on it's way back from the pulmonary circulation. extent of CHF and hepatomegaly |
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Do most pts with a VSD have a genetic abnormality? F/M more common?
What is the most common location? PE findings? EKG findings? Explain *relative* MS. Do they spontaneously close often? Tx otherwise? |
No, 95% do not. Females.
perimembranous (80%) - the thin area b/t the two ventricles that is not actually muscular. FTT if large defect; active precordium, PV loud in S2 holosystolic murmur Diasotlic rumble of 'relative' mitral stenosis hepatomegaly LVH, LAE, eventually BVH LA is getting more blood, and the functionally normal MV can't handle the additional flow. 50% do. Surgical closure, mostly. |
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Of those w/ Trisomy 21, 40% will have ____, with 40% of those having ____.
In Patrial AVSD, you will see a cleft ___ sided AVV. AVSD often results in ___ ventricular hypertrophy. |
CongenHtDef; AVSD.
cleft left-sided AVV. BVH. |
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Pt presents with FTT. Normal S1, S2 shows a fixed split w/ a loud P2. Holosystolic murmur @ LLSB. Systolic ejection murmur at LUSB. Diastolic murmur at LLSB to apex. Normal pulses, increased work of breathing, and hepatomegaly.
Top of the diff? Cause of the holosystolic murmur? Systolic LUSB ejection murmur? Diastolic murmur at LLSB? Why can CHF be particularly bad in these pts? How is this dz tx? |
AVSD
AVVR relative PV stenosis relative AVV stenosis. There are *two* sources of pulm overcirculation. Treat the CHF until surgical repair (diuretics, AL reduction, glycosides). |
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Which CongenHtDz is associated with a bicuspid aortic valve (85%) and Turner Syndrome?
Where is this defect located? Severe is detected when and with what Sx? Mild? In which (mild/severe) is the shunt L-->R? R-->L? |
Coarctation of the Aorta
it is juxtaductal, just oppostie to the ductal insertion. Newborn = shock HTN in the teenager Mild = L-->R Severe = R-->L |
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In Coarc of Aorta, explain the role of the PDA.
Really bad coarct results in what Sx? |
The Coarc can be either distal or proximal of the PDA. The coarc can also be really bad or not so bad.
When a PDA is open, and the coarc is proximal (and bad), you get a R-->L shunt. When the coarct is distal to the duct, the pressure buildup primarily causes L-->R shunt. The closing of the PDA can also cause problems by narrowing the coarc further, in either case. LV fail b/c high AL Global hypoperfusion b/c the whole sys is failing Symp. drive increased Renin-AngII-Aldosterone sys is increased ...also increased LA pressure and pulm HTN/Edema. |
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Pt (newborn) presents with tachycardia. No pulses, and no BP differential. FTT. Myocardial ischemia. Pulmonary edema and renal failure are present.
- normal S1/S2, systolic ejection click from bicuspid aortic valve - hepatomegaly - rales - CHF ECG is nonspecific, but the CXR shows signs of left-sided failure. ....top of the diffdx? Tx? |
Severe Coarctation of Aorta
ABCs Prostaglandins can open PDA temporarily ----eventually will need surgical repair tho'. |
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Pt (young child) presents w/ upper extremity hypertension and brachiofemoral pulse delay. PE shows a prominent LV impulse.
- ECG shows signs of LVH - CXR shows "rib notching" due to the prolonged enlargement of intercostal arteries. Top of the diff dx? |
Coarctation of the aorta, distal to the ductus arteriosis / less severe.
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What is a cyanotic CongenHtDz example that is a result of decreased pulmonary blood flow?
Increased pulmonary blood flow? |
Tetralogy of Fallot
Transposition of the Great Arteries |
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What is the most common cause of cyanotic ht dz beyond the newborn period?
What syndrome is it associated with 25% of the time? What are the four findings related to, and what is the one major defect in this dz? |
Tetralogy of Fallot
DiGeorge Syndrome "big one": anterior and cephalad deviation of outlet ventricular septum - right ventricular outflow tract obstruction - override of the aorta - outlet ventricular septal defect - RVH |
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What do the Sx of tetralogy of Fallot depend on? Results?
Which is more common? What is seen on CXR? EKG? |
the extent of the RVOT obstruction
Severe: R--> L shunt - significant cyanosis "blue tet" Mild: L-->R shunt - mild to no cyanosis "pink tet" blue tet. "Boot Shaped heart" RVH and RAD |
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Pt presents (child) that is well appearing. Prominent RV impulse is noted. Normal S1, ejection click, and a soft P2 are heard on auscultation. There is no VSD murmur, but a systolic ejection murmur is heard across the RVOT. Pulses are normal, lung exam is normal, and abdominal exam is normal.
...top of the diff? Tx? |
Tetralogy of Fallot
severe: prostaglandins, palliative surgery --> insertion of a mBT shunt (gortex tube b/t aorta and pulm arteries) to act as a man-made PDA = allows the blood to be oxygenated. ... complete repair w/ surgery @ 3-6 monhts of age. |
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What is the most common cause of cyanotic ht dz in the newborn?
M/F? In order to survive this, what must the child have? In the event of a patent foramen ovale, what can be done and why? What must be true of R->L and L->R shunting? EKG? CXR? |
TGA
M(60-70%) shunting of some sort (VSD, LVOT obstruction, ASD) Widen it w/ tearing to provide the type of shunt that is needed. They must equal each other. Normal newborn "Egg on a string" (narrow mediatstinal shadow) |
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A normal newborn EKG shows what?
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RVH and RAD
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In pts w/ TGA, do you see cyanosis when a large VSD is present? w/o one?
What else is seen on PE? Tx? |
Mild to none.... Cyanosis is incredible when there isn't one tho'.
^ RV impulse normal S1, single S2 (=loud A2) normal pulses +/- sys ejection murmur tachypnea hepatomegaly temporary = increase mixing by tearing a new hole, try to use prostaglandins for ductal patency Surgical fix: Arterial switch operation (Jatene Procedure) |
