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28 Cards in this Set

  • Front
  • Back
1. When does Cyanotic CHD often manifest itself?
a. After the PDA begins to close (i.e., ductus dependent)
2. What keeps the ductus open?
a. Prostaglandin E, an IV med.
3. What is Cyanotic CHD characterized by?
a. Decreased pulmonary blood flow.
b. Unsaturated blood returning to the heart from the periphery is shunted into the systemic circulation, thus bypassing the lungs.
4. Transposition of the Great Arteries (TGA) appearance on radiograph?
a. Egg-on-a string
b. Although the appearance may be normal in the first few days of life.
5. TGA on ECG?
a. Shows the normal right-sided dominant pattern of the neonate.
6. Confirmation of TGA diagnosis?
a. Echo.
7. Initial management of TGA (after prostaglandin E)?
a. Creation of an atrial septum (“atrial septostomy”) via cardiac cath, which provides immediate symptom palliation.
b. Definition surgical care often occurs in the first 2 weeks of life.
8. Complication of TGA repair?
a. Repair site stenosis is a potential long-term complication.
9. Pulmonary Valve Stenosis?
a. A cyanotic CHD (accounts for 20-30% of CHD)?
b. Cyanosis and exercise intolerance, if any, are proportional to the degree of stenosis.
10. How does Pulmonary Valve Stenosis appear on auscultation?
a. Upper left sternal border systolic murmur that radiates to the back
b. And
c. A systolic click.
11. ECG for Pulmonary Valve Stenosis?
a. Normal in mild cases.
b. Greater stenosis causes right-axis deviation and right ventricular hypertrophy.
12. Tx of Pulmonary Valve Stenosis?
a. Valvuloplasty is achieved via cardiac cath
13. In what genetic conditions may Pulmonary stenosis occur?
1. Glycogen storage disease
2. Noonan syndrome
14. Characteristic radiographic finding w/TET?
a. Boot or wooden shoe appearance
15. Pink Tetralogy?
a. Occurs if pulmonary stenosis is mild at birth, neonates have normal colour “pink tet”.
b. By early childhood most become cyanotic as a result of stenotic progression.
16. Tetralogy spells?
a. Many children w/TOF also experience hypercyanotic spells “tetralogy spells”
b. Caused by sudden increase in right-to-left shunting of blood.
c. May be brought on by activity or agitation, or they may occur w/o apparent precipitant.
d. Such children can be seen assuming a squatting posture, which compresses peripheral blood vessels, thus increasing pulmonary blood flow and systemic arterial oxygen saturation.
17. Prognosis of Tet?
a. With current surgical management, 90% of pts w/TOF survive to adulthood.
18. Hallmark of children who have tricuspid valve abnormalities of tricuspid atresia or Ebstein Anomaly?
a. Cyanosis!
19. Pathophys of Tricuspid atresia?
a. No outlet exists between the right atrium and right ventricle, forcing systemic enous return to enter the left atrium via the foramen ovale or an associated ASD.
b. A VSD is also often present.
20. Pathophys of Tricuspid valve of Ebstein anomaly?
a. Usually is regurgitant and often obstructs ventricular outflow bc or a large anterior leaflet.
21. Note: Both Tricuspid atresia and Tricuspid valve of Ebstein anomaly are “ductal dependent” in the neonate, and both require surgical correction.
21. Note: Both Tricuspid atresia and Tricuspid valve of Ebstein anomaly are “ductal dependent” in the neonate, and both require surgical correction.
22. How can you differentiate a benign pulmonary flow murmur from a pathological pulmonary murmur?
a. The benign murmur does not radiate.
b. No click is heard
c. No s/s of cardiac disease (digital clubbing, cyanosis, exercise intolerance) are found.
23. 3 Benign childhood murmurs?
a. Peripheral pulmonic stenosis
b. Venous hum (A low-pitched murmur at the sternal notch only when the child is upright)
c. Still vibratory murmur (A high-pitched “musical” systolic murmur heard best at the left sternal border in the supine position).
24. Venous hum in child?
a. A low-pitched murmur at the sternal notch only when the child is upright
25. Still vibratory murmur?
a. A high-pitched “musical” systolic murmur heard best at the left sternal border in the supine position.
26. Note, although pulmonary stenosis and tricuspid atresia are cyanotic heart lesions, exercise-induced cyanosis and systolic murmur are characteristic if pulmonary stenosis.
26. Note, although pulmonary stenosis and tricuspid atresia are cyanotic heart lesions, exercise-induced cyanosis and systolic murmur are characteristic if pulmonary stenosis.
27. 4 Heart Defects in Tet?
1. Overriding aorta
2. Pulmonic Stenosis
3. VSD
4. Right ventricular hypertrophy.
28. Best initial management of cyanotic heart disease?
a. Administer Prostaglandin E1!