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98 Cards in this Set
- Front
- Back
What and when does congenital heart disease occur?
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When the heart or blood vessels near the heart do not develop properly before birth
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What is the most common congenital malformation in newborns?
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congenital heart defects
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Atresia
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congenital absence or closure of a normal body opening or tubular structure
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Prostaglandins
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hormones important in the mediation of inflammation, platelet aggregation, vasodilation, pain reception, and maintenance of patent ductus arteriosus
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What are the prostaglandin inhibitors?
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nonsteroidal & steroid anti-inflammatory agents
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Stenosis
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constriction or narrowing of a passage or orifice
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Subacute Bacterial Endocarditis (SBE)
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heart valve infection not evident for weeks or months; usually streptococcal; often develops on abnormal heart valva
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With normal heart anatomy deoxygenated blood is pumped from the _______________ of the heart, through the _______________________, to the _________ where it is oxygenated
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right side
pulmonary artery lungs |
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With normal heart anatomy the oxygen-rich blood then returns to the _____________, via the _________________, and is pumped through the __________ to the rest of the body
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left heart
pulmonary veins aorta |
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Fetal Circulation
What supplies oxygen and nutrients from the placenta? |
umbilical vein
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Which side of the heart has higher pressure?
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right side has higher pressure than the left
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What allows blood to cross from right to left atrium?
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Foramen ovale
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What allows most of the blood from pulmonary artery to enter the aorta?
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Ductus arteriosus
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Transition from Fetal Circulation
What increases systemic pressure? |
Clamping of the umbilical cord
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With the increased systemic pressure what happens to the lungs?
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expands with air
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With increased oxygen what happens to the pulmonary pressure?
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decreased (vasodilation)
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With increased oxygen promotion closure of what occurs?
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ductus arteriosus
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How does the closure of foramen ovale occur?
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left atrial pressure > right atrial pressure
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What are two types of congenital heart defects
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Acyanotic
Cyanotic |
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Acynotic shunting
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left to right shunting of blood (increases pulmonary blood flow) Pink
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Cyanotic shunting
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right to left shunting of blood (decreased pulmonary blood flow) Blue
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Ventricular septal defect
acyanotic defect or cyanotic defect increased pulmonary flow or obstruction to blood flow out of the heart |
acyanotic
increased pulmonary flow |
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atrial septal defect
acyanotic defect or cyanotic defect increased pulmonary flow or obstruction of blood flow out of the heart |
acyanotic
increased pulmonary flow |
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pulmonary stenosis
acyanotic or cyanotic increased pulmonary flow or obstruction of blood flow out of the heart |
acyanotic
obstruction of blood flow out of the heart |
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patent ductus arteriosus
acyanotic or cyanotic increased pulmonary flow or obstruction to blood flow out of the heart |
acyanotic
increased pulmonary flow |
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coarctation of the aorta
acyanotic or cyanotic increased pulmonary flow or obstruction of blood flow out of the heart |
acyanotic
obstruction to blood flow out of the heart |
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aortic stenosis
acyanotic or cyanotic increased pulmonary flow or obstruction to blood flow out of the heart |
acyanotic
obstruction to blood flow out of the heart |
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Tetralogy of Fallot
acynotic or cynotic decresed pulmonary flow or mixed blood flow |
cynotic
decreased pulmonary flow |
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AV Canal
acynotic or cynotic decreased pulmonary flow or mixed blood flow |
cynotic
mixed blood flow |
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Truncus Arteriosus
acynotic or cynotic decreased pulmonary flow or mixed blood flow |
cynotic
mixed blood flow |
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Tricuspid Atresia
acyanotic or cyanotic decreased pulmonary flow or mixed blood flow |
cyanotic
decreased pulmonary flow |
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Transposition of the Great Arteries
acyanotic or cyanotic decreased pulmonary flow or mixed blood flow |
cyanotic
mixed blood flow |
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Hypoplastic Left Heart Syndrome
acyanotic or cyanotic decreased pulmonary flow or mixed blood flow |
cyanotic
mixed blood flow |
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Acyanotic Defects Blood Flow Patterns
WITH left to right shunting (increased pulmonary blood flow) what are the 3 defects? |
ventricular septal defect (VSD)
atrial septal defect (ASD) patent ductus arteriousus (PDA) |
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Acyanotic Defects
WITHOUT shunting what 3 defects |
pulmonary stenosis (PS)
aortic stenosis (AS) coarctation of the aorta (coarc) |
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With acynotic defects what 2 things happen to the blood?
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increased pulmonary flow
obstruction of blood flow out of the heart |
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Increased Pulmonary Flow (3)
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ASD, VSD, and PDA
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Obstructed blood flow out of the heart? (3)
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PS, AS, coarc
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Obstructed blood flow out of the heart? (3)
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Coarctation of aorta (coarc)
Aortic stenosis (AS) Pulmonic stenosis (PS) |
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Mixed blood flow (4)
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AV Canal
Transportation of the great vessels Truncus arteriosus Hypoplastic Left Heart Syndrome |
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Increased pulmonary blood flow (3)
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Atrial and ventricular septal defects
Patent ductus arteriosis |
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Decreased pulmonary blood flow (2)
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Tetralogy of Fallot
Tricuspid atresia |
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Which defect?
abnormal opening between the atria |
Atrial septal defect (ASD)
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ASD
right to left shunt or left to right shunt |
left to right
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What happens in the left to right shunt?
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the shunt allows the blood from higher-pressure left atrium to flow into lower-pressure right atrium
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Atrial Septal Defect (ASD)
Involves the abnormal presence of an opening between the two ventricles - symptoms vary with size of defect Involves failure of the opening between the pulmonary artery and the aorta to close after birth. Involves narrowing of the aorta & obstruction of blood flow from the Left ventricle - frequently located close to the junction of the pulmonary artery. Involves the abnormal presence of an opening between the 2 atria - may result from failure of foramen ovale to close after birth. |
Involves the abnormal presence of an opening between the 2 atria - may result from failure of foramen ovale to close after birth
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Symptoms of ASD
crepitus left to right cardiac shunt right to left cardiac shunt enuresis in a toilet trained child |
left to right cardiac shunt
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Symptoms of ASD
may be asymptomatic until preschool or later gastric hemorrhage vomiting cherry angioma |
May be asymptomatic until preschool or later
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Pick all the symptoms of ASD
CHF in adults lymphedema mild fatigue dyspnea Biot's respirations diaphoresis systolic murmur tachypnea dysrhythmias in adulthood |
CHF in adults
mild fatigue dyspnea diaphoresis systolic murmur dysrhythmias in adulthood |
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CHF
Inability of the heart to pump enough blood to meet the body's metabolic and O2 needs - usually occurs as a complication of major cardiovascular or respiratory disorders. Infection of the endocardium and/or heart valves - caused by bacterial and fungal infections. Multisystem autoimmune disorder triggered by a Group-A-beta-hemolytic streptococcus infection, especially untreated streptococcal pharyngitis. Acute systemic inflammatory illness of unknown etiology that causes vasculitis and can lead to the formation coronary artery aneurysms - most often diagnosed in infants and toddlers. |
Inability of the heart to pump enough blood to meet the body's metabolic and O2 needs - usually occurs as a complication of major cardiovascular or respiratory disorders
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Some symptoms of CHF - choose
ascites tremor rigid abdomen substernal retractions in infants weight gain tachycardia dypsnea decreased urine output |
ascites
substernal retractions in infants weight gain tachycardia dypsnea decreased urine output |
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Some symptoms of CHF choose
poor feeding and growth fatigue heptomegaly peripheral edema crackles distended neck veins in children cardiomegaly tachypnea |
All of them
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Venticular Septal Defect (VSD)
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Abnormal opening between the ventricles
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VSD
what may vary |
size and location
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VSD
right to left shunt left to right shunt |
left to right shunt
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VSD
increased pulmonary blood flow decreased pulmonary blood flow |
increased pulmonary blood flow
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VSD
What is common? |
CHF
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What happens to the heart in VSD?
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may enlarge from the added work
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When listening to the heart is VSD what will you hear?
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murmur (sound of turbulent blood flow)
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What diagnostic can you see VSD?
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chest x-ray
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What happens in VSD?
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increased pulmonary blood flow will cause prominent pulmonary vasculature
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Over time what happens in VSD?
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Increased pulmonary HTN may permanently damage the blood vessel walls
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If you have a small defect in VSD what can happen?
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small defects may close without surgery
small defects may be repaired surgically with a purse-string approach |
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Large defects in VSD may be repaired using what type of patch?>
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dacron
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What is required for surgical repair in VSD?
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cariopulmonary bypass
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What is required in VSD until defect can be repaired?
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SBE prophylaxis
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Patent Ductus Arteriosus (PDA)
Occurs twice as often in _________ as in _________ |
girls
boys |
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PDA
Will you have symptoms or severe heart failure? |
depending on the size of the PDA and the condition of the lungs there may be no symptoms or severe heart failure
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PDA
In utero, the ductus is a normal connection between what? |
the aorta and the pulmonary artery
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PDA - When does hormonal changes normally cause its closure
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At birth
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Failure to close the PDA can cause what?
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excessive blood flow to the lungs
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In PDA the pulmonary arteries will dilate why?
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due to the increased pulmonary blood flow
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PDA
right to left shunting left to right shunting |
left to right shunting
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PDA
When does the left to right shunting occur? |
both systole and diastole
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PDA
Is the pressure in the aorta higher or lower than that of the pulmonary artery during both systole and diastole? |
higher
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PDA
What are some s/s of PDA? |
respiratory distress
congestion in the lungs prominent pulmonary vascular markings seen on CXR continuous murmur hyperactive precordium enlarged heart (left atrium dilated) |
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In PDA what does inserting specially designed coils in the cath lab do?
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blocks blood flow in the vessel
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PDA may be closed medically with __________________, which blocks prostaglandins.
What can be used as an alternative? |
Indomethicine
Ibuprofen |
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When is Indomethicine used?
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when s/s presist after 48 hours of conservative treatment or in premature infants weighing 500 to 1750 grams
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What are some conservative treatments in PDA and Indomethacin?
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fluid restriction, diuretics, and respiratory support.
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When does Indomethacin become less effective?
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after 7 days of age
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What gastrointestinal problems can occur in PDA and Indomethacin?
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abdominal distention
bleeding gastric perforation transient ileus vomiting |
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What problems can occur in PDA and Indomethacin?
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gastrointestinal problems
renal function impairment bleeding problems hypoglycemia |
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Which defect?
shunting of blood can also be right to left, depending on the difference in pressures between systemic and pulmonary circulation. blood flow will follow the path of least resistance. may be life-saving in some cases. Prostaglandin (PGE1) will be given IV to keep ductus from closing in these cases. |
Patent Ductus Arteriosus (PDA)
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What studies are performed prior to the initiation of prostaglandin therapy for central cyanosis?
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Hyperoxic Challenge test
Chest X-ray (decreased pulmonary vascularity) serum glucose hematocrit adequate ventilation arterial blood gases |
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With Prostaglandin E 1 what 2 diagnostics will clearly id infants with ductal dependent pulmonary blood flow?
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echo and cardiac cath
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With Prostaglandin E1 what do you want to monitor?
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respiratory rate
temperature blood pressure arterial blood gases and pH |
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What are 3 common side effects of Prostaglandin E 1
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apnea
fever flushing |
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In obstruction defects what happens?
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an obstruction is a narrowing that partly or completely blocks the flow of blood
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What are obstructions called?
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stenoses
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Where can stenoses occur?
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heart valves
arteries veins |
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What are the 3 most common forms of stenoses?
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pulmonary stenosis
aortic stenosis coarctation of the aorta |
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A defective pulmonary valve that doesn't open properly is called _____________
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stenotic
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What does a stenosis force the right ventricle to do?
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pump harder to overcome the obstruction
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When is treatment needed in pulmonary stenosis?
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when the pressure in the right ventricle is higher than normal
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PS - in most children, the obstruction can be relieved how?
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a procedure called balloon vavuloplasty
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Pulmonary Stenosis requires what?
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SBE prophylaxis
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With pulmonary stenosis some pts may need open-heart surgery? T or F
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true
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