Congenital Heart Defects - Peds

Front 1

What and when does congenital heart disease occur?

Back 1

When the heart or blood vessels near the heart do not develop properly before birth

Front 2

What is the most common congenital malformation in newborns?

Back 2

congenital heart defects

Front 3

Atresia

Back 3

congenital absence or closure of a normal body opening or tubular structure

Front 4

Prostaglandins

Back 4

hormones important in the mediation of inflammation, platelet aggregation, vasodilation, pain reception, and maintenance of patent ductus arteriosus

Front 5

What are the prostaglandin inhibitors?

Back 5

nonsteroidal & steroid anti-inflammatory agents

Front 6

Stenosis

Back 6

constriction or narrowing of a passage or orifice

Front 7

Subacute Bacterial Endocarditis (SBE)

Back 7

heart valve infection not evident for weeks or months; usually streptococcal; often develops on abnormal heart valva

Front 8

With normal heart anatomy deoxygenated blood is pumped from the _______________ of the heart, through the _______________________, to the _________ where it is oxygenated

Back 8

right side
pulmonary artery
lungs

Front 9

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

Back 9

left heart
pulmonary veins
aorta

Front 10

Fetal Circulation
What supplies oxygen and nutrients from the placenta?

Back 10

umbilical vein

Front 11

Which side of the heart has higher pressure?

Back 11

right side has higher pressure than the left

Front 12

What allows blood to cross from right to left atrium?

Back 12

Foramen ovale

Front 13

What allows most of the blood from pulmonary artery to enter the aorta?

Back 13

Ductus arteriosus

Front 14

Transition from Fetal Circulation
What increases systemic pressure?

Back 14

Clamping of the umbilical cord

Front 15

With the increased systemic pressure what happens to the lungs?

Back 15

expands with air

Front 16

With increased oxygen what happens to the pulmonary pressure?

Back 16

decreased (vasodilation)

Front 17

With increased oxygen promotion closure of what occurs?

Back 17

ductus arteriosus

Front 18

How does the closure of foramen ovale occur?

Back 18

left atrial pressure > right atrial pressure

Front 19

What are two types of congenital heart defects

Back 19

Acyanotic
Cyanotic

Front 20

Acynotic shunting

Back 20

left to right shunting of blood (increases pulmonary blood flow) Pink

Front 21

Cyanotic shunting

Back 21

right to left shunting of blood (decreased pulmonary blood flow) Blue

Front 22

Ventricular septal defect

acyanotic defect or cyanotic defect

increased pulmonary flow or obstruction to blood flow out of the heart

Back 22

acyanotic

increased pulmonary flow

Front 23

atrial septal defect

acyanotic defect or cyanotic defect

increased pulmonary flow or obstruction of blood flow out of the heart

Back 23

acyanotic

increased pulmonary flow

Front 24

pulmonary stenosis

acyanotic or cyanotic

increased pulmonary flow or obstruction of blood flow out of the heart

Back 24

acyanotic

obstruction of blood flow out of the heart

Front 25

patent ductus arteriosus

acyanotic or cyanotic

increased pulmonary flow or obstruction to blood flow out of the heart

Back 25

acyanotic

increased pulmonary flow

Front 26

coarctation of the aorta

acyanotic or cyanotic

increased pulmonary flow or obstruction of blood flow out of the heart

Back 26

acyanotic

obstruction to blood flow out of the heart

Front 27

aortic stenosis

acyanotic or cyanotic

increased pulmonary flow or obstruction to blood flow out of the heart

Back 27

acyanotic

obstruction to blood flow out of the heart

Front 28

Tetralogy of Fallot

acynotic or cynotic

decresed pulmonary flow or mixed blood flow

Back 28

cynotic

decreased pulmonary flow

Front 29

AV Canal

acynotic or cynotic

decreased pulmonary flow or mixed blood flow

Back 29

cynotic

mixed blood flow

Front 30

Truncus Arteriosus

acynotic or cynotic

decreased pulmonary flow or mixed blood flow

Back 30

cynotic

mixed blood flow

Front 31

Tricuspid Atresia

acyanotic or cyanotic

decreased pulmonary flow or mixed blood flow

Back 31

cyanotic

decreased pulmonary flow

Front 32

Transposition of the Great Arteries

acyanotic or cyanotic

decreased pulmonary flow or mixed blood flow

Back 32

cyanotic

mixed blood flow

Front 33

Hypoplastic Left Heart Syndrome

acyanotic or cyanotic

decreased pulmonary flow or mixed blood flow

Back 33

cyanotic

mixed blood flow

Front 34

Acyanotic Defects Blood Flow Patterns

WITH left to right shunting (increased pulmonary blood flow) what are the 3 defects?

Back 34

ventricular septal defect (VSD)
atrial septal defect (ASD)
patent ductus arteriousus (PDA)

Front 35

Acyanotic Defects

WITHOUT shunting what 3 defects

Back 35

pulmonary stenosis (PS)
aortic stenosis (AS)
coarctation of the aorta (coarc)

Front 36

With acynotic defects what 2 things happen to the blood?

Back 36

increased pulmonary flow
obstruction of blood flow out of the heart

Front 37

Increased Pulmonary Flow (3)

Back 37

ASD, VSD, and PDA

Front 38

Obstructed blood flow out of the heart? (3)

Back 38

PS, AS, coarc

Front 39

Obstructed blood flow out of the heart? (3)

Back 39

Coarctation of aorta (coarc)
Aortic stenosis (AS)
Pulmonic stenosis (PS)

Front 40

Mixed blood flow (4)

Back 40

AV Canal
Transportation of the great vessels
Truncus arteriosus
Hypoplastic Left Heart Syndrome

Front 41

Increased pulmonary blood flow (3)

Back 41

Atrial and ventricular septal defects
Patent ductus arteriosis

Front 42

Decreased pulmonary blood flow (2)

Back 42

Tetralogy of Fallot
Tricuspid atresia

Front 43

Which defect?

abnormal opening between the atria

Back 43

Atrial septal defect (ASD)

Front 44

ASD

right to left shunt or left to right shunt

Back 44

left to right

Front 45

What happens in the left to right shunt?

Back 45

the shunt allows the blood from higher-pressure left atrium to flow into lower-pressure right atrium

Front 46

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.

Back 46

Involves the abnormal presence of an opening between the 2 atria - may result from failure of foramen ovale to close after birth

Front 47

Symptoms of ASD

crepitus
left to right cardiac shunt
right to left cardiac shunt
enuresis in a toilet trained child

Back 47

left to right cardiac shunt

Front 48

Symptoms of ASD

may be asymptomatic until preschool or later
gastric hemorrhage
vomiting
cherry angioma

Back 48

May be asymptomatic until preschool or later

Front 49

Pick all the symptoms of ASD

CHF in adults
lymphedema
mild fatigue
dyspnea
Biot's respirations
diaphoresis
systolic murmur
tachypnea
dysrhythmias in adulthood

Back 49

CHF in adults
mild fatigue
dyspnea
diaphoresis
systolic murmur
dysrhythmias in adulthood

Front 50

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.

Back 50

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

Front 51

Some symptoms of CHF - choose

ascites
tremor
rigid abdomen
substernal retractions in infants
weight gain
tachycardia
dypsnea
decreased urine output

Back 51

ascites
substernal retractions in infants
weight gain
tachycardia
dypsnea
decreased urine output

Front 52

Some symptoms of CHF choose

poor feeding and growth
fatigue
heptomegaly
peripheral edema
crackles
distended neck veins in children
cardiomegaly
tachypnea

Back 52

All of them

Front 53

Venticular Septal Defect (VSD)

Back 53

Abnormal opening between the ventricles

Front 54

VSD

what may vary

Back 54

size and location

Front 55

VSD

right to left shunt
left to right shunt

Back 55

left to right shunt

Front 56

VSD

increased pulmonary blood flow
decreased pulmonary blood flow

Back 56

increased pulmonary blood flow

Front 57

VSD

What is common?

Back 57

CHF

Front 58

What happens to the heart in VSD?

Back 58

may enlarge from the added work

Front 59

When listening to the heart is VSD what will you hear?

Back 59

murmur (sound of turbulent blood flow)

Front 60

What diagnostic can you see VSD?

Back 60

chest x-ray

Front 61

What happens in VSD?

Back 61

increased pulmonary blood flow will cause prominent pulmonary vasculature

Front 62

Over time what happens in VSD?

Back 62

Increased pulmonary HTN may permanently damage the blood vessel walls

Front 63

If you have a small defect in VSD what can happen?

Back 63

small defects may close without surgery
small defects may be repaired surgically with a purse-string approach

Front 64

Large defects in VSD may be repaired using what type of patch?>

Back 64

dacron

Front 65

What is required for surgical repair in VSD?

Back 65

cariopulmonary bypass

Front 66

What is required in VSD until defect can be repaired?

Back 66

SBE prophylaxis

Front 67

Patent Ductus Arteriosus (PDA)

Occurs twice as often in _________ as in _________

Back 67

girls
boys

Front 68

PDA

Will you have symptoms or severe heart failure?

Back 68

depending on the size of the PDA and the condition of the lungs there may be no symptoms or severe heart failure

Front 69

PDA

In utero, the ductus is a normal connection between what?

Back 69

the aorta and the pulmonary artery

Front 70

PDA - When does hormonal changes normally cause its closure

Back 70

At birth

Front 71

Failure to close the PDA can cause what?

Back 71

excessive blood flow to the lungs

Front 72

In PDA the pulmonary arteries will dilate why?

Back 72

due to the increased pulmonary blood flow

Front 73

PDA

right to left shunting
left to right shunting

Back 73

left to right shunting

Front 74

PDA

When does the left to right shunting occur?

Back 74

both systole and diastole

Front 75

PDA

Is the pressure in the aorta higher or lower than that of the pulmonary artery during both systole and diastole?

Back 75

higher

Front 76

PDA

What are some s/s of PDA?

Back 76

respiratory distress
congestion in the lungs
prominent pulmonary
vascular markings seen on
CXR
continuous murmur
hyperactive precordium
enlarged heart (left atrium dilated)

Front 77

In PDA what does inserting specially designed coils in the cath lab do?

Back 77

blocks blood flow in the vessel

Front 78

PDA may be closed medically with __________________, which blocks prostaglandins.

What can be used as an alternative?

Back 78

Indomethicine
Ibuprofen

Front 79

When is Indomethicine used?

Back 79

when s/s presist after 48 hours of conservative treatment or in premature infants weighing 500 to 1750 grams

Front 80

What are some conservative treatments in PDA and Indomethacin?

Back 80

fluid restriction, diuretics, and respiratory support.

Front 81

When does Indomethacin become less effective?

Back 81

after 7 days of age

Front 82

What gastrointestinal problems can occur in PDA and Indomethacin?

Back 82

abdominal distention
bleeding
gastric perforation
transient ileus
vomiting

Front 83

What problems can occur in PDA and Indomethacin?

Back 83

gastrointestinal problems
renal function impairment
bleeding problems
hypoglycemia

Front 84

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.

Back 84

Patent Ductus Arteriosus (PDA)

Front 85

What studies are performed prior to the initiation of prostaglandin therapy for central cyanosis?

Back 85

Hyperoxic Challenge test
Chest X-ray (decreased pulmonary vascularity)
serum glucose
hematocrit
adequate ventilation
arterial blood gases

Front 86

With Prostaglandin E 1 what 2 diagnostics will clearly id infants with ductal dependent pulmonary blood flow?

Back 86

echo and cardiac cath

Front 87

With Prostaglandin E1 what do you want to monitor?

Back 87

respiratory rate
temperature
blood pressure
arterial blood gases and pH

Front 88

What are 3 common side effects of Prostaglandin E 1

Back 88

apnea
fever
flushing

Front 89

In obstruction defects what happens?

Back 89

an obstruction is a narrowing that partly or completely blocks the flow of blood

Front 90

What are obstructions called?

Back 90

stenoses

Front 91

Where can stenoses occur?

Back 91

heart valves
arteries
veins

Front 92

What are the 3 most common forms of stenoses?

Back 92

pulmonary stenosis
aortic stenosis
coarctation of the aorta

Front 93

A defective pulmonary valve that doesn't open properly is called _____________

Back 93

stenotic

Front 94

What does a stenosis force the right ventricle to do?

Back 94

pump harder to overcome the obstruction

Front 95

When is treatment needed in pulmonary stenosis?

Back 95

when the pressure in the right ventricle is higher than normal

Front 96

PS - in most children, the obstruction can be relieved how?

Back 96

a procedure called balloon vavuloplasty

Front 97

Pulmonary Stenosis requires what?

Back 97

SBE prophylaxis

Front 98

With pulmonary stenosis some pts may need open-heart surgery? T or F

Back 98

true