Congenital Heart Disease And Cardiac Embryology

Front 1

What percent of live births have congenital heart disease?

Back 1

1%

Front 2

What is the most common cause of death in term infants from 1 day - 1 year?

Back 2

Congenital Heart Defects

Front 3

What % of CHD infants will require invasive therapy?

Back 3

60%

Front 4

Physiological Classifications of Congenital Heart Lesions?

Back 4

Obstructive
Left to Right Shunts (-->HF)
Right to Left Shunts (-->cyanosis)
Other (regurge, coronary)

Front 5

Mean Life Expectancy for Untreated:
ASD
VSD
AVSD
Coarctation

Back 5

ASD: 45
VSD: 30
AVSD: 25
Coarctaction: 40

Front 6

Mean Life Expectancy for Untreated:
Pulmonary Atresia
TGA
Interupted AA

Back 6

all are < 0.1 yrs (so about 1 month)

Front 7

Possible Etiologies of CHD?

Back 7

Teratogens
Maternal Diabetes/Infection
Flow Hypothesis
Genetics
MULTIFACTORIAL

Front 8

What is the main result of not know the cause for CHD?

Back 8

We can't clearly prevent it

Front 9

Challenges to Pediatric Heart Surgery

Back 9

-Kids don't respond well to heart-lung machine
-Artificial Material doesn't grow...kids do
-Hard to reestablish nutrition after long ICU stays

Front 10

What's the best option when invasive therapy in kids/infants is required?

Back 10

Catherization

Front 11

Possible Clinical Findings w/ a Patent Ductus Arteriosus?

Back 11

Often Asymptomatic
Acyanotic
Bounding Pulses
Wide Pulse Pressures
Obscured S2 due to murmur
Continuous murmur at 2nd LICS, radiating to back
Possible Click, Possible Thrill at SSN

Front 12

Of PDA signs, what is absent in newborns?

Back 12

the diastolic component

Front 13

PDA manifestation on CXR?

Back 13

enlarged heart

Front 14

Rx for a PDA?

Back 14

Surgery (cut it)
Catheterization: deposit a coil

Front 15

Incidence of Patent Foramen Ovale in general population?

Back 15

8-10%

Front 16

Incidence of PFO in population w/ stroke?

Back 16

35-40%

Front 17

Clinical Findings in ASD?

Back 17

Acyanotic
Widely-split, fixed S2
Soft SEM over pulmonic area
Large flow-->mid-diastolic murmur at LLSB (trans-tricus)

Front 18

ECG findings w/ ASD?

Back 18

RA Enlargement
RV Hypertrophy

Front 19

C-XR findings w/ ASD?

Back 19

RA Enlargement
RV Enlargement
Inc Pulmonary Vascular Markings

Front 20

Clinical Findings w/ VSD?

Back 20

Large VSD-->CHF
Inc LV Impulse (may-->thrill of LLSB)
Loud, harsh holosystolic murmur LLSB
Large Shunt-->mid diastolic rumble at apex (trans-mitral)

Front 21

ECG findings w/ VSD?

Back 21

Left Atrial and Ventricular Enlargement

Front 22

What is the most common form of CHD in Down's kids?

Back 22

AVSD

Front 23

Etiology of AV Septal Defect?

Back 23

Endocardial Cushion Failure to Fuse

Front 24

What should you think if there is a newborn that is different colors on its right and left side?

Back 24

Coarctation of the Aorta (while the DA is still patent)

Front 25

Clinical Findings w/ Coarctation of the Aorta?

Back 25

Severe presents w/ HF and shock w/in 2 weeks of birth
Mild may be asymptomatic, HTN
Decreased Femoral Pulses, Brachiofemoral Delay
Scapular Bruit

Front 26

70% of patients with coarctation have this?

Back 26

Bicuspid Aortic Valve

Front 27

How can you Dx a bicuspid aortic valve?

Back 27

Click at URSB
SEM at URSB and Apex

Front 28

Sign of Coarctation on C-XR?

Back 28

a "3" sign that is from stricture

Front 29

Other ways to Dx Coarctation?

Back 29

MRI
Angiography
Echocardiogram

Front 30

Rx options for Coarctation

Back 30

Plan A: cut out constricted piece and rejoin ends
Plan B: catheter, balloon, stent

Front 31

Infant w/ severe Resp Distress and difficult to mechanically ventilate?

Back 31

Double Aortic Arch constricting bronchus

Front 32

Clinical Findings in Pulmonic Valve Stenosis?

Back 32

Severe: Cyanosis
Mild: Asymptomatic w/ murmur
Maybe Inc RV impulse
Systolic Ejection Click and/or murmur ULSB (murmur reflects severity)

Front 33

How can the click at the ULSB in PS vary?

Back 33

it gets worse w/ respiration

Front 34

PS findings on C-XR?

Back 34

Prominent main pulmonary artery segment
Normal or Decreased pulmonary vascular markings

Front 35

Rx for Pulmonary Valve Stenosis?

Back 35

Balloon Valvuloplasty
PGE1

Front 36

Way to remember PS?

Back 36

Right Ventricular Constipation

Front 37

What causes LV constipation?

Back 37

Aortic Valve Stenosis

Front 38

How does Aortic Valve Stenosis compare to PS?

Back 38

It can be much more severe

Front 39

Clinical Findings for AVS?

Back 39

Similar to PS but
Murmur at RUSB that radiates along aorta's route (i.e. to back)

Front 40

What are the cyanotic heart diseases?

Back 40

Transposition of Great Arteries (TGA)
Tetralogy of Fallot
other???

Front 41

What is the only way a newborn w/ TGA survives a few days on its own?

Back 41

Patent Foramen Ovale

Front 42

Dx for TGA?

Back 42

Echo can do it
No Murmur
Narrow Mediastinum

Front 43

Rx for TGA?

Back 43

Atrial Switch (so right side is systemic, left is pulmonary). works for about 30 years till RV gets worn out

Arterial Switch is better