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43 Cards in this Set
- Front
- Back
What are the 4 main circulatory changes at birth?
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1. pulmonary vasodilation
2. systemic pressure rises, pulmonary pressure falls 3. closure of the foramen ovale 4. closure of the ductus arteriosus and ductus venosum |
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What is an atrial septal defect?
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abnormal opening between 2 atria (blood goes left to right); increases saturated blood on the right side and increases pulmonary blood flow
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What are the 3 types of atrial septal defect
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ASD 1 (ostium primum) opening at lower end of septum
ASD 2 (ostium secondum) opening at center of septum sinus venosus defect (opening near junction of SVC) |
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Signs/Symptoms of atrial septal defect
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May be asymptomatic
May develop CHF Characteristic murmur Risk of: atrial dyrhythmias, pulmonary vascular obstructive disease, emboli formation later in life |
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What is the treatment for Atrial Septal Defect?
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Surgical: Dacron patch for large defects, may require replacement of mitral valve
Nonsurgical: ASD 2 may be closed using devices during cardiac catheterization |
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What is ventricular septal defect? How is VSD classified?
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1. Abnormal opening between the 2 ventricles. Blood goes left to right--increase in pulmonary vascular resistance. Many VSDs spontaneously close during the 1st year of life.
2. Classified according to location: membranous (80%) or muscular. |
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What are the s/s of ventricular septal defect? What are the complications of VSD?
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Clinically, you will hear a characteristic murmur. CHF is a common complication. Pt at risk for: 1) bacterial endocarditis, 2) pulmonary vascular obstructive disease and Eisenmenger syndrome
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What is the treatment for ventricular septal defect?
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Surgical treatment is closure of hole with purse string sutures or dacron patch repair. Non surgical closure during cardiac catheterization under clinical trials.
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How are Congenital Defects Classified (2)?
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1. Acyanotic: disorders where there is an increase of pulmonary blood flow or obstruction of blood flow from a ventricle
2) Cyanotic: disorders where there is a decrease in pulmonary blood flow or mixed blood flow |
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What is Patent Ductus Arteriosus (PDA)?
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Failure of the ductus arteriosum to close completely--blood flows from the aorta to the pulmonary artery--extra blood then recirculates thru lungs and is returned to the left atrium. All this results in:
1) increased work for left ventricle 2) increase in pulmonary vascular congestion and resistance 3) increased right ventricular pressure |
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What are the S/S of patent ductus arteriosus?
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1. machine like murmur
2. widened pulse pressure 3. bounding pulses |
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What are the complications of patent ductus arteriosus?
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1. bacterial endocarditis
2. pulmonary vascular obstructive disease |
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What are 3 treatments for patent ductus arteriosus?
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1. administration of indomethacin (prostaglandin inhibitor) sometimes closes pda
2. surgical intervention involves types of thoractomy (clipping ductus) 3. non-surgical use of coils to occlude pda during catheterization |
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What is atrioventricular canal defect (AVC)?
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low atrial septal defect that is continuous with a high ventricular septal defect and clefts of the mitral and tricuspid valves, creating a large av valve that allows blood flow to all 4 chambers--most common defect of Downs syndrome
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What are the 4 signs and symptoms of atrioventricular canal defect?
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*moderate to severe CHF
* murmur *cyanosis when crying *high risk for pulmonary vas ob disease |
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What is the treatment of atrioventricular canal defect?
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1. palliative: pulmonary artery banding with severe symptoms
2. complete surgical repair involves patch closure and reconstruction of valve tissue |
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What are 5 post-op complications for pts with atrioventricular canal defect?
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1. heart block
2. chf 3. mitral regurgitation 4. dysrhythmias 5. pulmonary hypertension |
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What s/s do patients with cardiac defects with increased pulmonary blood flow demonstrate?
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* s/s CHF
* risk of pulmonary vascular obstructive disease |
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Describe defects with increased pulmonary blood flow
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Increased blood volume on the right side of the heart increases pulmonary blood flow at the expense of systemic blood flow.
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Describe obstructive defects
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Blood exiting the chamber meets an area of anatomic narrowing (stenosis). The pressure in the chamber before the obstruction is increased and the pressure beyond the obstruction is decreased. The end result is increased load on the ventricle and decreased cardiac output
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Describe the 3 main locations of obstructive defects (in relation to the valve)
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1. VALVULAR: at the site of the valve itself
2. SUBVAVLULAR: narrowing in the ventricle below the valve 3. SUPRAVALVULAR: narrowing in the great artery above the valve |
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What signs/symptoms do you expect in patients with obstructive defects
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1. may be asymptomatic, but typically some level of CHF
2. severe may exhibit hypoxemia |
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What is coarctation of the aorta
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Obstructive defect caused by a narrowing of the aorta near the insertion of the ductus arteriosis resulting in an increase in arterial pressure proximal to the defect (head and upper extremities) and decrease in pressure distal to the defect (body and lower extremities)
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What are the signs and symptoms of coarctation of the aorta?
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1.high blood pressure and bounding pulses in arms
2. weak/absent femoral pulses 3. CHF in infants 4. older children: dizziness, headaches, fainting & epitaxis (nosebleeds) |
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What are 4 complications of coarctation of the aorta?
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Pts at risk for:
1. hypertension (risk of lifelong hypertension if not corrected prior to 2 years of age) 2. ruptured aorta 3. aortic aneurysm 4. stroke |
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What is the treatment for coarctation of the aorta?
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Surgical: 1) resection of coarcted portion with anastomosis of aorta OR 2) enlargement of constricted portion with a prostetic graft or subclavian segment
NONSURGICAL treatment with balloon angioplasty |
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What is aortic stenosis?
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Obstruction narrowing of the aortic valve causing resistance, decreased cardiac output, left ventricular hypertrophy, and pulmonary congestion.
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What are the 3 types of aortic stenosis?
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1. valvular--bicuspid or fusion of cusps
2. subvalvular:fibrous ring below valve 3. supravalvular: so rare, not described in book |
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What are the three reasons why valvular aortic stenosis is so serious?
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1. obstruction is progressive
2. sudden episodes of ischemia, low cardiac ouput or MI result in sudden death 3. surgical repair rarely results in a normal valve |
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What are the signs and symptoms of aortic stenosis
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Could range from asymptomatic to severe. S/S include decreased cardiac output, faint pulses, hypotension, tachycardia, poor feeding, exercise intolerance, chest pain and dizziness when standing for long periods
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What are the complications of aortic stenosis
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* Left vent. hypertrophy interferes with coronary artery perfusion which may result in MI, scarring of papillary muscles of l vent.
* also risk of bacterial endocarditis, coronary insufficiency and ventricular dysfunction |
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What are the treatments for aortic stenosis
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1. Valvotomy: open the valve via balloon or surgery
2. Aortic valve replacement |
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What are the 4 types of surgical valve replacement used for aortic stenosis
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1. Ross procedure: aortic valve replaced with pulmonary vavle--pulmonary valve replaced with donor valve
2. aortic valve replaced with donor valve 3. aortic valve replaced with mechanical valve 4. Konno procedure: part of the left ventricle is enlarged with aortic valve replacement |
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What is pulmonary stenosis
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*Obstructive defect where a narrowing at the entrance to the pulmonary artery causes right ventricular hypertrophy and decreased pulmonary blood flow.
* If right vent failure, then right atr pressure increases and foramen ovale will open shunting deox blood into left atrium resulting in systemic cyanosis. * If pulmonary stenosis is severe, CHF & systemic venous engorgement is evident * Associated defect patent ductus arteriosis partially compensates for obstruction |
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What are the s/s of pulmonary stenosis?
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*can range from asymptomatic to mild/mod cyanosis to CHF
*characteristic murmur present *cardiomegaly seen on xray |
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What are the complications of pulmonary stenosis
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* risk of bacterial endocarditis
* progressive worsening of symptoms (CHF) |
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What is the treatment for pulmonary stenosis?
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Surgical treatment via Brock technique of valvotomy rare--more common nonsurgical technique of balloon angioplasty (few complications and highly effective)
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What is the Tetrology of Fallot (4 defects)?
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Cyanotic disorder characterized by decreased pulmonary flow due to the presence of 4 defects:
1. ventricular septal defect 2. pulmonary stenosis 3. overriding aorta 4. right ventricular hypertrophy (the shunt direction depends on the difference between the systemic and pulmonary resistance) |
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What are the s/s of Transposition of the Great Vessels
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Depends on the size and type of associated defects--some are severely cynaotic and depressed at birth--symptoms of CHF may be present
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What is the treatment for transposition of great vessels?
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1. initial administration of prostaglandin (or via balloon cath) to keep the ductus arteriosum patent
2. 2 main types of complete surgical correction:(1) creating a tunnel inside the atria to redirect blood to proper vessel--Rastelli procedure OR (2) switching the major arteries-- |
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What is the Transposition of the Great Vessels?
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When the aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle
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What are the s/s Tetrology of Fallot?
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Blue at birth or mild cyanosis that progresses over the 1st year of life as the pulmonic stenosis worsens
* Anoxic spells when the infant cries or eats |
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What is the treatment for Tetrology of Fallot?
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1) palliative shunt to improve pulmonary blood flow
2) complete surgical repair |