Cardiac Conditions and Assessment Quiz
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Questions and Answers

What is the primary function of the Patent Ductus Arteriosus (PDA) in the context of blood flow?

  • To reduce blood pressure in the pulmonary artery
  • To facilitate oxygen exchange in the left atrium
  • To increase blood flow exclusively to the systemic circulation
  • To allow blood from the aorta to flow back to the pulmonary artery (correct)

    • Which treatment option is given to help maintain the Patent Ductus Arteriosus (PDA) open in infants?

  • Insulin
  • Aspirin
  • Prostoglandin E (correct)
  • Epinephrine

    • What is a potential risk associated with surgeries like the Glenn and Fontan procedures?

  • Risk for clots due to altered blood circulation (correct)
  • Excessive blood flow to the brain
  • Increased red blood cell production
  • Decreased oxygen saturation in the extremities

    • Which symptom is NOT typically associated with Patent Ductus Arteriosus (PDA)?

    <p>Hypertension</p> Signup and view all the answers

    How does a Ventricular Septal Defect (VSD) contribute to oxygenation of the blood?

    <p>By directing blood flow into the small right ventricle and then to the pulmonary artery</p> Signup and view all the answers

    What does the presence of a thrill during cardiac examination indicate?

    <p>Valve anomaly</p> Signup and view all the answers

    When palpating for the apical impulse, what aspect of heart function does it reveal?

    <p>Left ventricle working status</p> Signup and view all the answers

    What is the significance of elevated hepatic and splenic borders in a physical assessment?

    <p>Signs of right-sided heart failure</p> Signup and view all the answers

    During auscultation, which characteristic of heart sounds should be assessed?

    <p>Quality, intensity, rate, and rhythm</p> Signup and view all the answers

    What is essential to document when identifying a heart murmur?

    <p>Location, time, and intensity</p> Signup and view all the answers

    In which part of the heart cycle is a diastolic murmur typically noted?

    <p>After S2</p> Signup and view all the answers

    What physical sign often accompanies a reduced capillary refill in an assessment?

    <p>Hypothermia of extremities</p> Signup and view all the answers

    What is the common symptom associated with Eisenmenger syndrome?

    <p>Cyanosis</p> Signup and view all the answers

    What is the recommended treatment for large defects in Eisenmenger syndrome?

    <p>Patch closure</p> Signup and view all the answers

    What type of defect is most commonly associated with Down’s syndrome?

    <p>AV canal defects</p> Signup and view all the answers

    Which symptom is NOT typically associated with coarctation of the aorta?

    <p>Increased blood pressure in lower extremities</p> Signup and view all the answers

    What is a significant complication that can arise from AV canal defects post-surgery?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Which treatment is primarily utilized for Patent Ductus Arteriosus (PDA) if it fails to close?

    <p>Medical management with indomethacin</p> Signup and view all the answers

    What is a typical symptom of aortic stenosis?

    <p>Faint pulses and poor capillary refill</p> Signup and view all the answers

    What anatomical structure is responsible for the localized narrowing in coarctation of the aorta?

    <p>Ductus arteriosus</p> Signup and view all the answers

    Which surgical procedure is commonly used for aortic stenosis treatment?

    <p>Ross procedure</p> Signup and view all the answers

    What is a primary consequence of severe pulmonic stenosis?

    <p>Reopening of the foramen ovale</p> Signup and view all the answers

    Which procedure is typically used to treat pulmonic stenosis?

    <p>Surgical valvotomy</p> Signup and view all the answers

    What risk is associated with mechanical valves?

    <p>Increased risk for clots</p> Signup and view all the answers

    Which of the following best describes the condition where the pulmonic artery entrance is narrowed?

    <p>Valvular stenosis</p> Signup and view all the answers

    Which symptom is most likely to be observed in newborns with severe pulmonic stenosis?

    <p>Murmur</p> Signup and view all the answers

    What is the result of right ventricular failure due to pulmonic stenosis?

    <p>Increased right atrial pressure</p> Signup and view all the answers

    Which condition involves a total fusion of the pulmonary valve?

    <p>Pulmonary atresia</p> Signup and view all the answers

    What defect is NOT part of Tetralogy of Fallot?

    <p>Aortic dilation</p> Signup and view all the answers

    What is a potential effect of the foramen ovale reopening in conditions of high right atrial pressure?

    <p>Cyanosis in systemic circulation</p> Signup and view all the answers

    What is likely to happen with untreated severe pulmonic stenosis in a newborn?

    <p>Significant cyanosis or CHF</p> Signup and view all the answers

    What is a common symptom of Tetralogy of Fallot (TOF)?

    <p>Cyanosis</p> Signup and view all the answers

    Which condition requires an Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO) to facilitate blood flow?

    <p>Tricuspid atresia</p> Signup and view all the answers

    What type of shunt is indicated for providing additional blood to the lungs in certain congenital heart defects?

    <p>Modified Blalock-Taussig shunt</p> Signup and view all the answers

    In tricuspid atresia, what is the primary consequence of the absence of the tricuspid valve?

    <p>No communication between the right atrium and ventricle</p> Signup and view all the answers

    What does the presence of a VSD (ventricular septal defect) facilitate in the context of heart defects?

    <p>Blood flow to enter the right ventricle</p> Signup and view all the answers

    What is a primary treatment goal for managing Tetralogy of Fallot in infants?

    <p>Increase blood flow to the lungs prior to surgery</p> Signup and view all the answers

    What complication does complete mixing of oxygenated and deoxygenated blood lead to in congenital heart defects?

    <p>Cyanosis</p> Signup and view all the answers

    In the context of right ventricular hypertrophy, which of the following is an anatomical characteristic?

    <p>Thickening of the right ventricular wall</p> Signup and view all the answers

    Which anatomical structure or condition is involved in the mixing of blood due to congenital heart defects?

    <p>Patent ductus arteriosus (PDA)</p> Signup and view all the answers

    What is the primary surgical intervention for managing blood flow issues in Tetralogy of Fallot?

    <p>Closure of ventricular septal defect and pericardial patching</p> Signup and view all the answers

    Study Notes

    Pediatric Cardiology

    • Pediatric cardiology focuses on the heart and circulatory system in children.

    Fetal Circulation

    • In fetal circulation, pressure is higher on the right side because pulmonary circulation resistance is higher (lungs are collapsed).
    • After birth, this reverses, and the left side has higher pressure (lungs are open).
    • Key structures involved in fetal circulation include the foramen ovale, ductus arteriosus, and ductus venosus.

    Neonates & Infants

    • Heart and great vessels develop in the first 3-8 weeks of gestation.
    • Neonates and infants have higher-pitched heart sounds of greater intensity than adults.
    • They rely on adequate heart rate and rhythm to maintain cardiac output because they cannot increase stroke volume easily.
    • Myocardial muscle in neonates and infants is less efficient and has fewer organized myocardial fibers.
    • Consequently, they depend greatly on calcium, glucose, and blood volume for adequate cardiac output.

    Conduction System

    • Surgeries can affect AV nodes and lead to heart blocks or arrhythmias.
    • Most surgical procedures target the AV node.
    • The Sinoatrial node (pacemaker) initiates the heartbeat.
    • The system includes the atrioventricular node, bundle of His, right and left bundle branches, and Purkinje fibers.

    Physiology

    • Cardiac output is the volume of blood expelled by the heart in one minute.
    • Preload is the volume of blood returning to the heart.
    • Afterload is the resistance against which the ventricles pump when ejecting blood.
    • Contractility is the ability of the cardiac muscle to function as an efficient pump.

    Adequate Systemic Profusion

    • Appropriate heart rate is essential.
    • Adequate blood volume is crucial.
    • Low pulmonary vascular resistance is important.
    • Capillary permeability and tissue utilization of oxygen (O2) are vital.

    Assessment of Cardiac Function

    • History: Important aspects to consider include the mother's health (diabetes, lupus, PKU), pregnancy (assisted reproduction), and birth history (Apgar score, birth weight, complications, full-term). Family history of congenital heart disease increases risk.
    • Infections (rubella, Coxsackie) and exposure to certain medications during pregnancy can increase the risk of congenital heart defects.
    • Birth and family history are important details to note for assessing risk factors.

    Health History of Infant

    • Feeding patterns, weight gain, and development are evaluated.
    • Respiratory infections and breathing problems are considered.
    • Color changes, exercise intolerance (in older children), edema, chest pain, palpations, and neurological problems are assessed.
    • Recent infections and exposures to toxins are also documented.
    • Other health issues and medications are noted.

    Physical Exam

    • Vital signs, including blood pressure in all four extremities and oxygen saturation, are essential.
    • General inspection of skin color, comfort level, and nutritional status are assessed.
    • Heart sounds, including point of maximum intensity, apical impulse, and presence of thrill, are evaluated.

    Physical Assessment Continued

    • The quality and symmetry of pulses, the warmth of extremities, and capillary refill time are checked.
    • Edema, and enlarged liver and/or spleen are examined.
    • Auscultation of heart and lung sounds (quality, intensity, rhythm, and additional sounds) is performed.

    Heart Murmurs

    • Murmurs are swishing sounds detected in addition to normal heart sounds.
    • Key details: location (where best heard), time (during S1 or S2 cycle), intensity (relation to child's position), and loudness are recorded.

    Grading of Murmurs

    • Murmur grades range from I (very faint) to VI (loud, audible without stethoscope contact).

    Hemodynamics

    • Blood flow originates from higher pressure areas, seeking paths of lowest resistance.
    • Right-sided pressure is generally less than left-sided pressure.
    • Pulmonary artery resistance is typically lower than systemic circulation resistance.
    • Pulmonary artery pressure is lower than aortic pressure

    Saturations

    • Blood returning from the body (SVC and IVC) has lower oxygen saturation.
    • Blood returning from the lungs has high oxygen saturation.
    • The aorta distributes oxygenated blood to the body's organs.

    Hemodynamic Classifications

    • Increased pulmonary blood flow
    • Decreased pulmonary blood flow
    • Obstruction to blood flow out of the heart
    • Mixed blood flow

    Classification of Congenital Heart Disease

    • Acyanotic defects (increased pulmonary blood flow)
    • Cyanotic defects (decreased pulmonary blood flow, mixed blood flow, obstruction of blood flow).
    • Specific defects: atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA), coarctation of the aorta, aortic stenosis, pulmonic stenosis, tetralogy of Fallot, AV canal defect, tricuspid atresia, transposition of the great arteries, total anomalous pulmonary venous connection, truncus arteriosus, hypoplastic left heart syndrome

    Incidence

    • Congenital heart defects (CHD) occur in approximately 5 – 8 per 1000 births.
    • CHD is a significant cause of death in the first year of life.

    Defects with Increased Pulmonary Blood Flow

    • Atrial Septal Defect (ASD).
    • Ventricular Septal Defect (VSD),
    • Patent Ductus Arteriosus (PDA),
    • Atrioventricular Canal Defect (AV canal).

    Ventricular Septal Defect (VSD)

    • Opening between right and left ventricles.
    • Defects can be membranous or muscular.
    • Often associated with additional defects.
    • Many spontaneously close within the first year of life.

    AV Canal

    • Incomplete closure of endocardial cushions.
    • Often accompanies a high VSD.
    • Defects in mitral and tricuspid valves.
    • Blood flow between all four chambers of the heart.

    Patent Ductus Arteriosus (PDA)

    • Failure of the ductus arteriosus to close after birth.
    • Results in increased pulmonary blood flow.
    • Right ventricular hypertrophy can develop.
    • Symptoms: signs of heart failure (CHF), murmur.
    • Treatment, medical and/or surgical.

    Obstructive Defects

    • Coarctation of the Aorta.
    • Aortic stenosis.
    • Pulmonic stenosis.

    Aortic Stenosis

    • Narrowing or stricture of the aortic valve.
    • Results in decreased cardiac output and left ventricular hypertrophy.
    • Increased pulmonary vascular congestion.
    • Three main types are valvular stenosis, subvalvular stenosis, and supravalvular stenosis.

    Pulmonic Stenosis

    • Narrowing of entrance to pulmonary artery.
    • Results in right ventricular hypertrophy and decreased pulmonary blood flow.
    • Symptoms: may be asymptomatic, possible cyanosis or CHF (if severe), murmur in newborns, etc

    Defects with Decreased Pulmonary Blood Flow

    • Tetralogy of Fallot (TOF).
    • Tricuspid atresia.

    Tricuspid Atresia

    • No communication between the right atrium and right ventricle.
    • ASD or patent foramen ovale (PFO) are typically present.
    • Complete mixing of oxygenated and deoxygenated blood.
    • Patent ductus arteriosus (PDA) facilitates blood flow for oxygenation.
    • VSD allows oxygenated blood to pass to the right ventricle.
    • Decreased pulmonary blood flow results

    Transposition of the Great Arteries (TGV)

    • The pulmonary artery and aorta swap positions.
    • Systemic circulation defects need to be present to allow for oxygenated blood mixing.
    • Characterized by cyanosis and cardiomegaly.
    • Treatment is usually an arterial switch operation to re-implant the coronary arteries.

    Hypoplastic Left Heart Syndrome (HLHS)

    • Underdevelopment of the left side of the heart,
    • Aortic atresia.
    • Requires a PFO or ASD, and systemic circulation from a PDA.
    • Mild cyanosis with CHF.
    • Progressive deterioration after PDA closure.
    • Treatment includes Norwood procedure, bidirectional Glenn, and modified Fontan operations.

    Truncus Arteriosus

    • Main artery that fails to bifurcate.

    Total Anomalous Pulmonary Venous Connection (TAPVC)

    • Pulmonary veins emptying into the wrong circulatory system (usually the right atrium).

    Congestive Heart Failure (CHF)

    • Volume overload (left-to-right shunts)
    • Pressure overload (obstructive defects)
    • Poor contractility (cardiomyopathy)
    • High cardiac output demands

    Types of CHF

    • Right-sided: edema, hepatomegaly
    • Left-sided: respiratory distress, congestion

    Clinical Manifestations

    • Symptoms include tachycardia, diaphoresis, easily fatigued, tachypnea, dyspnea, mild cyanosis, retractions, grunting, wheezing, cough, poor profusion, hepatomegaly, edema, weight gain, developmental delays, and variations due to myocardiac contraction, afterload, and preload in the heart to compensate for function.

    Management

    • Digoxin: Increases cardiac output, reduces heart size, lowers venous pressure, and relieves edema.
    • Ace inhibitors (Captopril, Enalapril): May improve heart function and reduce pressure.
    • Diuretics (lasix, aldactone): Remove excess fluid and sodium.
    • Nutritional support for BMR increase, caloric intake, and well-rested feeding.

    Other important concepts

    • Central cyanosis
    • Clubbing
    • Hypercyanotic spells ("tet" spells)
    • Knee-chest position

    Web Sites

    • Websites providing information about pediatric cardiac defects.

    Online Resources for Pediatric Cardiac Auscultation

    • Links to websites with sounds and information for auscultation.

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    Pediatric Cardiology - PDF

    Description

    Test your knowledge on various cardiac conditions and their assessments, including the Patent Ductus Arteriosus, Ventricular Septal Defect, and surgical procedures like Glenn and Fontan. Understand the implications of heart sounds, symptoms, and physical examination findings related to these conditions.

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