Alteration in Cardiovascular Function in Children

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Questions and Answers

What characterizes a left to right shunt in terms of blood flow?

Deoxygenated blood is sent to the lungs.

Oxygenated blood returns to the systemic circulation.

There is a 'back-leak' of blood from the systemic to the pulmonary circulation. (correct)

Increased systemic resistance occurs.

Which of the following is a defect associated with increased pulmonary blood flow?

Ventricular Septal Defect (correct)

Coarctation of the Aorta

Tetralogy of Fallot

Aortic Stenosis

What is a common clinical manifestation of aortic stenosis in infants?

Cyanosis at birth

Increased feeding ability

Poor feeding and faint pulses (correct)

High blood pressure

What does coarctation of the aorta lead to if left undiagnosed in older children?

Hypertension detected in the upper extremities Signup and view all the answers

What are the long-term effects of uncontrolled pulmonary stenosis in children?

Right ventricular hypertrophy and decreased cardiac output Signup and view all the answers

A right-to-left shunt results in which of the following?

Cyanosis due to decreased blood flow to the lungs Signup and view all the answers

Which of the following congenital heart defects is classified as a mixing defect?

Tricuspid Atresia Signup and view all the answers

What prenatal condition increases the risk of congenital heart disease?

Diabetes in the mother Signup and view all the answers

Which congenital heart defect is commonly known to cause severe cyanosis?

Tetralogy of Fallot Signup and view all the answers

How does a narrowed lumen in coarctation of the aorta affect blood flow?

Creates turbulence and reduced blood flow to the upper body Signup and view all the answers

What is the primary characteristic of patent ductus arteriosus (PDA)?

Failure of the ductus arteriosus to close Signup and view all the answers

Which clinical manifestation indicates an atrial septal defect (ASD) in later age?

Pulmonary symptoms on exertion Signup and view all the answers

What is the most common type of congenital heart defect?

Ventricular septal defect Signup and view all the answers

Which sequence of defects is characteristic of Tetralogy of Fallot?

Ventricular septal defect, pulmonary valve stenosis, right ventricular hypertrophy, overriding aorta Signup and view all the answers

What symptom is characteristic of Kawasaki disease?

Fever for 5 or more days unresponsive to antibiotics Signup and view all the answers

What is a common clinical manifestation of transposition of the great arteries?

Cyanotic heart disease Signup and view all the answers

Which complication is associated with untreated Tetralogy of Fallot?

Emboli and stroke Signup and view all the answers

What is the main consequence of a ventricular septal defect (VSD)?

Increased pulmonary blood flow and pulmonary hypertension Signup and view all the answers

What does the term 'overriding aorta' refer to in congenital heart defects?

Aorta positioned above the right ventricle Signup and view all the answers

What does the presence of peripheral edema and erythema indicate in Kawasaki disease?

Vascular inflammation Signup and view all the answers

Study Notes

Congenital Heart Disease

Leading cause of death among infants after prematurity.
Prenatal, environmental, and genetic factors can all influence the development of congenital heart disease. These factors include:
- Maternal rubella or increased age, diabetes, alcoholism, medications, and hypercalcemia.
- Antepartum bleeding.
- Prematurity.
- Chromosomal differences.

Hemodynamic Alterations

Left to right shunts involve a "back-leak" of blood from the systemic to the pulmonary circulation, potentially leading to pulmonary hypertension.
A right-to-left shunt allows deoxygenated systemic venous blood to bypass the lungs and return to the body, resulting in chronic hypoxemia.

Congenital Heart Defects

Obstructive Defects
- Coarctation of the Aorta: Narrowing of the aorta impedes blood flow.
  - Severe coarctation can cause decreased cardiac output, acidosis, and hypotension at birth.
  - If undiagnosed, symptoms may not appear until hypertension in the upper extremities is detected in older children.
- Aortic Stenosis: Narrowing of the left ventricular outlet increases workload on the left ventricle and causes left ventricular hypertrophy.
  - Infants with significant aortic stenosis may present with faint pulses, hypotension, tachycardia, and poor feeding.
  - Older children may experience exercise intolerance.
- Pulmonary Stenosis: Narrowing of the pulmonary valve restricts blood flow from the right ventricle to the pulmonary artery, leading to right ventricular hypertrophy.
  - Severe pulmonary stenosis can cause cyanosis due to a right-to-left shunt through an atrial septal defect and decreased cardiac output.
Defects with Increased Pulmonary Blood Flow
- Patent Ductus Arteriosus (PDA): Failure of the ductus arteriosus to close allows blood to shunt from the aorta to the pulmonary artery, causing a left-to-right shunt.
  - PDA can present asymptomatically or with pulmonary overcirculation, manifested as dyspnea, fatigue, and poor feeding.
- Atrial Septal Defect: Abnormal opening between the atria allows blood to flow from the left atrium to the right atrium.
  - This defect may be asymptomatic in early childhood.
  - Pulmonary symptoms, particularly during exertion, may develop in later years.
- Ventricular Septal Defect: Abnormal communication between the ventricles, the most common type of congenital heart lesion.
  - Ventricular septal defects can be asymptomatic.
  - Severe cases lead to increased pulmonary blood flow from the left-to-right shunt and potential pulmonary hypertension.
Defects with Decreasing Pulmonary Blood Flow
- Tetralogy of Fallot: Characterized by four defects:
  - Ventricular septal defect (VSD).
  - Overriding aorta.
  - Pulmonary valve stenosis.
  - Right ventricle hypertrophy.
  - This syndrome can cause acute cyanosis at birth or gradual cyanosis, clubbing, poor growth, and hypercyanotic ("Tet") spells.
- Tricuspid Atresia: Absence of the tricuspid valve preventing blood flow from the right atrium to the right ventricle.
Mixing Defects
- Transposition of the Great Arteries: The aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle, resulting in separate, parallel circulatory systems.
  - Unoxygenated blood continuously circulates through the systemic circulation.
  - Oxygenated blood continuously circulates through the pulmonary circulation.
  - Mixing of blood in these circuits is dependent on the size and association with other defects.
Hypoplastic Left Heart Syndrome: The left ventricle is underdeveloped leading to insufficient blood flow to the body.

Heart Failure

A common complication of congenital heart disease.

Kawasaki Disease

An acquired cardiovascular disorder, an acute, self-limiting systemic vasculitis that can lead to cardiac sequelae.
Typically affects children under 5 years of age during winter or spring.
Inflammation of the heart's vasculature can progress to aneurysms, scarring, and stenosis.
Diagnosis requires five out of six major findings:
- Fever for 5 or more days (unresponsive to antibiotics).
- Bilateral conjunctivitis without exudation.
- Erythema of the oral mucosa ("strawberry tongue").
- Peripheral edema and erythema.
- Polymorphous rash.
- Cervical lymphadenopathy.

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Description

Explore the various factors contributing to congenital heart disease, which is a leading cause of infant mortality after prematurity. This quiz delves into the hemodynamic alterations in left to right and right to left shunts, as well as the classification of congenital heart defects, including obstructive defects like coarctation of the aorta.