Pediatric Cardio

What is the most common congenital disorder?

congenital heart disease

What is considered “critical” CHD?

lesion requiring surgery or catheter based intervention in the first year of life

How are newborns screened for CHD?

pulse oximetry

What is considered a positive pulse oximetry screen for CHD?

less than 90% in right hand or any foot

90-94% in right hand or any foot or greater than 3% difference in right hand and foot (after 2 previous tests)

What should be done if pulse oximetry screen shows SpO2 of 90-94% or a greater than 3% difference in right hand and foot?

repeat screen in 1 hour, then again in another hour

What is considered a negative pulse oximetry screen for CHD?

95% in right hand or foot AND less than 3% difference between right hand and foot

What is the purpose of fetal hemoglobin?

helps maintain oxygen delivery in fetus despite the relatively low pressure of oxygen

What is the pathway for fetal circulation?

placenta —> umbilical vein —> ductus venosus —> R atrium —> foramen ovale —> L atrium —> L ventricle —> aorta and carotids

What are the 3 normal shunts in fetal circulation?

ductus venosus

foramen ovale

ductus arteriosus

What is the function of arteries in fetal circulation?

carry deoxygenated blood away from the heart

What is the function of arteries in postnatal circulation?

carry oxygenated blood away from the heart

What is the function of veins in fetal circulation?

carry oxygenated blood to the heart

What is the function of veins in postnatal circulation?

carry deoxygenated blood to the heart

Where does gas exchange occur in fetal circulation?

occurs in placenta

Where does gas exchange occur in postnatal circulation?

occurs in lungs

What side of fetal circulation has higher pressure?

right side

What side of postnatal circulation has higher pressure?

left side

What is the RV-LV circuit in fetal circulation?

parallel

What is the RV-LV circuit in postnatal circulation?

series

What murmurs are innocent?

Still’s murmur

Venous hum

Pulmonary flow murmur

How are diastolic murmurs graded?

Grade I-IV

What is a Grade I murmur?

can be heard with intense listening in a quiet room

What is a Grade II murmur?

quiet but can be heard immediately

What is a Grade III murmur?

moderately loud, no thrill

What is a Grade IV murmur?

loud, thrill is present

What is a Grade V murmur?

heard with stethoscope partially off the chest

What is a Grade VI murmur?

extremely loud murmur audible with stethoscope off the chest

What murmurs are pathologic?

systolic ejection murmur

holosystolic

continuous

diastolic

What murmurs should be considered if heard best at the aortic area?

aortic stenosis

PDA

aortic valve sclerosis

What murmurs should be considered if heard best at the pulmonic area?

pulmonic stenosis

ASD

What murmurs should be considered if heard best at the tricuspid area?

pansystolic murmur (tricuspid regurgitation or VSD)

diastolic murmur (tricuspid stenosis or ASD)

What murmurs should be considered if heard best at the mitral area?

mitral regurgitation

mitral stenosis

What murmurs should be considered if heard best at the left sternal border?

aortic regurgitation

pulmonic regurgitation

hypertrophic cardiomyopathy

What makes the S1 heart sound?

closure of the AV valves

What makes the S2 heart sound?

closure of the semilunar valves

What makes the S3 heart sound?

blood hitting a loose ventricle in diastole

What makes the S4 heart sound?

atrial contraction into a stiff ventricle

What CHDs shunt blood right to left and can cause cyanosis?

tetralogy of fallot

transposition of the great arteries

truncus arteriosus

tricuspid atresia

TAPVR

What CHDs shunt blood left to right and do not cause cyanosis?

ASD

VSD

atrioventricular septal defect

PDA

What CHDs are obstructive?

hypoplastic left heart syndrome

aortic stenosis

pulmonary stenosis

coarctation of the aorta

What CHDs are considered critical?

5 T’s:

transposition of great arteries

truncus arteriosus

total anomalous venous return

tricuspid atresia

tetralogy of fallot

What cyanotic CHDs have decreased pulmonary vascular markings?

tetralogy of fallot

pulmonary atresia

tricuspid atresia

critical pulmonary stenosis

ebstein anomaly

What cyanotic CHDs have increased pulmonary vascular markings?

truncus arteriosus

transposition of great arteries with VSD

total anomalous pulmonary venous return

What are the 4 defects seen in Tetralogy of Fallot?

pulmonary stenosis

VSD

right ventricular hypertrophy

overriding aorta

What is the ductus venosus?

bypasses hepatic circulation by directing oxygenated blood from placenta to IVC

What is the foramen ovale?

right to left shunt between atria, allowing oxygenated blood to bypass the lungs

What is the ductus arteriosus?

connects pulmonary artery to aorta, diverting blood from non-functioning fetal lungs