Acyanotic Congenital Heart Defects Terms & Definitions | Quizlet

Fossa Ovalis

the atrial pressure changes in the first 24 hours after birth causes the foramen ovale to close and become the _________________________

Ligamentum Venosum

in the first 24 hours after birth, the ductus venosus closes and becomes the ______________________

Ligamentum teres

in the first 24 hours after birth, the umbilical vein becomes the ______________________

Medial Umbilical Ligaments

in the first 24 hours after birth, the umbilical arteries becomes the _____________________________

Atrial Septal Defect (ASD)

-if small, asymptomatic

-failure to thrive and decreased exercise tolerance

-if large, increased blood volume on the right side leading to pulmonary edema and right sided heart failure

-loud S1, fixed split S2

-systolic ejection murmur at left sternal border

1. Oxygenated bloof from placenta

2. Umbilical vein

3. Ductus Venosus

4. Inferior vena cava

5. R. Atrium

6. Foramen Ovale

7. L. Atrium

8. L. Ventricle

9. Aorta

10. Body

11. Umbilical arteries

describe fetal blood circulation

Inferior Vena Cava

where in fetal circulation does oxygenated blood mix with deoxygenated blood from the body?

1. R. atrium

2. R. ventricle

3. Pulmonary artery

4. Ductus arteriosus

5. Aorta

although most of blood during fetal circulation goes from R. atrium to foramen ovale and L. atrium, a small portion flows where?

Ligamentum arterosum

in the first 24 hours after birth, the ductus arteriosus constricts and becomes the ________________________________

Increases; decreases

in the first 24 hours after birth, left atrial pressure ____________________, and right atrial pressure ____________________

VSD

the most common of all congenital heart defects

Cognenital Heart Disease

leading cause of birth defects associated infant illness and death

-family history

-maternal meds

-maternal alcohol and cocaine use

-maternal diabetes

-maternal infections

-poor growth of fetus

-syndromes/genetic defects

congenital heart disease risk factors

Ebstein's Anomaly

what CHD is assoc with lithium use in pregnancy

-Endocardial Cushion Defect

-VSD

-ASD

what CHDs are assoc with Trisomy 21?

-Bicupsid aortic valve

-coarctation of aorta

what CHDs are assoc with Turner syndrome (XO)?

-Aortic arch anomalies

-Conotruncal anomalies

what CHDs are assoc with DiGeorge Syndrome?

-Patent ductus arteriosus

-Peripheral pulmonic stenosis

what CHDs are assoc with Congenital Rubella?

ASD and VSD

what CHDs are assoc with fetal alcohol syndrome?

-Hypertrophic cardiomyopathy

-VSD

-Conotruncal Anomalies

what CHDs are assoc with an infant of a diabetic mother?

Congenital Heart Disease

signs and symptoms of _____________________:

• Cyanosis

• Sweating

• Pale Cool Skin

• Fatigue

• Tachypnea

• Tachycardia

• Weak or absent pulses

• Poor feeding

• Poor weight gain

• Sweating or fatigue when eating

• Clubbing

• Edema

• Syncope

• Heart Failure

Left-to-Right

acyanotic CHD is associated with what kind of shunts?

Right-to-left and Left-to-right

(depends on which CHD)

cyanotic CHD is associated with what kind of shunts?

Central Cyanosis

• Typically caused by a cardiac or respiratory issue

• Involves the trunk and mucous membranes

• SpO2 <85%

Peripheral Cyanosis

• Hands and feet

• Sluggish blood flow in capillaries due to cold or peripheral vascular disorder

• Does NOT involve trunk or mucous membranes

• True oxygen saturation is normal for age

Acrocyanosis

cyanosis of the hands and feet

Pre-ductal Sat

-describes the right subclavian coming off the aorta first and before the ductus arteriosus

-supplies the head and right arm

Patent Ductus Arteriosus (PDA)

-failure of the ductus arteriosus to close after birth

-left to right shunt

-increased incidence in prematurity and with congenital rubella

Patent Ductus Arteriosus (PDA)

-can be asymptomatic if small

-continuous systolic machinery murmur (heard in left clavicular region radiating to the left back

-widened pulse pressure

-bounding pulse

-if severe: mid-diastolic murmur heard at apex, thrill and/or split S2, enlarged heart

Patent Ductus Arteriosus (PDA)

EKG

• Left ventricular hypertrophy

• If pulmonary hypertension is present you may see right ventricular hypertrophy

CXR

• Increased Pulmonary Vasculature

• Enlarged pulmonary Arteries

Echo

• Diagnostic showing the persistent ductus and Left to Right shunt of blood flow

-initially with diuretics/supportive

-closure with indomethacin/ibuprofen and through a catheter with coil embolization or a closure device

PDA treatment

Atrial Septal Defect (ASD)

-failed growth or excessive reabsorption of the septum

-left to right shunt

-increased incidence in downs syndromes and fetal alcohol syndrome

Ostium Secundum

-most common ASD

-arises from failed/poor growth of the ostium secundum or larger than normal foramen ovale or more than average reabsorption of the ostium primum

Ostium Primum

-ASD

-arises typically from an endocardial cushion defect and often assoc with a VSD

Sinus Venosus

-least common ASD

-defects in the septum at either the enery of SVC or IVC

-assoc with anomalous pulmonary venous connection

Atrial Septal Defect (ASD)

EKG

• Right axis deviation

• Right ventricular enlargement

CXR

• Cardiomegaly

• Right atrial enlargement

Echo

-L→R blood flow

-Monitoring if asymptomatic

-Surgical closure (if ostium primum or sinus venosus)

-Percutaneous ASD closure devices

ASD treatment

Patent Foramen Ovale (PFO)

-failed closure of foramen ovale

-rarely does shunting occur

-risk of embolization

-usually asymptomatic

Ventricular Septal Defect (VSD)

-defect in formation of teh ventricular septum

-more commonly a defect in the membranous portion but can also be muscular

-left to right shunt

-increased incidence in down syndrome, fetal alcohol syndrome, and gestational diabetes

Ventricular Septal Defect (VSD)

-around 6-8 weeks, pulmonary vascular resistance decreases

-fatigue, poor growth, diaphoresis with feeding

-loud murmur

-heart failure (if large)

Ventricular Septal Defect (VSD)

Physical Exam:

• Holosystolic Murmur heard best at the Left Lower Sternal Border (LLSB)

• Large shunts will also have a Mid-diastolic murmur at the apex (Due to increased blood flow across the Mitral valve)

Ventricular Septal Defect (VSD)

EKG

• Small VSD- normal study

• Large VSD- left atrial and ventricular enlargement and hypertrophy

CXR

• Cardiomegaly

• Left ventricular enlargement

• Increased pulmonary blood flow

Echo

• Defect in the septum and blood flow across

it from left to right

-diuretics, digoxin, and afterload reduction

-open surgical closure

-closure devices

VSD treatment

Endocardial Cushion Defect (Atrioventricular Canal Defect)

Caused by abnormal development of endocardial cushion which causes failure of the septum to fuse with the endocardial cushion leading to abnormal atrioventricular valves

Complete Endocardial Cushion Defect (Atrioventricular Canal Defect)

-primum ASD

-posterior or inlet VSD

-clefts in the anterior leaflet to the mitral valve and septal leaflet of the tricupsid valve

Endocardial Cushion Defect (Atrioventricular Canal Defect)

-left to right shunting thru ASD and VSD

-may result in AV valve insufficiency

-increased incidence with Down's Syndrome

Endocardial Cushion Defect (Atrioventricular Canal Defect)

-Symptoms develop as pulmonary vascular resistance decreases ~ 6-8 weeks of life

-Pulmonary hypertension often develops early and leads to heart failure

-Poor growth, fatigue and diaphoresis with sweating are typical symptoms

Endocardial Cushion Defect (Atrioventricular Canal Defect)

Physical Exam:

• Presence of murmur is variable depending on the amount of shunting thru the ASD & VSD

• If there is a large VSD, S2 will be single

Endocardial Cushion Defect (Atrioventricular Canal Defect)

ECG

• Left axis deviation

• Combined ventricular hypertrophy

CXR

• Cardiomegaly with increased vascular

markings

Echo

• ASD, VSD and malformed valves

• Initial management is diuretics to reduce afterload

• Surgical repair is required

treatment for Endocardial Cushion Defect

Coarctation of the Aorta

-congenital narrowing of the aorta

-area of the aorta proximal to the insertion of the ductus fails to develop causing the narrowing

-ductal dependent

-increased incidence in Turner's Syndrome

Coarctation of the Aorta

• Poor feeding

• Fatigue

• Poor growth

• Headache

• Leg pain with exercise

• Epistaxis

• Respiratory distress

• Shock

Coarctation of the Aorta

Physical Exam:

• Harsh systolic ejection murmur heard in left axilla and back

• Weak or ABSENT femoral pulses

• Upper extremity hypertension

• ALWAYS palpate femoral pulses and compare to brachial on every infant

get pulse O2 and BP in all 4 extremities and a CXR

if you suspect Coarctation of the Aorta, what should you do?

Coarctation of the Aorta

EKG

• Right ventricular hypertrophy

• Cardiomegaly

• Pulmonary edema

CXR

• Rib Notching >8yo (Red Arrows)

ECHO

• Location and degree of coarctation, aortic valve morphology and function

• Initial Prostaglandin E1 & diuretics

• Cardiac catheter with ballooning may be used in some cases

• Standard treatment is open surgery

treatment for Coarctation of the Aorta

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