Pathophysiology Test 2 SP: Acyanotic CHD

Question Answer Considered to be the MOST common ______ AND the ______ congenital defect; leading cause os morbidity and mortality in the first year of life ***Characterized by _____ OR _____ left to right intracardiac shunt, obstructive lesions (stenosis) What is the primary focus of this problem Because of the shunt from left to right, extra strain is put on the right side of the heart. This leads to right atrial/ventricular enlargement, pulmonary htn Pulmonary htn, if not caught early can lead to what Eisenmenger Syndrome – left to right shunt changes direction and sends deoxygenated blood into oxygenated (cyanosis) risk factors All maternal: diabetes, febrile illnesses, Systemic Lupus Erythematosus (SLE), folic acid deficiency, advanced maternal/paternal age, previous hx of stillbirths & abortions, drug use presenting factors symptoms of CHF: feeding/exercise intolerance, poor weight gain, delayed recovery from minor respiratory infections diagnosis made how echocardiography, CXR, MRI, cardiac catheterization ***Acyanotic CHD: 7 defects that can cause it Ventricular septal defect, Atrial septal defect, Atrioventricular septal defect, patent ductus arteriosus, pulmonary stenosis, aortic stenosis, coarctation of the aorta what is the most common defect responsible for acyanotic CHD Ventricular Septal Defect Ventricular Septal Defect: caused by what? lesion in the interventricular septum (right to left shunt) Ventricular Septal Defect: S/S loud holostolic murmer in left lower sternal border, cardiomegaly, increased PA pressures, aortic regurg, SOB, sweating, fatigue, poor weight gain Ventricular Septal Defect: how fixed resolved on its own or surgically closed Atrial septal defect: 3 types ostium secundum, primum, sinus venosus Atrial septal defect: S/S usually asymptomatic with systolic murmur and widely split S2 on exam Atrial septal defect: how fixed resolves on its own – if not, needs to be corrected by age 4-5 yo to prevent pulmonary vascular disease Atrioventricular septal defect: characterized by complete vs incomplete development of the septal tissue surrounding the AV valves or defects in the valves themselves Most common congenital defect in downs syndrome atrioventricular septal defect Atrioventricular septal defect: S/S systolic murmer, RVH, LVH, enlarged pulmonary artery, weak pulse, cyanosis, poor weight gain, fatigue Atrioventricular septal defect: how fixed sx repair 2mo -5 years of age (depending on severity Patent Ductus Arteriosus : common in what populations premies with LBW Patent Ductus Arteriosus : characterized by diversion of deoxygenated blood away from the unventilated pulmonary vasculature (left to right shunt & increased pulmonary blood flow) Patent Ductus Arteriosus : how fixed should close in the firs 2-3 weeks Patent Ductus Arteriosus : S/S asymptomatic, HF, increased # of resp infections, cardiomegaly, continuous murmur at left upper sternal border Patent Ductus Arteriosus : Rx treatment indomethacin & ibuprofen: COX inhibitors; inhibits prostaglandin synthesis Pulmonary Stenosis: characterized by obstruction of blood flow from the RV to the pulmonary artery Pulmonary Stenosis: what else may be present Atrio-septal defect (ASD) or Patent Foramen Ovale (PFO) Pulmonary Stenosis: how fixed balloon dilation Aortic Stenosis: characterized by obstruction of blood flow across the aortic valve Aortic Stenosis: common in what populations boys 3x more likely than girls Aortic Stenosis: S/S asymptomatic, fatigue, SOB, arrhythmias, left ventricular hypertrophy (LVH) Aortic Stenosis: how fixed balloon dilation/valvotomy, valve replacement Coarctation of the aorta: characterized by Narrowing of the aorta close to the ductus arteriosus insertion site (causes increased upper extremity perfusion and decreased lower extremity perfusion) Coarctation of the aorta: T/F – more common in females false – more common in males Coarctation of the aorta: S/S metabolic acidosis, systemic hypoperfusion, CHF, systolic murmur, LVH, htn Coarctation of the aorta: treatment baloon angioplasty, sx repair ***preoperative needs/tests Preoperative assessment and hx, EKG, Labs, Type and Cross, Chest Xray, ECHO medical (Rx) treatment Digoxin, Diuretics, ACE inhibitors, Adequate nutrition to treat, start with _____ then go to _____ medical management, sx treatment Induction indications Cautious! Volatile, propofol, etomidate, and barbiturates all decrease SVR – use cautiously. Opioids are good to reduce the stress response Management indications all standard, art line, central line. ***Maintain hemodynamic and respiratory status Resp managment – what to avoid all the regular – avoid hypoxemia and hypercapnia (increase pulmonary htn) Special considerations beware of poor cardiac reserve, avoid hyperoxygenation for too long, get rid of bubbles, cardiac bypass can lead to hemodilution Atrial and ventricular septal defects are often treated how? cardiac catheterization (using ECHO/TEE to help guide) Postoperative considerations postoperative monitorin in ICU, adequate analgesia, endocarditis prophylaxis for 6 months post-surgical repair ***Signs and symptom severity depends on ______ size and location of defect ***Which of the following is considered the most common type of acyanotic heart defect? Ventricular Septal defect ***Which congenital heart disease is commonly found patients with Down Syndrome? Atrioventricular Septal Defect (AVSD) ***Signs & symptoms that are commonly found in patients with acynotic CHD include: (select all that apply) Tachypnea, Heart murmer, Cardiomegaly ***A loud holosystolic murmur located at the lower left sternal border is often associated with which type of acyanotic heart disease? Ventricular Septal Defect (VSD) ***Failure to medically manage patients with severe left to right shunts, who present with elevated PAP may result in the following syndrome? Eisenmenger Syndrome

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