Embryonic development
What develops at week 4 of embryonic development?
What is the heart and face?
4 heart defects associated with Tetralogy of Fallot
1. Pulmonary stenosis
2. Ventricular septal defect
3. Overriding aorta (aorta is right over VSD, cradling septum)
4 Right ventricular hypertrophy
When does the use of Blalock-Taussig shunt become useful
(Bonus: Why is it used?)
TOF with severe Right ventricular outflow tract obstruction (RVOTO), critical pulmonary stenosis (PS), pulmonary atresia
Used to increase pulmonary blood flow when restricted by connecting the subclavian artery to the pulmonary artery
List 3 normal pediatric ECG changes
What is:
Juvenile T waves (V1-V3), Increased HR in infants, RV dominance, R wave in V1 taller than R wave in V6 (resembles RVH and sometimes RBBB), Sinus arrhythmia
Most common CHD for patients with T21?
AVSD
What is the Bulbus Cordis?
outlet of ventricles ad most of right ventricle
What is Ebsteins anomaly
enlarged RA and small RV + ASD. Tricuspid flaps fused to inside RV
What is bypassed in a Fontan procedure?
What is the RA and RV (systemic circuit is connected directly to the pulmonary arteries)
Common ECG changes in patients with previous congenital heart surgery
RBBB, JET, CHB, ST segment changes (ischemia/inflammation post-operatively), T wave changes
Biggest concern for pts with KD (Kawasaki disease)
Ischemia/Inflammation during coronary spasm (ST segment elevated, myocarditis
Pt needs IV immunoglobulin to reduce inflammation and prevent damage
Atrium, AV canal, Ventricle, Truncus arteriosus
What defect is an PDA essential for survival
(Bonus: what medication is given for it to remain open)
Hypoplastic left heart syndrome
(Prostaglandin)
What is the Norwood procedure?
First step in heart procedures, enlarge aorta- cut off and attach to pulmonary artery + expand it
ECG changes for TOF (TET)
RAD, RVH, Wide QRS, RBBB (post-surgery)
Common cardiac issues with Marfan's syndrome
Aortic dilation, aortic dissection (tearing of the aortic wall) + arrhythmias (lots of surgery = more risk)
Where is the foreman ovale and what is its function?
Between the left and right atrium to allow blood to flow freely.
(Closes at first breath or is a patent foreman ovale (PFO)
What are the Five T's of cyanotic heart disease
1. TOF
2. TGA (transposition of great vessels)
3. truncus arteriosus
4. tricuspid atresia
5. Total anomalous pulmonary venous return (TAPVR)
Explain TGA and why you might need surgery?
PA and Aorta are switched!
RV pumps oxygen- poor blood from the body directly to aorta and LV pumps oxygen rich blood from the lungs to the pulmonary artery
NEED surgery to mix blood! (most babies are born with VSD that allows blood mixing and a few days of intervention-less survival
ECG changes in Noonan syndrome
PS, HCM, ASD, VSD, CoA, Arrhythmias
Symptoms of LQTS and what phases does it affect?
Affects phases 2,3, and 4.
Symp.: Syncope, seizures, cardiac arrest/ death (longer QT allows for more time for ventricular ectopy to induce an arrhythmia)
What is:
1. Zygote 2. Blastomere 3. Morula. 4. Blastocyst 5. Cytotrophoblast 6. Syncitiotrophoblast 7. Mother 8. Ectoderm 9. Notocord
What defect arises from defects in all structures formed by endocardial cushions
(Bonus: what can increase in these infants)
Complete AVSD
Pulmonary blood flow (can have symptoms of CHF/FTT)
What is the Fontan procedure?
(Bonus: Why CPR isn't as effective)
Inferior vena cava (IVC) is disconnected and attached to the pulmonary artery.
CPR: relies on gravity, if elevated pulmonary vascular resistance, can increase workload on single ventricle. (Can increase pressure in SVC and lead to neural injury)
What causes deep T waves in V2 and V3?
Hint: high risk for AWMI
Wellens syndrome
*This is not genetic, caused by LAD obstruction
What is turners syndrome? ECG changes
RVH, accelerated arrhythmia, T wave abnorm.