19. Cardiovascular disorders Flashcards
What are the two types of heart murmurs and what is the difference between the two?
- Innocent/Functional/Normal: absence of cardio abnormality, no FU required
- Organic/Abnormal: presence of pathologic abnormality
What is the most common heart problem in children?
congenital heart disease (CHD)
What are the types of L to R shunts
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Patent Ductus arteriosus (PDA)
Atrioventricular septal defect (AV canal)
What are the types of R to L shunts
Tetraology of fallot Transposition of great vessels Tricuspid atresia Persistent truncus arteriosus Total anomalous pulmonary venous return (TAPVR) Hypoplastic left heart syndrome (HLHS) Ebstein anomaly
What types of shunts produce cyanosis?
R to L
What type of shunts produce pulmonary edema?
L to R
What are the 4 characteristics of tetraology of fallot?
VSD
Pulmonic stenosis
Aorta overrides VSD
Hypertrophy of R ventricle
What is the anatomical change in transposition of the great vessels?
pulmonary artery arises from L ventricle
aorta arises from R ventricle
What CHD lead to obstruction of blood flow?
pulmonary valve stenosis
aortic stenosis with bicuspid aortic valve
coarctation of the aorta
What syndromes are commonly associated with cardiac defects?
Down Turner Noonan Marfan Ehlers-Danlos DiGeorge and other 22q11 deletions
What are the surgical procedures and sequence for single ventricle defects?
Glenn
Fontan
What are two anatomical structures that are present in fetal circulation and normally close after birth?
Foramen ovale: connects R and L atria
Ductus arteriosus: connects aorta with pulmonary artery
What types of medications are used for ventricular failure and/or pulmonary edema?
diuretics
ACE inhibitors
What is the rheumatic fever?
delayed autoimmune reaction with diffuse inflammation due to URI (Group A B-hemolytic strep)
At what age is rheumatic fever more prevalent?
ages 5 to 15
What living conditions/temperatures is rheumatic fever more prevalent?
temperate zone
high altitudes
substandard living conditions
What are s/s of rheumatic fever?
arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules
What medications are used to tx rheumatic fever?
benzathine peniciilin G
salicylates
codeine
What is the difference between rheumatic fever and rheumatic heart disease?
disease has residual carditis as a result of the fever
commonly seen as murmur, exertional dyspnea and CHF
What is the diagnosis criteria for hypertension in children?
systolic pressure exceeding the 95th percentile for gender, age and height in children (after 3 readings in non-stressful situation)
When is essential hypertension more common?
adolescents
What INR is required if a patient is on anticoagulants?
3.5 or less
What is the bacteria associated with bacterial endocarditis?
staph. aureus
What is the bacteria associated with subacute bacterial endocarditis?
Strep viridans and Staph aureus
What type of bacterial endocarditis are pediatric patients more susceptible to?
subacute
What conditions should have antibiotic prophylaxis?
Prosthetic cardiac valves
Previous hx of infective endocarditis
Unrepaired congential heart disease
Repaired congenital heart defect or prosthetic material within first six month
Repaired congential heart disease with residual defect
Cardiac transplant patient who develop calculopathy
What dental procedures is abx prophylaxis recommended?
manipulation of gingival tissue
manipulation of periapical region
perforation of oral mucosa
What is standard antibiotic prophylaxis Rx?
Amoxicllin
Adults: 2 g
Child: 50 mg/kg
What is Clinda antibiotic prophylaxis Rx?
Adult: 600 mg
Child: 20 mg/kg
What is Ampicillin antibiotic prophylaxis Rx? When would it be used?
Adult: 2 g
Child: 50 mg/kg
If unable to take meds (take IM or IV 30 min pre op)
What is Cephalexin antibiotic prophylaxis Rx?
Adult: 2 g
Child: 50 mg/kg
What is Azithromycin antibiotic prophylaxis Rx?
Adult: 500 mg
Child: 15 mg/kg
What is Cefazolin antibiotic prophylaxis Rx? When would it be used?
Adult: 1 g
Child: 50 mg/kg
Take if allergic to penicillins and cannot take po.
