3Cardiac Flashcards by Brendon Allen

Blood flows which direction

Which side of heart has higher pressure?

Path of least resistance

Left side has more pressure

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What does this mean:

PVR<SVR

Pulmonary vascular resistance is lower so blood can get to the lungs

Systemic vascular resistance is higher (get blood out to rest of body)

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Two things fetus hearts have that adults dont?

Foramen ovale:
-connects right and left atrium

Ductus arteriosus:
-connects aortic arch and pulmonary artery

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higher pulmonary resistance during fetal life

What is happening with the ventricles
This is why what vital is high or low

Larger RV

PVR drops and SVR increases causing the LV to develop/strengthen

BP lower (d/t LV muscle being weak)
HR higher (meet metabolic and oxygen requirement)

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Little cardiac reserve causes what

Heart muscle is fully developed by when

LCR: risk for Heart Failure

Fully developed heart muscle by 5y/o

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Assessment of ped heart 6

-Family hx (HD/HTN/cholesterol/defects)
-Prenatal care
-Birth hx
-Feeding difficulties (cant eat is a sign in infants)
-Activity intolerance (preschooler not able to keep up)

-Growth and development issues (need more calories to keep up with heart working so hard)

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Assessment (look) for cardiac

Visible pulsation (chest)
Edema
JVD/engorgement
Clubbing
Skin color
WOB

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Assessment (touch) cardiac

-Skin (temp, moisture, pitting edema)
-Cap refill
-Pulse (central vs peripheral)
-Palpate liver (kids with cardiac issues tend to have enlarged livers)

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Where to feel central pulses on different ages

Under 1(babies): brachial

5yr old(over 1): carotid/femoral

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Assessment (listen) cardiac

Vital signs
Auscultate lung sounds

Auscultate heart sounds:
-apical x1 min

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APE vs MAN

Aortic area
Pulmonic area
Tricuspid area
Mitral or apical area

Aortic: Right 2nd ICS RMCL

P: Left 2nd ICS LMCL

T: Right 4th ICS

M or Apical: Left 5th ICS

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S1 vs S2

(where best heard)
(What it represents happening)

S1: 4-5th ICS LMCL
-systole/contraction (hearing mitral valve shut)

S2: 2nd ICS
-diastole/relaxation (hearing aortic/pulmonic valve shut

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CHF (congestive heart failure)

Early signs

Poor feeding/ Diaphoretic with feedings
activity intolerance
Tachypnea

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CHF

Right (3) vs Left sided (2)

Right: (backs up systemically)
-JVD
-Swelling/Edema
-Enlarged liver

Left: (backs up into lungs)
-pulmonary congestion
-increased WOB

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Therapeutic management of CHF

-improve cardiac function (2 meds)

Digoxin (increases myocardial contractility)
-monitor s/s of toxicity
-monitor K levels

ACE-inhibitors
-monitor BP
-(-pril)

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Digoxin

Toxicity s/s
K levels explained

Toxicity:
-halos (vision)
-bradycardia
-N/V
(Baby cant tell you this so HR is a good way to check)

K levels:
-digoxin binds to potassium receptors
-if hyperkalemic=causes digoxin to be less effective
-if hypokalemic=digoxin toxicity

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Therapeutic management of CHF

Remove extra fluid

Diuretics (lasix-furosemide, spironolactone)

-monitor K (causes us to pee out potassium)
Decreased potassium

Normal K level

3.5-5

Therapeutic management of CHF

Treating underlying cause
Lessen workload on heart
Nutrition

Lessen workload on heart
-promote rest
-cluster care

Nutrition:
-increase calorie intake (heart working harder)
-150Kcal/kg/day
-24-28kcal/oz

Congenital heart disease

What is it
Age

Defext of heart or great vessels

Before week 8 of gestation

Congenital heart disease diagnostic tests(7) XEECCCC

X-ray (cardiomegaly)
ECG or holter monitor (short vs long picture)
Echocardiogram
CT/MRI
CBC/H&H
Cardiac Cath
CCHD (screen for heart defects)

CCHD screening protocol

Who required to get it
Pulse ox screening
Who is the only ones screened

Newborns ages 28 days or less are required by law that every newborn receives the:
-NEWBORN SCREENING TEST

Pulse oximetry screening (as close to 48hrs of age as possible)

For asymptomatic newborns only

CCHD screening

How to perform 3
Where to put pulse ox

-Quiet area
-Infant should not be crying or cold (decreased oxygen)
-Infant must be on Room Air (not receiving o2)

Pulse oximetry reading on right hand (pre-ductal)
And
Either foot (post-ductal

Congenital heart disease

Chart (acyanotic) -pink skin

Acyanotic:

—increased pulmonary blood flow
-atrial septal defect
-ventricular septal defect
-patent ductus arteriosus
-atrioventriuclar canal

—obstruction to blood flow from ventricles
-coartctation of aorta
-aortic stenosis
-pulmonic stenosis

Congenital heart disease Chart (cyanotic) -blue skin

Cyanotic: —decreased pulmonary blood flow -tetralogy of fallot -tricuspid atresia —mixed blood flow -transposition of great arteries -total anomalous pulmonary venous return -truncus arteriosus -hypoplastic left heart syndrome

Defects that increase pulmonary blood flow: acyanosis(pink)

PDA (patent ductus arteriosus) ASD (atrial septal defect) VSD (ventricular septal defect) AV canal (atrioventricular canal) Left to right shunt

Defects that increase pulmonary blood flow (general manifestations) Long term risks

-tachypnea -tachycardia -feeding difficulties/activity intolerance -long term- pulmonary vascoconstriction/HTN/CHF —if not addressed

Defects that increase pulmonary blood flow —patent ductus arteriosus (PDA) What is it

Ductus arteriosus should be close when born Some systemic blood slips back to pulmonary artery leading to increased blood flow back to lungs

Defects that increase pulmonary blood flow —atrial septal defect (ASD) What is it S/s

Hole between two atrium !not foramen ovale! S/s: -systolic murmur -usually asymptomatic -dyspnea/activity intolerance -poor feeding/growth

Defects that increase pulmonary blood flow —atrial septal defect (ASD) Tx

If small it may close on its own —if not closed by age 3 = sx Sx: sutured shut/patched

Defects that increase pulmonary blood flow —ventricular septal defect (VSD) What is it -s/s

Hole between ventricles S/s: Same as ASD -Systolic murmur -asymptomatic -dypnea/ activity intolerance -poor feeding/growth

Defects that increase pulmonary blood flow —ventricular septal defect (VSD) Tx

Same as ASD -may close on own -if not sx to suture or patch

Defects that increase pulmonary blood flow —atrioventricular canal (AV canal) What is it -s/s

Hole in middle of heart connecting both atriums and ventricles S/s: Large L to R shunt Same as ASD/VSD -murmur -asympomatic -dypnea/activity intolerance -poor feeding/growth

Defects that increase pulmonary blood flow —atrioventricular canal (AV canal) Tx

Patch closure/valve reconstruction

Defects that obstruct blow flow -acyanotic (pink)

Aortic stenosis Pulmonic stenosis Coarctation of the aorta

Defects that obstruct blood flow —aortic stenosis What it looks like and causes

Stenosis of aorta -restricts blood flow from LV to aorta -decreased CO -LV hypertrophy (working harder and grows)

Defects that obstruct blood flow —aortic stenosis S/s (2 different, 3 similar to others) Tx

S/s: -Tachycardia/HOTN -Chest Pain -systolic murmur -activity intolerance -difficulty feeding Tx: Cardiac cath - balloon dilation

Defects that obstruct blood flow —pulmonic stenosis What is it and causes

Stenosis of pulmonic valve -resticts blood flow from RV to PA -RV hypertrophy (has to work harder and grows) -PFO (patent foramen ovale) could reopen due to high pressures

Defects that obstruct blood flow —pulmonic stenosis S/s (3 common, 1 unique) Tx

S/s: -asymptomatic sometimes -murmur -dyspnea, fatigue -if severe (hypercyanotic spells) (even though its technically acyanotic) Tx: -pallitative blalock tussig shunt (connects major arteries to pulmonary artery -cardiac cath: ballon dilation

Defects that obstruct blood flow —coarctation of the aorta What is it S/s

Narrowing of aorta (after the aortic branch) S/s: -stronger pulses & higher BP in BLE -weak/absent pulses & lower BP in BLE -systolic murmur

Defects that obstruct blood flow —coarctation of the aorta Tx

-Ballon angioplasty -Aortic resection