3Cardiac Flashcards
Blood flows which direction
Which side of heart has higher pressure?
Path of least resistance
Left side has more pressure
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)
Two things fetus hearts have that adults dont?
Foramen ovale:
-connects right and left atrium
Ductus arteriosus:
-connects aortic arch and pulmonary artery
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)
Little cardiac reserve causes what
Heart muscle is fully developed by when
LCR: risk for Heart Failure
Fully developed heart muscle by 5y/o
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)
Assessment (look) for cardiac
Visible pulsation (chest)
Edema
JVD/engorgement
Clubbing
Skin color
WOB
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)
Where to feel central pulses on different ages
Under 1(babies): brachial
5yr old(over 1): carotid/femoral
Assessment (listen) cardiac
Vital signs
Auscultate lung sounds
Auscultate heart sounds:
-apical x1 min
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
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
CHF (congestive heart failure)
Early signs
Poor feeding/ Diaphoretic with feedings
activity intolerance
Tachypnea
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
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)
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
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
