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PDAT5 CV > 40/41 - Pediatric cardiology > Flashcards

40/41 - Pediatric cardiology Flashcards

1
Q

Normal Fetal Circulation

PLACENTA

A

PLACENTA
provides Oxygen + Nutrients to fetal blood via:
UMBILICAL VEIN

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2
Q

Normal Fetal Circulation

DUCTUS VENOSUS

A

Ductus Venosus

Allos umbilical venous blood to

  • *BYPASS LIVER** –> IVC
  • inferior vena cava –> right atrium*
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3
Q

Normal Fetal Circulation

FORAMEN OVALE

A

Foramen Ovale

Allows blood from the right atrium
VVV
to pass into the Left Atrium

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4
Q

Normal Fetal Circulation

DUCTUS ARTERIOSUS

A

Ductus Arteriosus

connect Pulmonary Artery** to the **Descending Aorta
VVV
allowing the blood to
BYPASS THE LUNGS

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5
Q

Normal Fetal Circulation

Fetal difference in CARDIAC OUTPUT?

A

BP = CO x SVR

CO = STROKE VOLUME** x **HEART RATE

Fetus has a
LIMITED ability to Increase Stroke Volume
So….
CO is MORE Sensitive to HEART RATE

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6
Q

Normal Fetal Circulation

Fetal Difference in PVR
Pulmonary Vascular Resistance

A

Adults:
Systemic Vascular Resistance = Pulmonary Blood Flow > PVR

Fetus:
PVR > Systemic/Pulmonary Blood flow
VVVV
↓PVR before BIRTH due to ↑# pulmonary veins
VVV
SWITCHES AROUND
Systemic/Pulmonary Blood flow > PVR

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7
Q

CV Changes AFTER birth

What causes the:
CLOSURE OF THE FORAMEN OVALE?

A

Closure of foramen ovale:
RA –> LA

Due to the:
DECREASE** in **Right Atrium Pressure

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8
Q

CV Changes AFTER birth

What causes the:
CLOSURE of DUCTUS ARTERIOSUS

A

Ductus Arteriosus:
Pulmonary Artery –> Descending Aorta
Bypass lungs

Constriction due to:
↑pO2 and ↓Prostaglandin 2 (PGE2)

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9
Q

Neonatal Cardiovascular Parameters

Neonatal HR / BP

A

Heart Rate:
140 - 160 bpm

BP:
70 / 50

Cardiac Output:
Neonates have a decreased cardiac reserve
cardiac fxn is CLOSE to PEAK performance @all times

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10
Q

Congenital Heart Defects

Different Classifications

A

L>R Shunts
PDA / VSD / ASD

R>L Shunts
hypoplastic left heart syndrome = “ductal dependent” lesions

OBSTRUCTIVE LESIONS
Mild-moderate obstruction = stenosis
complete obstruction = atresia
ex. coarctation of the aorta

REGUGITANT LESIONS
due to an incompetent valve ex. mitral valve

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11
Q

Congenital Heart Defects

LEFT to RIGHT Shunts

Examples / Consequence

A

PDA** / **VSD** / **ASD
Patent ductus arteriousus / ventricularseptal defect / artrial septal defect

Allows for:
OXYGENATED BLOOD –> RE-circulate through LUNGS
ACYONOTIC
↓CO, since blood is SHUNTED off to lungs

↓Renal Fxn / ↓Systemic Perfusion / Pulmonary Edema
can lead to right heart failure

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12
Q

PDA = Patent Ductus Arteriosus

Etiology / Pathophysiology

A

PDA = Left -> Right Shunt

  • *Premature Infant** - 20% > Term infant
  • *Birth weight < 1000g** = 80%

Patho:
Blood flows from:
Aorta –> PDA –> Pulmonary Artery
directrion of flow determined by:
SVR** & **PVR
↑ blood in pulmonary circuit
↑ workload on the heart

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13
Q

PDA = Patent Ductus Arteriosus​

Diagnosis / Confirmation

A

PDA = L>R Shunt

Clinical Features:
Cardiac MURMUR
HYPERactive PREcordium = heart beat out of chest
Bounding Pulses + WIDE pulse pressure
TachyCardia + TachyPnea

ECHOCARDIAGRAM
used to CONFIRM –> size of PDA
Degree+Direction of shunt

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14
Q

PDA = Patent Ductus Arteriosus

TREATMENT OPTIONS

A

Symptom Management:
Fluid Restriction** + **Diuretics
↓ intravascular volume -> ↓ workload of the heart
↓pulmonary edema

  • *PROSTAGLANDIN INHIBITORS**
  • *Indomethacin =** Ibuprofen

Surgical Closure
LIGATION

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15
Q

Indomethacin** = **Ibuprofen

Class / MoA / ADR

A

↓PGE2 –> natural closure of Ductus Arteriosus
PRASTOGLANDIN INHIBITORS
↓PGE2 –> drug-induced closure of PDA

Indomethacin - 3 doses q12-24 hrs
Ibuprofen - 3 doses q24 hrs

ADRs:

  • *RENAL: dysfunction, ↑BUN/SCr,** oliguria, (indo)-hypoNatremia
  • *GI**:bleeding, (indo) - alterned mesenteric blood flow
  • *HEMATOLOGIC: bleeding, ↓platelet fxn**
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16
Q

Indomethacin = Ibuprofen
treatment for PDA

CONTRAINDICATIONS

A

ADRs are
RENAL / GI / HEMATOLOGIC

Active Bleeding

THROMBOCYTOPENIA
for kids <50k platelets

  • *Renal Impairment**
  • *SCr > 1.5**

Ductal-Dependent Congenital Heart Defect

17
Q

Congenital Heart Defects

RIGHT to LEFT Shunts

Examples / Consequence

A
  • *“Ductal Dependent” Lesions**
  • *HypoPlastic Left Heart Syndrome** + Transposition of Great Arteries
  • *Ttralogy of Fallot** + Coarctation of Aorta

Allows for:

  • UNoxygenated Blood* CIRCULATES to the body
  • *CYONOTIC**

PDA has to STAY OPEN so that BLOOD can reach the body

18
Q

TREATMENT

“Ductal Dependent” Lesions
HypoPlastic Left Heart Syndrome + Transposition of Great Arteries
Tetralogy of Fallot + Coarctation of Aorta

A
  • *ALPROSTADIL**
  • *Prostaglandin E1**

Used to temporarily maintain Patency of DA
until SURGERY can be performed

MoA:
relaxation of smooth muscle of ductus arteriosis –> vasodilation

Admin:
continuous IV infusion

19
Q

ALPROSTADIL
Prostaglandin E1

Use / ADR / Monitoring

A

“Ductal Dependent” Lesions = R>L Shunts
HypoPlastic Left Heart Syndrome + Transposition of Great Arteries
Tetralogy of Fallot + Coarctation of Aorta

Vasodilation: ADRs”
Apnea / Flushing
HypoTension / Fever

Monitoring:
O2 saturation, blood gas, blood pressure, respiratory rate, temperature, HR

20
Q

Hypertension Classifications

Children > 13yo

Diagnosis needs to be confirmed by:
3 seperate readings taken >1 week apart

A

same as ADULTS, stage them depending on HIGHEST classification

Normal BP
<120 / <80

Elevated BP
120-129 / <80

Stage 1 HTN
130-139 / 80-89

Stage 2 HTN
> 140 / 90

21
Q

Hypertension Classifications

Children < 13yo

Diagnosis needs to be confirmed by:
3 seperate readings taken >1 week apart

A

Need AGE** + **GENDER** + **HEIGHT

Normal BP
<90th %

Elevated BP
>90th%<95th%

Stage 1 HTN
>95th% BUT <95th% + 12mmhg

Stage 2 HTN
_>_95th% + 12mmhg

22
Q

When to BP Screen for Pediatrics

A

ANNUAL BP Screening
for ALL children 3- 17 y/o

@Every “Health Care Encounter” for 3yo+ for:
OBESE / Diabetes / RENAL disease
Coarctation of the aorta/arch abstruction
MEDICATIONS that ↑BP

23
Q

MEDICATIONS that ↑BP
Requires 3yo+ to get BP SCREENED @EVERY health care encounter
Also:
Obese / Diabetes / RENAL disease
Coarctation of he aorta/arch abstruction
annual if NOT

A

Prescription Drugs

  • *OCPs** / STIMULANTS
  • *CorticoSteroids / TCAs**

OTC
DECONGESTANTS / Caffeine / Herbal

Recreational
Amphetamines / Cocaine / Steroids

24
Q

Treatment of Ped. HTN

ELEVATED BP

Classification / Recommendation

A

ELEVATED BP
BP >90th% <95th% or 120-129 / <80 (13+)

LIFESTYLE MODS
VV
Recheck in 6 Months
VV
BP Meds if presence of:
LVH / CKD / DM / Cardiac Failure

25
Q

Treatment of Ped. HTN

STAGE 1 HTN

Classification / Recommendation

A

STAGE 1 HTN
BP >95th% BUT <95th% +12mmhg

LIFESTYLE MODS
VV
Recheck in 1-2 Weeks, sooner if Sxs
VV
if BP is PERSISTANTLY elevated in 2+ checks:
refer to nephrology / HTN clinic

26
Q

Treatment of Ped. HTN

STAGE 2 HTN

Classification / Recommendation

A

ELEVATED BP
BP _>_95th% + 12mmhg

REFER TO NEPHROLOGY** / **HTN clinic

BP Meds

27
Q

Indications for Pharmacologic BP Management

A

FAILED >6 mo of Lifestyle Mods

Stage 2 HTN** or **Symptomatic
BP _>_95th% + 12mmhg

Presence of other comorbidities:
HYPERlipidemia** / **DM** / **Renal Disease** / **LVH

28
Q

Which Anti-HTN agents are available as
ORAL-LIQUID

A

Ped. HTN –> weight based dosing

FUROSEMIDE

ENALAPRIL

29
Q

Treatment of Pediatric Hypertension

HYPERTENSIVE EMERGENCY

A
  • *Symptomatic BP + >99th%-ile**
  • LESS COMMON in children vs adults*

Usually related to:
Comorbidity = Renal Disease

often manifests as:
Encephalopathy w/ Seizures

treat with:
IV meds

30
Q

Treatment of Pediatric Hypertension

When would we prefer to use this HTN MED?

ACE/ARB

A

enalapril available as ORAL LIQUID

DIABETES** or **Proteinuric RENAL disease
preferred

  • African American*
  • LESS responsive*
  • Pregnancy*
  • fetal kidney dmg, CONTRAINDICATED*
31
Q

Treatment of Pediatric Hypertension

When would we prefer to use this HTN MED?

Calcium Channel Blockers

A

CONCURRENT MIGRAINES
Also for BETA Blockers

  • **associated with*
  • PERIPHERAL EDEMA***
32
Q

Treatment of Pediatric Hypertension

When would we prefer to use this HTN MED?

BETA BLOCKERS

A

NOT RECOMMENDED for INTIAL TREATMENT
initial is:
ACE/ARB > CCB > Thiazide Diuretics

MIGRAINES
also CCBs > BB first use

Want to avoid NON-CARDISELECTIVE if ASTHMA:
CARVEDILOL / PROPRANOLOL

  • INSULIN-DEPENDENT DIABETIC*
  • mask symptoms of hypoglycemia*

PDAT5 CV (30 decks)

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