Cardiac 10/16 Flashcards
Where can a heartbeat be heard the loudest?
Apex
When do you use the bell to auscultate?
Lower pitch sounds
What is an innocent murmur?
Benign, no clinical symptoms or signficance, normal cardiac anatomy and function
When would congenital murmurs most likely be detected?
Weeks after delivery (ASD, VSD, aortic or pulmonic stenosis)
What might syncope be a symptom of?
- Arrhythmia
- Mitral valve prolapse
- Aortic stenosis
- Long QT syndrome
What is a concern post-strep infection?
Post-strep murmur
What should be done if a murmur is detected at a well-child visit?
Assess for other s/s of compensation or complication (benign murmurs are common in pediatric population)
How is a murmur characterized?
- Intensity
- Location
- Quality
- Radiation
- Timing
- Pitch
- Grade
- Associated factors
What does a murmur’s intensity describe?
Loudness
What does a murmur’s location describe?
Where it is best heard (where it is the loudest)
What does a murmur’s quality describe?
Description of the sound- musical, blowing, swishing
What does a murmur’s radiating quality describe?
Can the murmur be heard elsewhere throughout the body
What does a murmur’s timing describe?
During what part of the heartbeat does the murmur occur
What are possible associated factors of a murmur?
- Occurs only when in a certain position (sitting, lying down)
- Child is dehydrated
- Child has infection
How do you grade a murmur?
- Grade 1-6 (I-VI)
- 1 = difficult to hear with stethoscope
- 4 = accompanied by thrill (vibration over the heart)
6 = can hear without stethoscope
What might trigger an innocent murmur?
Bodily/cardiac stress:
- Anemia
- Fever
- Rapid growth
What is a thrill?
Vibration heard related to murmur at the heart (heard in grade 4-6 of murmurs)
What are the parts of the heart present in a fetus (that should close with birth)?
- Foramen ovale
- Ductus arteriosus
Where is the foramen ovale?
Between RA and LA
Where is the ductus arteriosus?
Connects pulmonary artery and aorta
Describe the blood flow of a fetus.
Placenta –> umbilical vein –> liver –> ductus venosus –> inferior vena cava –> RA –> RV or foramen ovale
What happens to the foramen ovale, ductus arteriosus, and ductus venosus after delivery?
Close and atrophy; become legamentum
What causes the foramen ovale and ductus arteriosus to close?
Pressure changes once baby starts breathing
What are S/S of pediatric cardiac dysfunction?
- Poor feeding/falling asleep
- Tachypnea
- Tachycardia
- Sweating on head (d/t increased metabolic rate)
- Freq low respiratory infections
- Poor weight gain
- Activity intolerance
- Developmental delas
- Prenatal hx
- Family hx
How does Maslow’s hierarchy related to pediatric cardiac dysnfunction?
Cardiac dysfunction leads to hypoxia; hypoxia leads to poor feeding, poor growth, and then poor development
What prenatal conditions may predispose a child to cardiac dysfunction?
- Lack of prenatal care
- Preterm birth
- Diabetes
- IUGR
- Infection during pregnancy
- Teratogen exposure
What are the S/S of CHF?
- Respiratory s/s (fluid = wheezing, congestion, crackles; tachypnea)
- Sweating of upper brow (d/t increased metabolism)
- Tachycardia
- Edema
- Cool extremities
- Lethargy
What are the respiratory s/s of CHF?
- Fluid (wheezing, congestion, crackles)
- Tachypnea
What is the cardiac cycle?
Sequential contraction and relaxation of the atria and ventricles
What is afterload?
The resistance (pressure) that the ventricles must pump against
What is stroke volume?
The volume of blood ejected by the heart with each contraction
What is cardiac output?
The volume of blood ejected by the heart per minute (CO = HR x SV)
What are the 2 categories of cardiac defects?
- Congenital
- Acquired
What are possible causes of acquired cardiac defects?
- Autoimmune response
- Infection
- Environmental exposure
What is the most common cause of congenital cardiac defect?
Multifactorial (85%)
What is more common: genetic cause of a congenital heart defect or environmental/maternal illness during pregnancy?
Genetics (10-12%) vs. maternal/environment (1-2%)
What are maternal illnesses or exposures that increase fetal risk of congenital heart defect?
- Rubella during first 7 weeks of pregnancy
- Viral illness
- Diabetes
- Alcolohol use (FAS)
What is the most common congenital heart defect?
VSD
What are the 4 classes of congenital heart disorders?
- Increased pulm blood flow
- Decreased pulm blood flow
- Obstruction of blood flow out
- Mixed blood flow
What is a s/s of an increased pulm flow CHD?
CHF
What is a s/s of a decreased pulm flow CHD?
Cyanosis
What is a s/s of obstructive defects of the ventricles?
- Obstructed L heart = CHF
- Obstructed R heart = cyanosis
What is ASD?
- Atrial septal defect
What category of CHD does ASD fit in?
Increased pulmonary flow (blood flows from high P to low P, therefore goes form L heart to R increasing pulm blood flow)
What is the change in cardiac blood flow from ASD?
Blood flows from LA to RA via hole in atrial septum
What part of the heart becomes distended in ASD?
RA and RV (d/t increased filling secondary to septal defect and pulmonary resistance)
What s/s are seen with ASD?
- Typically asymptomatic (although septal defect, since in atria, less s/s seen)
- Even pulm s/s are less since only atrial involvement
How is ASD tx?
- surgical = cardiac cath repair w/ patch
How is ASD detected?
Since nonsymptomatic, detect via murmur auscultation or s/s of slowed growth and development
What category of CHD is patent ductus arteriosus?
Increased pulm flow
When should the ductus arteriosus close normally?
- Starts w/ first breath
- Should be close (by P changes) 15hrs after birth
What is PDA?
Patent ductus arteriosus
What are s/s of PDA?
- CHF (tachypnea, tachycardia, dyspnea, hoarse cry)
- Bounding peripheral pulse
- Widened pulse pressure
- Murmur @ upper L (pulmonic aorta)
How is PDA definitively diagnosed?
Echo
How is PDA managed?
- Medically = indomethacin
- Surgery = surgical ligation via cath
What is Indomethacin and what is it used for?
NSAID that closes ductus arteriosis
What needs to be dosed prior to a surgical ligation of PDA?
Prophylactic antibiotics to prevent bacterial endocarditis
What category is VSD?
Increased pulm flow
What 3 heart conditions increase pulmonary flow?
- ASD
- VSD
- PDA
Which of the following is typically asymptomatic: ASD, VSD, PDA?
ASD
Which of the following frequently cause pulm HTN and CHF s/s: ASD, VSD, PDA?
VSD and PDA
Which CHD is the most common?
VSD
Which way does blood flow in VSD?
LV to RV via septal defect
What part of the heart first hypertrophies in VSD?
LV
What are s/s of VSD?
- Murmur
- CHF
- Pulm vascular obstructive disease/HTN
What is an increased risk d/t VSD?
Bacterial endocarditis
What is a serious side effect of advanced VSD?
Eisenmenger syndrome
What is Eisenmenger syndrome?
Severe pulmonary vascular obstruction is»_space; than systemic circulation; causes reversal of blood flow through ventricles (RV pressure > LV pressure, therefore deoxygenated blood travels systemically)
How is VSD treated?
Surgical repair via pulm artery banding (to close hole) or patch
What is tetraology of Fallot?
A dx that involves 4 different CHD
What 4 CHDs are included in tetralogy of Fallot?
- VSD
- Pulmonic stenosis
- Overriding aorta
- RV hypertrophy
What is overriding aorta?
Aorta pulls blood from both RV and LV