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Peds exam 2 > Cardiac 10/16 > Flashcards

Cardiac 10/16 Flashcards

1
Q

Where can a heartbeat be heard the loudest?

A

Apex

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2
Q

When do you use the bell to auscultate?

A

Lower pitch sounds

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3
Q

What is an innocent murmur?

A

Benign, no clinical symptoms or signficance, normal cardiac anatomy and function

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4
Q

When would congenital murmurs most likely be detected?

A

Weeks after delivery (ASD, VSD, aortic or pulmonic stenosis)

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5
Q

What might syncope be a symptom of?

A
  • Arrhythmia
  • Mitral valve prolapse
  • Aortic stenosis
  • Long QT syndrome
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6
Q

What is a concern post-strep infection?

A

Post-strep murmur

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7
Q

What should be done if a murmur is detected at a well-child visit?

A

Assess for other s/s of compensation or complication (benign murmurs are common in pediatric population)

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8
Q

How is a murmur characterized?

A
  • Intensity
  • Location
  • Quality
  • Radiation
  • Timing
  • Pitch
  • Grade
  • Associated factors
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9
Q

What does a murmur’s intensity describe?

A

Loudness

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10
Q

What does a murmur’s location describe?

A

Where it is best heard (where it is the loudest)

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11
Q

What does a murmur’s quality describe?

A

Description of the sound- musical, blowing, swishing

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12
Q

What does a murmur’s radiating quality describe?

A

Can the murmur be heard elsewhere throughout the body

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13
Q

What does a murmur’s timing describe?

A

During what part of the heartbeat does the murmur occur

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14
Q

What are possible associated factors of a murmur?

A
  • Occurs only when in a certain position (sitting, lying down)
  • Child is dehydrated
  • Child has infection
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15
Q

How do you grade a murmur?

A
  • Grade 1-6 (I-VI)
  • 1 = difficult to hear with stethoscope
  • 4 = accompanied by thrill (vibration over the heart)
    6 = can hear without stethoscope
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16
Q

What might trigger an innocent murmur?

A

Bodily/cardiac stress:

  • Anemia
  • Fever
  • Rapid growth
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17
Q

What is a thrill?

A

Vibration heard related to murmur at the heart (heard in grade 4-6 of murmurs)

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18
Q

What are the parts of the heart present in a fetus (that should close with birth)?

A
  • Foramen ovale

- Ductus arteriosus

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19
Q

Where is the foramen ovale?

A

Between RA and LA

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20
Q

Where is the ductus arteriosus?

A

Connects pulmonary artery and aorta

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21
Q

Describe the blood flow of a fetus.

A

Placenta –> umbilical vein –> liver –> ductus venosus –> inferior vena cava –> RA –> RV or foramen ovale

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22
Q

What happens to the foramen ovale, ductus arteriosus, and ductus venosus after delivery?

A

Close and atrophy; become legamentum

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23
Q

What causes the foramen ovale and ductus arteriosus to close?

A

Pressure changes once baby starts breathing

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24
Q

What are S/S of pediatric cardiac dysfunction?

A
  • 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
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25
Q

How does Maslow’s hierarchy related to pediatric cardiac dysnfunction?

A

Cardiac dysfunction leads to hypoxia; hypoxia leads to poor feeding, poor growth, and then poor development

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26
Q

What prenatal conditions may predispose a child to cardiac dysfunction?

A
  • Lack of prenatal care
  • Preterm birth
  • Diabetes
  • IUGR
  • Infection during pregnancy
  • Teratogen exposure
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27
Q

What are the S/S of CHF?

A
  • Respiratory s/s (fluid = wheezing, congestion, crackles; tachypnea)
  • Sweating of upper brow (d/t increased metabolism)
  • Tachycardia
  • Edema
  • Cool extremities
  • Lethargy
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28
Q

What are the respiratory s/s of CHF?

A
  • Fluid (wheezing, congestion, crackles)

- Tachypnea

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29
Q

What is the cardiac cycle?

A

Sequential contraction and relaxation of the atria and ventricles

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30
Q

What is afterload?

A

The resistance (pressure) that the ventricles must pump against

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31
Q

What is stroke volume?

A

The volume of blood ejected by the heart with each contraction

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32
Q

What is cardiac output?

A

The volume of blood ejected by the heart per minute (CO = HR x SV)

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33
Q

What are the 2 categories of cardiac defects?

A
  • Congenital

- Acquired

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34
Q

What are possible causes of acquired cardiac defects?

A
  • Autoimmune response
  • Infection
  • Environmental exposure
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35
Q

What is the most common cause of congenital cardiac defect?

A

Multifactorial (85%)

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36
Q

What is more common: genetic cause of a congenital heart defect or environmental/maternal illness during pregnancy?

A

Genetics (10-12%) vs. maternal/environment (1-2%)

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37
Q

What are maternal illnesses or exposures that increase fetal risk of congenital heart defect?

A
  • Rubella during first 7 weeks of pregnancy
  • Viral illness
  • Diabetes
  • Alcolohol use (FAS)
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38
Q

What is the most common congenital heart defect?

A

VSD

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39
Q

What are the 4 classes of congenital heart disorders?

A
  • Increased pulm blood flow
  • Decreased pulm blood flow
  • Obstruction of blood flow out
  • Mixed blood flow
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40
Q

What is a s/s of an increased pulm flow CHD?

A

CHF

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41
Q

What is a s/s of a decreased pulm flow CHD?

A

Cyanosis

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42
Q

What is a s/s of obstructive defects of the ventricles?

A
  • Obstructed L heart = CHF

- Obstructed R heart = cyanosis

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43
Q

What is ASD?

A
  • Atrial septal defect
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44
Q

What category of CHD does ASD fit in?

A

Increased pulmonary flow (blood flows from high P to low P, therefore goes form L heart to R increasing pulm blood flow)

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45
Q

What is the change in cardiac blood flow from ASD?

A

Blood flows from LA to RA via hole in atrial septum

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46
Q

What part of the heart becomes distended in ASD?

A

RA and RV (d/t increased filling secondary to septal defect and pulmonary resistance)

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47
Q

What s/s are seen with ASD?

A
  • Typically asymptomatic (although septal defect, since in atria, less s/s seen)
  • Even pulm s/s are less since only atrial involvement
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48
Q

How is ASD tx?

A
  • surgical = cardiac cath repair w/ patch
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49
Q

How is ASD detected?

A

Since nonsymptomatic, detect via murmur auscultation or s/s of slowed growth and development

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50
Q

What category of CHD is patent ductus arteriosus?

A

Increased pulm flow

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51
Q

When should the ductus arteriosus close normally?

A
  • Starts w/ first breath

- Should be close (by P changes) 15hrs after birth

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52
Q

What is PDA?

A

Patent ductus arteriosus

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53
Q

What are s/s of PDA?

A
  • CHF (tachypnea, tachycardia, dyspnea, hoarse cry)
  • Bounding peripheral pulse
  • Widened pulse pressure
  • Murmur @ upper L (pulmonic aorta)
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54
Q

How is PDA definitively diagnosed?

A

Echo

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55
Q

How is PDA managed?

A
  • Medically = indomethacin

- Surgery = surgical ligation via cath

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56
Q

What is Indomethacin and what is it used for?

A

NSAID that closes ductus arteriosis

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57
Q

What needs to be dosed prior to a surgical ligation of PDA?

A

Prophylactic antibiotics to prevent bacterial endocarditis

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58
Q

What category is VSD?

A

Increased pulm flow

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59
Q

What 3 heart conditions increase pulmonary flow?

A
  • ASD
  • VSD
  • PDA
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60
Q

Which of the following is typically asymptomatic: ASD, VSD, PDA?

A

ASD

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61
Q

Which of the following frequently cause pulm HTN and CHF s/s: ASD, VSD, PDA?

A

VSD and PDA

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62
Q

Which CHD is the most common?

A

VSD

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63
Q

Which way does blood flow in VSD?

A

LV to RV via septal defect

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64
Q

What part of the heart first hypertrophies in VSD?

A

LV

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65
Q

What are s/s of VSD?

A
  • Murmur
  • CHF
  • Pulm vascular obstructive disease/HTN
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66
Q

What is an increased risk d/t VSD?

A

Bacterial endocarditis

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67
Q

What is a serious side effect of advanced VSD?

A

Eisenmenger syndrome

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68
Q

What is Eisenmenger syndrome?

A

Severe pulmonary vascular obstruction is&raquo_space; than systemic circulation; causes reversal of blood flow through ventricles (RV pressure > LV pressure, therefore deoxygenated blood travels systemically)

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69
Q

How is VSD treated?

A

Surgical repair via pulm artery banding (to close hole) or patch

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70
Q

What is tetraology of Fallot?

A

A dx that involves 4 different CHD

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71
Q

What 4 CHDs are included in tetralogy of Fallot?

A
  • VSD
  • Pulmonic stenosis
  • Overriding aorta
  • RV hypertrophy
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72
Q

What is overriding aorta?

A

Aorta pulls blood from both RV and LV

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73
Q

What category of CHD is tetralogy of Fallot?

A

Decreases pulmonary flow

74
Q

What are s/s of tetralogy of fallot?

A

Cyanosis, chronic need for O2:

- Tet spells (blue spells) = acute episodes of cyanosis and hypoxia

75
Q

Which way does blood flow in tetralogy of fallot?

A

Depends on severity of each CHD (if PVR > systemic resistance, blood flows from RV to LV)

76
Q

What are risks associated with the s/s of tetralogy of fallot?

A
  • Emboli
  • Altered LOC
  • Sudden death
  • Seizures
77
Q

How is tetralogy of fallot treated?

A

Surgically:

  • Shunt placed from subclavian artery to pulm artery (bypasses stenosis to increase pulm blood flow)
  • Complete repair = VSD repair, resect stenosed pulm artery
78
Q

What is a tet spell?

A

AKA blue spell = acute episode of cyanosis or hypoxia

79
Q

When is complete surgical repair of tetralogy of fallot indicated?

A

With increased occurrences of tet spells

80
Q

What often triggers a tet spell?

A

Increased output of energy (stress or energy output):

  • Lab draws
  • Feeding
  • Crying
  • Defecating
81
Q

What is done at home to manage a tet spell?

A
  • Knee to chest position to optimize blood flow

- Calm approach, calm child

82
Q

What is done in patient to manage a tet spell?

A
  • Knee to chest position
  • Calming presence
  • Morphine to stop spasm
  • 100% O2
  • IVF
83
Q

What category of CHD is pulmonary stenosis?

A

Obstructed flow

84
Q

What structural heart changes occur d/t pulmonary stenosis?

A
  • RV hypertrophy

- Narrowing of pulmonary artery

85
Q

What is an extreme form of pulmonary stenosis?

A

Pulmonary atresia

86
Q

What is pulmonary atresia

A

Complete fusion/closure of the pulmonary artery

87
Q

What happens to the ductus arteriosus and foramen ovale secondary to significant pulmonary stenosis?

A

Foramen ovale and ductus arteriosus reopen (allows for some blood flow to lungs: RV > RA > foramen ovale > LA > LV > aorta > ductus arteriosus > PA > lungs)

88
Q

What are s/s of pulm stenosis?

A

Systemic cyanosis

89
Q

How is pulmonary stenosis dx?

A

Chest x-ray = cardiomegaly and pulm stenosis

90
Q

How is pulm stenosis tx?

A
  • Balloon angioplasty to dilate pulmonary artery

- Replace valve (bypass to do valvotomy)

91
Q

What is coarctation of the aorta?

A

Narrowing of the artery near ductus arteriosus

92
Q

What category of CHD is coarctation of the aorta?

A

Obstructive flow

93
Q

What are the s/s of coarctation of the aorta?

A
  • Bounding pulse and high BP @ arms
  • Weak pulse and low BP @ lower extremities
  • CHF s/s
  • Dizziness,
  • HA
  • Fainting
  • Epistaxis (from upper body high BP)
94
Q

What are the risks of coarctation of the aorta?

A
  • Aortic aneurysm

- Stroke

95
Q

How do you tx coarctation of the aorta?

A
  • Nonsurgical = balloon angioplasty

- Surgical = resection of coarctation

96
Q

Does surgical tx of coarctation of the aorta require bypass?

A

No- site of defect is outside of the pericardium

97
Q

What are possible post-op complications r/t tx of coarcation of the aorta?

A
  • Systemic HTN

- Recurrence

98
Q

What is aortic stenosis?

A

Narrowing of the aortic valve

99
Q

Which is more common, aortic or pulmonary artery stenosis?

A

Aortic stenosis (more common in bi- vs. tri-cuspid valves)

100
Q

What category of CHD is aortic stenosis?

A

Obstructed flow

101
Q

What effects does aortic stenosis have on the heart?

A
  • Increased LV resistance
  • Decreased CO
  • LV hypertrophy
  • Backup of blood into pulmonary circuit (eventually leads to pulm HTN)
  • Decreased systemic perfusion
  • Decreased coronary artery perfusion (increased risk of MI)
102
Q

What are the s/s of aortic stenosis?

A
  • Murmur
  • Faint pulses
  • Hypotension
  • Poor feeding
  • Tachycardia
  • Exercise intolerance
  • Chest pain
  • Dizziness with standing
103
Q

How is aortic stenosis tx?

A
  • Nonsurgical = balloon angioplasty

- Surgical = valve replacement

104
Q

If aortic stenosis is detected early in birth, what med may be given to support hemodynamic stability?

A

Prostaglandin (to keep ductus arteriosis patent)

105
Q

What category of cardiac disease does hypoplastic left heart syndrome fall into?

A

Mixed blood flow

106
Q

What is the prognosis for untreated hypoplastic L heart?

A

Untreated condition is not compatible with life

107
Q

What is hypoplastic L heart?

A
  • L side of heart is underdeveloped
  • L ventricle is small
  • Aortic atresia on L side (valve from LV to aorta = small, not fully functional)
  • Patent foramen ovale and ductus arteriosus (allows some blood flow to aorta from pulmonary artery)
108
Q

What is tx plan for hypoplastic L heart?

A
  • Keep ducti (DA and FO) open w/ Prostaglandin E infusion
  • Surgery (3)
  • Option for transplant if surgeries unsuccessful
109
Q

Why is heart transplant the last effort?

A
  • Hard to get a heart to donate

- High mortality rate with procedure (30-50%)

110
Q

What are the 3 surgeries involved with hypoplastic L heart?

A 
1 = Norwood procedure = create new aorta using main pulm artery and creation of large ASD
2 = Bidirectional Glenn Shunt @ 6-9mo to reduce volume load on R ventricle
3 = modified Fontan procedure = tricuspid valve atresia repair @ L ventricle
111
Q

In which category of cardiac condition does transposition of the great vessels belong?

A

Mixed flow

112
Q

What is “transposition of the great vessels”?

A

Pulm artery leaves L ventricle and aorta leaves R ventricle (patent ductus arteriosus and foramen ovale for life to be sustained)

113
Q

How do you surgically tx “transposition of the great vessels”?

A

Arterial switch = resect and re-anastomose the great vessels (requires coronory arteries to be reimplanted in order to supply blood to heart with new vessel arrangement)

114
Q

What are the s/s of “transposition of the great vessels”?

A
  • Desaturation of O2
  • Cyanosis
  • CHF
115
Q

In which category of cardiac condition does truncus arteriosus belong?

A

Mixed blood flow

116
Q

What is truncus arteriosus?

A

A single large vessel supplies blood to both the pulm artery and aorta (ASD present)

117
Q

Is Digoxin a positive or negative inotrope?

A

Positive- increases the F of contraction

118
Q

At what apical infant HR would you give the dose of Digoxin?

119
Q

At what apical chidlren/toddler HR would you give the dose of Digoxin?

120
Q

What are two assessments conducted regularly for a ped on Digoxin (hint: physical assessment and lab)?

A
  • Daily weight

- Labs drawn for K+

121
Q

Is Digoxin a positive or negative chronotrope?

A

Negative (slows HR while increasing contractility)

122
Q

What is the mechanism of digoxin?

A

Angiotensin enzyme inhibitor (reduces afterload of the heart)

123
Q

What are s/s of digoxin toxicity?

A
  • Vomiting
  • Neuro changes (irritability, responsiveness)
  • Visual disturbances (frequent blinking)
124
Q

How is digoxin tox tx?

A
  • Lasix to remove excess drug

- K+ supplements (dosing meds and PO (leafy greens, bananas. etc.)

125
Q

Does Digoxin have a slow or rapid onset?

126
Q

Does Digoxin have a long or short 1/2 life?

127
Q

How do you administer PO liquid Dig to a pediatric patient?

A

Squirt to side/back of mouth

128
Q

When should Digoxin be given releative to food?

A
  • W/o food

- 1hr before feeding or 2 hrs after

129
Q

What should you do if a dose of Digoxin is vomited?

A

Do not automatically repeat dose

130
Q

What are possible causes of acquired cardio disorders?

A
  • Infection
  • Autoimmune response
  • Environment
  • Family tendencies
131
Q

What is endocarditis?

A
  • Infection in valves and endocardium of heart
132
Q

What are the 3 acronyms for types of endocarditis?

A
  • BE = bacterial endocarditis
  • IE = infective endocarditis
  • SBE = subacute bacterial endocarditis
133
Q

What is often present in the PMH of a ped dx w/ endocarditis?

A
  • Usually sequelae of sepsis in child w/ congenital heart anomaly
  • Ex: staph, strep, Candida, gram - bacteria
134
Q

What are prophylactic measure taken to prevent endocarditis?

A

1hr before procedures, IV or PO antibiotics are given (before dental procedures, bronchoscopy, T&A, surgeries)

135
Q

What are the risks of unmanaged endocarditis?

A

Long term damage to the heart (possible CHF or valvular damage)

136
Q

How is endocarditis tx?

A
  • 2-8 wks of antibiotics
  • Antibiotics dosed often: -cillin, streptomycin or gentamicin
  • Amphotericin or flucytosine for fungal infections/causes
137
Q

Why are rheumatic fever and rheumatic heart disease seen less often in the peds population?

A

Strep is better treated today

138
Q

What is rheumatic fever?

A

An inflammatory disease that occurs after group A strep infection

139
Q

What are s/s of rheumatic fever?

A
  • Fever affects joints, skin, brain, serous surfaces, and heart
  • Carditis (involves all muscle layers of the heart and the mitral valve)
  • Arthritis (reversible; migrates from large joints to others)
  • Erythema marginatum (rash)
  • Sub-q nodules over bony prominences (hands, feet, vertebrae, etc.); may persist after disease resolves and will eventually clear
  • Aschoff bodies (inflammed hemorrhagic bullous lesions that cause swelling and alterations in connective tissue); found in heart, blood vessels, brain, joints, and serous surfaces
140
Q

Where is rheumatic fever seen more often today?

A

3rd world countries (with less strep control)

141
Q

What is rheumatic heart disease?

A
  • The most common complication of rheumatic fever

- Damage to heart valves secondary to fever

142
Q

What is carditis?

A

Carditis involves endocardium, pericardium, and myocardium; most commonly the mitral valve

143
Q

What is polyarthritis in RF?

A

Arthritis is reversible and migrates, especially in large joints (knees, elbows, hips, shoulders, wrists)

144
Q

What is erythema marginatum in RF?

A

Erythema marginatum = rash; usually on trunk and proximal portion of extremities. Red macule w/ clear center and wavy, well-demarcated border

145
Q

What are subcutaneous nodules related to RF?

A

Subcutaneous nodules are inflammation typically on the wrists; resolve after RF resolves

146
Q

What are Aschoff bodies r/t RF?

A

Aschoff bodies: inflammed Hemorrhagic bullous lesions that cause swelling, fragmentation and alterations in connective tissue. Found in the heart, blood vessels, brain and on serous surfaces of joints and pleura

147
Q

How is rheumatic fever dx?

A

Presence of 2 major or 1 major and 2 minor s/s

148
Q

Is rheumatic fever an autoimmune rxn?

149
Q

What is Kawasaki disease?

A

Inflammation of the coronary arteries

150
Q

How is Kawasaki disease dx?

A

S/s:

  • Severe irritability
  • Fever
  • Rash/peeling of palms of hands and feet
  • Edema of hands and feet
  • Swollen and cracked lips
  • Strawberry tongue (red with white dots)
151
Q

How is Kawasaki disease tx?

A
  • IV immunoglobulin G (IgG)
  • Aspirin
  • Possible use of coumadin (warfarin)
152
Q

How is IgG dosed with Kawasaki disease?

A
  • High doses (to reduce fever and coronary artery abnormalities)
  • Given within the 1st 10 days of illness
153
Q

Why is Aspirin dosed in Kawasaki disease in spite of Reye’s syndrome?

A

The risks of Reye’s syndrome are weighed against Kawasaki disease and it was determined that it is more appropriate to control the Kawasaki’s effectively and assess for Reye’s than the alternative

154
Q

What dose of aspirin is given?

A
  • 80-100 mg/kg/day in divided doses Q6h until fever is gone
  • After fever is gone, dose 3-5mg/kg/day for antiplatelet effects
  • Continue until platelet count returns to normal
155
Q

Should aspirin be continued indefinitely?

A

Only if there are longterm coronary abnormalities

156
Q

When is Coumadin/warfarin indicated for children with Kawasaki’s disease?

A

Children with giant aneurysm (>8mm)

157
Q

What is cardiomyopathy?

A
  • When contractability of the myocardium is impaired

- Muscle is rigid and reduced

158
Q

What are s/s of cardiomyopathy?

A

CHF symptoms

159
Q

What are types of cardiomyopathys?

A
  • Secondary cardiomyopathy
  • Dilated cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
160
Q

How is a cardiomyopathy tx?

A
  • Correct underlying cause if possible

- Manage CHF and dysrhythmia

161
Q

How are CHF and dysrhytmia s/s of cardiomyopathy managed?

A
  • Possible surgery
  • Anticoagulants
  • Defibrillator
  • Vasodilator
162
Q

What meds are used to manage a cardiomyopathy?

A
  • Digoxin (increase cardiac contractions)

- Diuretics (Lasix/Furosemide, or Thiazides)

163
Q

What needs to be considered when dosing diuretics to manage a cardiomyopathy?

A
  • Consider K+, Na+, hypotension

- Low Na+, increased K+ diet

164
Q

What is the difference between Lasix/Furosemide and thiazides?

A

Thiazides are K+ sparing

165
Q

What are common pharmacologic meds used with CV disorders?

A
  • IV IgG
  • Digoxin (improves contractility, need to observe for toxicity)
  • Aspirin (antiplatlet and decrease coronary artery inflammation)
  • NSAIDs
  • Lasix (need to supplement K+)
  • Spironolactone (Thiazide)
166
Q

How is a cardiac dysrhythmia dx?

A
  • ECG
  • Holter monitor
  • Cardiac cath (pressures, diagnostic structural assessment, intervention)
  • Transesophageal recording
  • Chest x-ray (size of heart)
  • Echo (structure and blood flow)
167
Q

What are tachydysrhtymias?

A
  • HR too fast

- Doesn’t allow for quality refill and ejection, inefficient contractions and perfusion

168
Q

What is the most common tachydysrhythmia?

A

SVT (HR >200 bpm)

169
Q

What are the s/s of a tachydysrhtymia?

A
  • Neuro changes

- Cyanosis

170
Q

How is a tachydysrthymia tx?

A
  • Vagal maneuver

- Adenosine (med)- slows HR, very short 1/2 life

171
Q

What is important to know about Adenosine?

A

Very short 1/2 life

172
Q

How do you perform a vagal maneuver in peds?

A

Bag of cold ice to the face

173
Q

What is a bradydysrthythmia?

A

Too slow HR, possible AV block

174
Q

How is a bradydysrhythmia tx?

175
Q

What is the difference between primary and secondary HTN?

A

Primary HTN has no known cause; secondary has an identifiable cause

176
Q

What is the common cause of secondary HTN in the pediatric population?

A
  • Structural abnormality of cardio

- Underlying pathology abnormality (renal disease, CV disease, endocrine or neuro disorder)

177
Q

How is systemic HTN dx?

A
  • Need 3 separate appointments/occasions to document systemic elevated HTN
178
Q

When should BP be screened for children?

A

ALL OF THE TIME

  • Routine check ups
  • With any illness
  • Failure to thrive
179
Q

What is assessed pre cardiac cath?

A
  • VS (Q1min apical pulse)
  • Cap refill and perfusion
  • H+H
  • Pulses
  • Height and weight
  • Skin assessment
180
Q

What is assessed post cardiac cath?

A
  • Gauze site and diaper for bleeding (under butt too)
  • Temp
  • Cap refill
  • Pulses
  • IO
  • Keep quiet for 4-6hrs
181
Q

For which conditions can cardiac catheterization be a tx measure rather than solely dx in ped population?

A
  • Transposition of great vessels
  • Single-ventricle defects
  • ASD
  • Pulmonary artery stenosis
182
Q

How often should VS be taken post cardiac cath?

Peds exam 2 (1 decks)

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