Cardiac Flashcards
What are the components of tetralogy of Fallot?
Pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, overriding aorta
What classification is tetralogy of Fallot?
Defect with decreased pulmonary flow
What classification is tricuspid atresia?
Defect with decreased pulmonary flow
What classification is ventricular sepal defect?
Defect with increased pulmonary flow
What classification is atrial sepal defect?
Defect with increased pulmonary flow
What classification is patent ductus arteriosus?
Defect with increased pulmonary flow
What classification is atrioventricular canal defect?
Defect with increased pulmonary flow
What classification is coarctation of the aorta?
Defect with obstructed ventricular flow
What classification is pulmonary stenosis?
Defect with obstructed ventricular flow
What classification is aortic stenosis?
Defect with obstructed ventricular flow
What classification is transportation of the great arteries?
Defect with mixed blood flow rt purposeful PDA
What classification is hypoplastic left heart syndrome?
Defect with mixed blood flow
What classification is truncus arteriosus?
Defect with mixed blood flow
What classification is total anomalous pulmonary venous return
Defect with mixed blood flow
What are signs and symptoms of heart defects in infants: general, neuro, cardiac, GI/GU, respiratory
S/S: cyanosis, dyspnea, SOB, edema, poor nutrition
Neuro: fatigue, lethargy, developmental delay from decreased oxygen to brain, irritability
Cardiac: murmur, poor perfusion, weak pulses, cyanosis, tachycardia, hypotension, edema, end-organ damage, decreased urine output (poor perfusion to kidneys)
GI/GU: poor weight gain, decreased feeding, nausea vomiting, increased metabolic rate, weight loss, hepatomegaly
Respiratory: tachypnea, hypoxia, exercise intolerance, pulmonary edema, wheezing/coughing
What meds might be given for CHF (can be caused from any heart defect with increased flow/obstructed flow)
Digoxin to control heart rate and rhythm
Diuretics to control fluid volume
ACE inhibitors to control heart rate and decrease aortic pressure
What are signs and symptoms of coarctation of the aorta?
Tachypnea, poor feeding, cool lower extremities, hypertension in the upper extremities, hypotension in the lower extremities, murmur, absent lower pulses
What are risks of coarctation?
Aortic aneurism, ruptured aorta, stroke, hypertension
What’s the patho behind coarctation of the aorta? When is it found?
Narrowing of the proximal portion of the descending aorta; symptoms are typically not present at birth but can start developing as early as the first week of life; when the PDA remains open perfusion to the lower extremities is adequate, once the PDA closes impaired perfusion to the lower extremities can occur
What is PDA? Patho?
Patent ductus arteriosus. Connects aorta to pulmonary artery
What is treatment for PDA?
Indomethacin, ASA, and other NSAIDs. These drugs inhibit the prostaglandins which are required to keep the DA open
What are the signs and symptoms of tetrology of Fallot
Respiratory: mild-to-severe cyanosis, tachypnea, dyspnea
Cardiac: loud, harsh systolic ejection murmur, tachycardia, clubbing of fingers (over time), squatting in toddlers (if uncorrected)
Growth: failure to gain weight
“TET Spells”
What is a TET spell? And what is the treatment?
Sudden increase in pulmonary vascular resistance at a time when there is increased demand for oxygen. Cyanosis, murmur, anoxic spells with feeding, crying, defection, or stress. Increased demand causes right to left shunting in the ventricles leads to
deoxygenated blood going to the aorta and not the lungs.
Place the child in the knee/chest position, provide O2, calming environment, may
give morphine and IV fluids as needed
What is the surgery done for TOF? What is the issue with this surgery?
Blalock-taussig shunt which connects the subclavian artery to the pulmonary artery. Can only temporarily be used because of the risk for clot formation
What and when are additional surgeries for TOF done?
Done after 6 months.
Closing the VSD with a synthetic patch or autograft using the pericardium
Closing the ASD if present
Pulmonary stenosis is relieved by resecting the right ventricular outflow tract, a pulmonary valvotomy, or reconstruction using a patch
What is the patho behind rheumatic fever?
Group A strep infection: antibodies are made that can have an abnormal immune response and attack the valve tissue in the heart
What are symptoms of acute rheumatic fever? Heart involvement?
Redness, pain, swelling of joints, chorea. Macules, swollen
lymph nodes. Fever, tachycardia, tachypnea
Immune response -> antibodies get deposited in and around the heart. Leads to tachycardia, cardiomegaly, chest pain, friction rub, murmur, ECG changes
What is the most common heart related issue from acute rheumatic fever?
Mitral valve damage
What labs might be looked at for acute rheumatic fever?
Positive ASO titer. Elevated ESR and CRP
What is important for post acute rheumatic fever patients to know regarding medications
Will need antibiotics for 5-10 years and also as prophylaxis with dental care
Use of aspirin as anti-inflammatory
How is hypertension determined in children?
Prehypertension is BP above the 90th percentile, stage 1 is between 95 and 99th percentile, and stage 2 is > 99th percentile
What are the causes of primary HTN in children?
Obesity, genetics, environmental factors
What is the initial drug of choice to treat hypertension?
Hydrochlorothiazide diuretic
What drugs are used for hypertension? Key side effects to know?
HCTZ: hyponatremia, hypokalemia
ACE inhibitors (prils): cough is normal
ARBs (tans): dizziness, muscle cramps
Calcium channel blockers (pines): vasodilation-hypotension, dizziness,
flushing, gingival hyperplasia
What are complications of HTN?
Aneurysms, hemorrhagic stroke, MI, HF, LV hypertrophy, metabolic syndrome (DM, high triglycerides, decreased HDL)
