Cardiac Flashcards
Compare Congenital Heart Defects vs. Acquired Heart Defects
- Congenital Cardiac Defects (CHD): Defects in the heart structure that occur during fetal heart development.
- Acquired Heart Disorders: Occurs after birth related to infection, autoimmune responses, or environmental factors.
S/S of Cardiac Dysfunction in Infants?
- Poor feeding-fatigues during feedings
- Diaphoresis with feeding (Sweating on the head/brow)
- Tachypnea/tachycardia
- Failure to thrive-weight loss
- Recurrent respiratory infections
- Developmental delays
S/S of Cardiac Dysfunction in Older Childrens?
- Activity intolerance
- Fatigue
- Chest pain
- Fainting with exercise
- Cardiac murmur
How is Cardiac Dysfunction diagnosed?
- ECG
- Chest X-ray
- Echocardiogram
- Cardiac catherization
What does an Echocardiogram look for?
- Size of heart and chambers
- Movement of valves
- Blood flow-normal vs turbulence
- Presence or absence of structures
Describe Cardiac Catherization.
- Balloon catheter dilates vessels/valves
- Insertion of valves or stents
How is the pulse oximeter used to detect critical congenital heart disease?
- All infants are screened for Critical Congenital Heart Defects (CCHD) using a Pulse Oximeter prior to being discharged from hospital.
- Newborn Pulse Oximetry Screening
Performed after 24 hours of age or prior to discharge if baby is < 24-hours-old.
Post Cardiac Catheterization Care?
- Child must lay flat and supine, with affected leg straight for 4-6 hours.
- Monitor vitals, pulses, temperature
- Observe for bleeding at insertion site
- Observe for reactions to dye
- Push fluids to flush dye out of body.
- Acetaminophen for minor discomfort
- Discharge instructions: Keep the area of insertion dry and avoid tub baths and swimming for 3 days
Cardiac defects characterized by Increased Pulmonary Flow?
- Atrial Septal Defect
- Ventricular Septal Defect
- Patent Ductus Arteriosus.
Atrial Septal Defect pathophysiology?
- Abnormal opening between the atria
- Left to right shunt
- Right atrial and ventricular hypertrophy due to increased workload
Atrial Septal Defect manifestations?
- Asymptomatic
- May close spontaneously
- Undiagnosed ASD:
- Heart failure in 3rd and 4th decade of life
- Atrial Arrhythmias
- Emboli
Atrial Septal Defect treatments?
If large close in cardiac cath lab or open heart surgery
Ventricular Septal Defect pathophysiology?
- Abnormal opening between the ventricles.
- Pressures higher on the left side of the heart- left to right shunt
- Right ventricle hypertrophy due to increased workload
Ventricular Septal Defect manifestations?
Small Ventricular Septal Defect:
- Asymptomatic
- Watchful Waiting- 75% of small VSD close within the first year of life without treatment
Large Ventricular Defect:
- Surgical-Dacron patch
- Closure during cardiac catherization.
Patent Ductus Arteriosus pathophysiology?
- Ductus Arteriosus - normal fetal connection between the aorta and the pulmonary artery. - should close at 72hrs.
- Patent Ductus Arteriosus - Persistent, abnormal connection between aorta and pulmonary artery.
- Left to right shunt
- Left ventricular hypertrophy
Patent Ductus Arteriosus management?
- Medical management
- Indomethacin IV in preemies
- Stimulates muscles in PDA to tighten and close.
- Surgical management or cardiac cath
Cardiac defect characterized by Obstruction?
Coarctation of the Aorta
Coarctation of the Aorta pathophysiology?
- Narrowing of the aorta
- Left ventricular hypertrophy
Coarctation of the aorta manifestations?
- Blood pressure higher in the upper extremities than the lower extremities.
- Bounding pulses in the arms (radial/brachial)
- Weaker or absent pulses in lower extremities
- Cool lower extremities
Coarctation of the Aorta treatment?
Resection and anastomosis (removal and reconnection of unaffected aorta)
Cardiac defects characterized by Decreased Pulmonary Flow?
Tetralogy of Fallot
Tetralogy of Fallot pathophysiology?
Right to Left Shunt- Pressures on right side of heart higher than left
4 Defects of Tetralogy of Fallot?
1) Ventricular septal defect
2) Pulmonary Stenosis
3) Overriding aorta- positioned above the VSD allows both oxygenated and deoxygenated blood to enter the aorta.
4) Right ventricular hypertrophy
Tetralogy of Fallot manifestations?
- Cyanosis
- Dyspnea
- Hypercyanotic (TET) spells
Tetralogy of Fallot treatment?
Repair through open heart surgery
Hypercyanotic (TET) Spells management?
- First-Knee to chest position-increases SVR and blood flow to pulmonary artery.
- Administer blow-by oxygen
- Give Morphine subq or through existing IV line (decreases HR)
- Begin IV fluids (Increase preload)
- Phenylephrine – vasoconstriction –increases SVR
S/S of Heart Failure?
- Tachycardia
- Tachypnea
- Decreased pulses
- Decreased B/P
- Decreased urinary output
- Sleep more or have less energy
- Poor weight gain/growth
- Infants difficulty with feeding
- Older children exercise intolerance
Pediatric Heart Failure management?
Medication:
- Diuretics
- Ace inhibitors
- Beta blockers
- Digoxin
Oxygen – improve tissue oxygenation
Digoxin considerations?
- Measure apical pulse (for 1 minute) prior to administrating digoxin
- Order will specify at what heart rate the drug is withheld (depends on age)
- Do not repeat a dose if the child vomits after administering drug –wait until next scheduled dose.
Feeding interventions for pediatric Heart Failure?
- Provide periods of rest
- Neutral thermal environment
- Hold infant in upright position, improves respiratory effort
- Frequent, small feedings
- High calorie
- NGT may be necessary
Etiology of Rheumatic Heart Disease?
- Rheumatic Heart Disease most common acquired cardiac disease.
- Rheumatic Fever is an autoimmune response to an infection caused by Group A Streptococcus
- Widespread inflammatory response affects connective tissues, especially in the heart, joints, skin, and brain
Rheumatic Heart Disease manifestations?
- Fever of 38.2–38.9°C (100.8–102.0°F),
- Carditis:Inflammation of the heart muscle (most common manifestation)
- Polyarthritis
- Subcutaneous nodules
- Erythema marginatum: Reddish ring-shaped rash
Rheumatic Heart Disease complications?
- Cardiac valve stenosis and scarring
- Mitral valve is the most common valve
damaged.
Rheumatic Heart Disease treatments?
- Penicillin (oral or IM)-long term
- Corticosteroids may be required
- Severe RHD may require surgical intervention to repair or replace damaged valves.
- Surgery is often needed early in life to prevent CHF
Laboratory findings that indicate a recent history of a streptococcal infection?
- Positive ASO (Antistreptolysin)-streptococcal antibody titer
- Positive throat culture or rapid antigen detection test
Kawasaki Disease etiology?
- Acute febrile syndrome with generalized vasculitis affecting blood vessels throughout the body, including the coronary arteries
- Commonly seen in children less than 5 years of age
Kawasaki Disease manifestations?
- Abrupt onset of fever > 5 days
(unresponsive to antibiotics) - Bilateral conjunctivitis
- Red cracked lips
- Erythematous (Strawberry) tongue
- Edema and erythema of hands and feet with peeling skin
- Cervical Lymphadenopathy
- Irritability
Kawasaki Disease complications?
Coronary artery aneurysms and abnormalities
Kawasaki Disease management?
- Echocardiogram (serial)
- Intravenous immunoglobulin (IVIG)
- High dose aspirin 6-8 weeks-decrease inflammation and antiplatelet
- Activity restriction for 6-8 weeks
