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328 Pediatrics Final Exam > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Compare Congenital Heart Defects vs. Acquired Heart Defects

A
  • 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.
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2
Q

S/S of Cardiac Dysfunction in Infants?

A
  • 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
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3
Q

S/S of Cardiac Dysfunction in Older Childrens?

A
  • Activity intolerance
  • Fatigue
  • Chest pain
  • Fainting with exercise
  • Cardiac murmur
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4
Q

How is Cardiac Dysfunction diagnosed?

A
  • ECG
  • Chest X-ray
  • Echocardiogram
  • Cardiac catherization
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5
Q

What does an Echocardiogram look for?

A
  • Size of heart and chambers
  • Movement of valves
  • Blood flow-normal vs turbulence
  • Presence or absence of structures
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6
Q

Describe Cardiac Catherization.

A
  • Balloon catheter dilates vessels/valves
  • Insertion of valves or stents
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7
Q

How is the pulse oximeter used to detect critical congenital heart disease?

A
  • 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.
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8
Q

Post Cardiac Catheterization Care?

A
  • 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
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9
Q

Cardiac defects characterized by Increased Pulmonary Flow?

A
  • Atrial Septal Defect
  • Ventricular Septal Defect
  • Patent Ductus Arteriosus.
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10
Q

Atrial Septal Defect pathophysiology?

A
  • Abnormal opening between the atria
  • Left to right shunt
  • Right atrial and ventricular hypertrophy due to increased workload
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11
Q

Atrial Septal Defect manifestations?

A
  • Asymptomatic
  • May close spontaneously
  • Undiagnosed ASD:
    - Heart failure in 3rd and 4th decade of life
    - Atrial Arrhythmias
    - Emboli
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12
Q

Atrial Septal Defect treatments?

A

If large close in cardiac cath lab or open heart surgery

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13
Q

Ventricular Septal Defect pathophysiology?

A
  • 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
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14
Q

Ventricular Septal Defect manifestations?

A

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.

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15
Q

Patent Ductus Arteriosus pathophysiology?

A
  • 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
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16
Q

Patent Ductus Arteriosus management?

A
  • Medical management
    • Indomethacin IV in preemies
    • Stimulates muscles in PDA to tighten and close.
  • Surgical management or cardiac cath
17
Q

Cardiac defect characterized by Obstruction?

A

Coarctation of the Aorta

18
Q

Coarctation of the Aorta pathophysiology?

A
  • Narrowing of the aorta
  • Left ventricular hypertrophy
19
Q

Coarctation of the aorta manifestations?

A
  • 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
20
Q

Coarctation of the Aorta treatment?

A

Resection and anastomosis (removal and reconnection of unaffected aorta)

21
Q

Cardiac defects characterized by Decreased Pulmonary Flow?

A

Tetralogy of Fallot

22
Q

Tetralogy of Fallot pathophysiology?

A

Right to Left Shunt- Pressures on right side of heart higher than left

23
Q

4 Defects of Tetralogy of Fallot?

A

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

24
Q

Tetralogy of Fallot manifestations?

A
  • Cyanosis
  • Dyspnea
  • Hypercyanotic (TET) spells
25
Q

Tetralogy of Fallot treatment?

A

Repair through open heart surgery

26
Q

Hypercyanotic (TET) Spells management?

A
  1. First-Knee to chest position-increases SVR and blood flow to pulmonary artery.
  2. Administer blow-by oxygen
  3. Give Morphine subq or through existing IV line (decreases HR)
  4. Begin IV fluids (Increase preload)
  5. Phenylephrine – vasoconstriction –increases SVR
27
Q

S/S of Heart Failure?

A
  • 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
28
Q

Pediatric Heart Failure management?

A

Medication:

  • Diuretics
  • Ace inhibitors
  • Beta blockers
  • Digoxin

Oxygen – improve tissue oxygenation

29
Q

Digoxin considerations?

A
  • 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.
30
Q

Feeding interventions for pediatric Heart Failure?

A
  • Provide periods of rest
  • Neutral thermal environment
  • Hold infant in upright position, improves respiratory effort
  • Frequent, small feedings
  • High calorie
  • NGT may be necessary
31
Q

Etiology of Rheumatic Heart Disease?

A
  • 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
32
Q

Rheumatic Heart Disease manifestations?

A
  • 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
33
Q

Rheumatic Heart Disease complications?

A
  • Cardiac valve stenosis and scarring
  • Mitral valve is the most common valve
    damaged.
34
Q

Rheumatic Heart Disease treatments?

A
  • 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
35
Q

Laboratory findings that indicate a recent history of a streptococcal infection?

A
  • Positive ASO (Antistreptolysin)-streptococcal antibody titer
  • Positive throat culture or rapid antigen detection test
36
Q

Kawasaki Disease etiology?

A
  • 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
37
Q

Kawasaki Disease manifestations?

A
  • 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
38
Q

Kawasaki Disease complications?

A

Coronary artery aneurysms and abnormalities

39
Q

Kawasaki Disease management?

A
  • Echocardiogram (serial)
  • Intravenous immunoglobulin (IVIG)
  • High dose aspirin 6-8 weeks-decrease inflammation and antiplatelet
  • Activity restriction for 6-8 weeks

328 Pediatrics Final Exam (5 decks)

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