Cardiac Flashcards
What is the most common cause of a cyanotic baby?
Tetrology of Fallot
Areas to auscultate
Upper R sternal border (base/aortic)
U L sternal border (pulmonic)
LRSB (tricuspid)
LLSB (apex)
Cardiac physical exam
What color is the baby?
Respiratory distress?
Diaphoretic?
Palpate
Palpation during cardiac exam
Extremity pulses Femoral pulses BP(Doppler) The chest Precordium Thrills?
Heart defects with increased pulmonary flow
Patent ductus arteriosus (PDA) Septal defects (ASD, VSD) Atrioventricular canal (AVC) defect **L to R shunting ** fix these defects **L high pressure ** pulmonary congestion, pulmonary drowning ** these patients demonstrate s/s of HF
Heart defects that are obstructive
Coarctation Pulmonary stenosis (PS) Aortic stenosis (AS) **s/s of coarctation: increased pressure in upper extremities with bounding pulses, headaches, dizziness ** obstructive = blood cannot get out
Heart defects with decreased pulmonary flow
Tetralogy of Fallot
Transposition
** Tetralogy of Fallot = VSD, PS, Overriding aorta, RV hypertorphy
Urine Output
1mL/kg/hr
Diaphoresis
sign of low cardiac output
S/S of CHF
cardiac enlargement tachycardia tachypnea diaphoresis weak pulses decreased UOP Gallop rhythm
Treatment for CHF
Digoxin
Lasix
Fluid restriction
Inotropes
Treatment of cyanosis
Low O2 or RA Maintain sats 75 PGE (prostaglandin E) Cardiac cath. Surgery
Normal ductus arteriosis closure
1st breath causes a sharp increase in PAO2 and causes the ductus arteriosis to close.
CXR
- most frequently ordered radiologic test for children with suspected cardiac problems.
- provides a permanent record of the heart’s size and configuration, its chambers, and the great vessels as well as the pattern of blood flow, especially in pulmonary vessels.
Decreased HgB
- s/s of tissue hypoxia because of diminished O2 binding capacity. Tx: packed RBCs
- Chronic hypoxia: polycythemic; thick blood. Risk for stroke. Keep very well hydrated.
Cardiac cycle
systole and diastole
Cardiac output
volume of blood ejected by the heart over one minute
Stroke volume
volume of blood ejected by the heart per contraction
Preload
Volume of blood returning to the heart, or circulating blood volume.
**Circulating blood volume is easiest to assess clinically using the central venous pressure. (CVP)
Afterload
Volume of blood against which the heart has to beat. Also known as BP or systemic vascular resistance.
**a higher BP indicates greater afterload.
Frank-starling law
As preload increases, stroke volume increases and as stroke volume increases, cardiac output increases.
-It is also how we describe contractility.
CHF in kids is most commonly caused by
congenital heart defects (CHD)
CHF in kids described
- kids have both right and left sided HF
- RV is shot. This leads to increased RV end diastolic pressure which causes everything to back up. This creates increased central venous pressure, systemic engorgement (JVD, hepatomeglea, generalized edema)
- L side; pulmonary congestion
Goals of tx in CHF
- improve cardiac function
- remove accumulated fluid and sodium
- decrease cardiac demands
- improve tissue oxygenation
- decrease O2 consumption