Cardiac Alterations Flashcards
In a fetus, what does the foramen ovale do?
Allows blood to pass from the right to left atrium
What does the ductus venosus do?
Channel blood from the umbilical vein to the inferior vena cava and into the right atrium
When does the foramen ovale close?
When pressure in the left atrium exceeds that of the right atrium
Ductus arteriosus constricts in response to what?
Higher oxygen saturation
What is the leading cause of death excluding prematurity during the first year of life
Congenital defects
Which ventricle is larger?
Right ventricle is initially larger than left
Immature heart is more sensitive to _________ and __________ __________.
Volume or pressure overload
Newborns cardiac output primarily depends on what?
Heart rate
At what age is the heart muscle fully developed?
Five years of age
What is congestive heart failure?
A congenital disorder, cardiac output is inadequate to support bodies circulatory and metabolic needs. There is increased pulmonary bloodflow and obstructed outflow and problems with hard contractility
What are some pathological conditions that lead to congestive heart failure?
Severe anemia, acidosis, respiratory disease
Left-sided heart failure results in what?
Pulmonary edema
What is left-sided heart failure?
The left ventricle is unable to pump blood into systemic circulation. Increased pressure in the left atrium and pulmonary veins
Describe right-sided heart failure.
The inability to pump blood into the pulmonary artery, increased pressure in the right atrium and systemic venous circulation.
What does right-sided heart failure cause?
Causes hepatosplenomegaly and occasional edema
Eventually, heart failure is ___________
Bilateral
Heart failure results in __________ ________ _______
Inadequate cardiac output
Inadequate cardiac output results in what problem with the organs and tissues?
poorly oxygenated organs and tissues
What happens to the kidneys and heart muscle in congestive heart failure?
The kidney stimulate sodium and water reabsorption causing fluid overload. The heart muscle becomes hypertrophied
What are signs and symptoms of congestive heart failure?
Tachycardia, decreased cardiac output: poor perfusion, cold extremities, weak pulses, slow capillary refill, low blood pressure, mottled skin. Pulmonary congestion: tachypnea , dyspnea , retraction, nasal flaring. Diaphoresis: during feeding and at rest. Pulmonary edema, orthopnea, wheezing, cough, gasping and grunting respirations
What is management of CHF?
Improve cardiac function: digitalis glycosides (digoxin), angiotensin converting enzyme inhibitors (captopril). Remove accumulate fluid and sodium: Lasix for Rappa diuresis, diurnal for maintenance diuresis. Decreased cardiac commands. Improve tissue oxygenation
What should be done prior to the administration of digoxin?
Apical pulse should be counted for one minute prior to administration
What are signs of digitalis toxicity?
Bradycardia, vomiting , neurological or visual disturbances
What needs to be monitored carefully when administering digoxin?
Serum k levels
How does CHF need to be managed differently in infants?
Infants with CHF have an increased metabolic rate and need additional calories above the normal baseline requirements to promote growth. As a result of poor weight gain and activity intolerance infants may demonstrate developmental delays
Fetal heart development occurs during what weeks of pregnancy? When do defect usually occur?
Fourth and seventh weeks of gestation, defects occur during the first eight weeks
Congenital heart defect’s are combined result of genetic and environmental factors. What are some genetic and environmental factors that may cause defects?
Fetal exposure to drugs and alcohol. Maternal viral infections, age, metabolic disorders, complications of pregnancy. Genetic factors: chromosome, family pattern
What are the two classifications of congenital heart defect’s?
Acyanotic, cyanotic
What is an acyanotic heart defect?
A defect with increased pulmonary bloodflow
What are three acyanotic heart defects?
Atrial septal defect’s, ventricular septal defect’s, patent ductus arteriosus
What are acyanotic obstruction to bloodflow from ventricles?
Coarctation of aorta, aortic stenosis, pulmonary stenosis
What is a cyanotic heart defect?
A defect the decreases pulmonary bloodflow or mixed blood flow
What is a heart defect that decreases pulmonary bloodflow?
Tetralogy of fallot
What is a heart defect with mixed blood flow?
Transposition of the great vessels
What are consequences of congenital heart defect?
Congestive heart failure, and hypoxemia
What is the most common type of defect?
Acyanotic defects
What is a connection between the left and right side of the heart?
Septal defect
What is the connection between the great arteries?
Patent ductus arteriosus
And acyanotic heart defect does what?
Permits blood to flow from higher to lower pressure from left to right. It increases vascular resistance, pulmonary hypertension. Right ventricular hypertrophy
What is an atrial septal defect
An opening in the arterial wall, it may vary in size
What are symptoms of an atrial septal defect?
Children are frequently asymptomatic. They may develop CHF, tire easily, and have poor growth. May have soft systolic ejection murmur
Patients with an atrial septal defect’s are at risk for what?
Atrial arrhythmias
What are treatments for an atrial septal defect?
Sometimes there a spontaneous closure with in four years. A Dacron patch to close moderate to large defects, ASD may require repair or replacement of the mitral valve
What is the prognosis and mortality rate for ASD?
The prognosis is excellent and mortality is less than 1%
What is a ventricular septal defect?
An abnormal opening in the septum of the ventricles it permits blood flow from higher pressure of the left ventricle to lower pressure on the right ventricle, the size can range from a pinhole to the whole septum
What is the most common defect?
Ventricular septal defect
What percentage of ventricular septal defect are large enough to cause problems?
Only 15%
What are treatments for ventricular septal defect?
Treatment is conservative if there’s no symptoms. Surgical patching during infancy if poor growth, child will catch up quickly. Risk for bacterial endocarditis, prophylaxis is use with procedures.
Patent ductus arteriosus, what is it?
The ductus arteriosus is part of the fetal circulation, it closes during the first few weeks of life. Failure to close result in blood flow from higher pressure aorta into the lower pressure pulmonary artery.
Who is most at risk for PDA?
Preemies
What is the prognosis for PDA?
Less than 1% mortality
What is the classic characteristic murmur a symptom of?
Ventricular septal defects
What produces a machinery like murmur?
Patent ductus arteriosus
What are symptoms of PDA?
The child with PDA may be asymptomatic or have symptoms of CHF. There will be a widened pulse pressure and bounding pulses.
Patients with PDA are at risk for what later in life due to chronic excess of pulmonary bloodflow?
Bacterial endocarditis and pulmonary vascular obstructive disease
What is treatment for patent ductus arteriosus?
Surgical ligation via left thorax tommy. Administration of IV indomethacin to promote vascular construction and close PDA: contraindicated if IVH is present. Administer over 20 to 30 minutes to avoid reduction in cerebral blood flow. Insertion of coil in cardiac Cath Lab
What is an acyanotic obstruction to bloodflow from ventricles?
Blood exiting the heart makes an area of anatomic narrowing or stenosis. Pressure in the ventricle and the artery before the obstruction is increased, pressure be on the obstruction is decreased. Result in decreased cardiac output
What is coarctation of the aorta
Localize narrowing near the insertion of the doctors arteriosus America. It results in increased pressure to vessel supplying the head and upper extremities and decrease pressure distal to the obstruction - vessels to the body and lower extremities have low-pressure
What are manifestations of coarctation of the aorta?
High blood pressure and bounding pulses in the arms. Week or absent femoral Pulses and cool lower extremities with lower blood pressure. In infants, signs of CHF. In older children, dizziness, headaches, fainting, and epistaxis resulting from hypertension
If coarctation of the aorta is not corrected, what are the risks?
Hypertension, ruptured aorta, aortic aneurysm him, stroke, hemodynamic condition can deteriorate rapidly
In coarctation of the aorta, what is the treatment?
Surgical resection/enlargement: graft of prosthetic material or portion of the left subclavian artery. Balloon angioplasty: limited use – concerned about in adequate relief of pressure gradients, risk of aneurysm formation, and re-stenosis. 5 to 10% risk of recurrent narrowing
What is aortic stenosis?
Narrowing of the aortic valve, obstructs blood flow to systemic circulation.
What are signs and symptoms of aortic stenosis?
Majority of children are asymptomatic. Peripheral pulses maybe weak. fainting, dizziness, CHF with significant stenosis. Stenosis progresses with age as a valve calcified
What is treatment for aortic stenosis?
Severe stenosis at birth requires PGEs to maintain PDA until aortic valve dilated. Balloon valvuloplasty dilates valve. Surgical treatment is palliative. Valve replacement may be needed by adulthood: lifelong anticoagulant therapy, lifelong infective endocarditis prophylaxis
What is pulmonic stenosis?
Obstruction of blood flow into the pulmonary artery, increases preload. Right ventricular hypertrophy. Stenosis can occur above, below, or at valve
What is the second most common congenital defect?
Pulmonic stenosis
What are signs and symptoms of pulmonic stenosis?
Mild: asymptomatic, normal growth. Moderate: dyspnea and fatigue on exertion
What type of murmur is present in pulmonic stenosis?
Loud systolic murmur
What is treatment for pulmonic stenosis?
Dilation by balloon valvuloplasty during cardiac catheterization
What are the disorders of tetralogy of fallot?
Right ventricular hypertrophy. Ventricular septal defect’s. Overriding aorta. Pulmonary stenosis
What type of murmur does tetralogy of fallot have?
Characteristic murmur
What are initial symptoms of TOF?
Acute cyanosis or mild cyanosis that progresses over the first year as Pulmonic stenosis worsens
And TOF what happens during acute episodes of cyanosis and hypoxia?
Blue spells/TET spouse/hypoxic spells
When do hypoxic spells occur?
Hypoxic spells occur when the infant oxygen requirement of the blood supply. During crying, after feeding, during a stressful procedure.
What are signs of a hypercyanotic episode in TOF?
Increased rate and depth of respirations, increased cyanosis, increased heart rate, diaphoresis, irritability and crying, seizures and loss of consciousness, syncope in older children
What is treatment for TET spells?
Need chest position: reduce his cardiac output by decreasing venous return from lower extremities. Increases systemic vascular resistance. COM child, promote rest, 100% oxygen by facemask, morphine, IV fluids
What is treatment of TOF?
Primary repair of all defects when possible. Usually done during the first year of life. Not all children cared by surgery: improve quality-of-life, and improved longevity.
What are indications for repair and TOF?
Increasing cyanosis. Development of hypercyanotic spells
In TOF what does a palliative surgery accomplish?
Increased pulmonary bloodflow and increase oxygen saturation
What is Balock-taussig?
A procedure that provides blood flow to the pulmonary arteries from left or right subclavian artery
What is acyanotic defect that has mixed blood flow?
Transposition of the great vessels
What is transposition of the great vessels?
When the pulmonary artery leave the left ventricle and the aorta exits from the right ventricle. There is no communication between the systemic and pulmonary circulation which resulted to close parallel circuit in with associated defects are present.
What is the most common associated defect with transposition of great vessels?
Patent foramen ovale
In the transposition a great vessels if PTA and VST our present what is a child at greater risk for?
CHF
what are the manifestations of transposition of the great vessels?
They vary with the type and size of associated defects. Minimal communication leads to severe cyanosis and depression at birth. Large septal defect’s or PDA less severely cyanotic but may have symptoms of CHF. Heart sounds were very what type of defect present. Cardiomegaly a few weeks after birth
What is the treatment for transposition of great vessels?
The goal is to have oxygen saturation over 75%. Prostaglandin E: maintain open PDA until surgery. Balloon atrial septistomy: increase mixing and maintain cardiac output over a longer period of time until corrective surgery. Surgical treatment: transecting the great arteries and anastomosing the main pulmonary artery to the proximal aorta and anastomosing the ascending aorta to the proximal pulmonary artery
What is a cardiac catheterization?
The most invasive diagnostic procedure related to cardiac anomalies where radiopaque catheter inserted through a peripheral blood vessel into the heart usually combined with angiography.
What is angiocardiography?
Radiopaque contrast material injected through the catheter and into circulation
What is the purpose of a cardiac catheterization?
It can be diagnostic, interventional, or electrophysiologic
A cardiac Catherine station provides information about:
Oxygen saturation, pressure changes, cardiac output or stroke volume, anatomic abnormalities
For cardiac Catherine station where is the catheter usually introduced in children?
Usually introduced through percutaneous puncture in the femoral vein
What are side effects of contrast material in children?
May cause child to feel warm, have nausea or vomiting, restlessness, or develop headache.
What are pre-procedural nursing considerations for a cardiac catheterization?
Assessment a pedal pulses. Notation of allergies. Signs and symptoms of infection. Baseline oxygen saturation. Baseline vital signs. Medications for analgesia and a sedative/anxiolytic drug combination are administered prior to going to the lab. Children are not anesthetize for this procedure. NPO prior to procedure.May require IV fluids to prevent dehydration. Neonates may need dextrose to prevent hypoglycemia
After cardiac Catherine station how long should the patient maintain bed rest?
Depending on hospital policy, maintain bedrest with affected extremity straight for 4 to 6 hours after venous catheterization and 6 to 8 hours after arterial catheterization to promote healing of the cannulated vessel
What is infective endocarditis?
Inflammation of the lining, valves, and arterial vessels of the heart
What is the highest risk to postop obstruction to pulmonary flow or aortic valve replacement?
Infective endocarditis
What is Kawasaki syndrome?
And acute febrile, systemic inflammatory onus of unknown cause. it is the leading cause of acquired heart disease and North America and developed countries.
What is the primary cause of Kawasaki syndrome?
Infections in genetically predisposed children
What is another term for Kawasaki syndrome?
Mucocutaneous lymph node syndrome
Kawasaki syndrome is often preceded by what?
Upper respiratory infection
How is Kawasaki syndrome diagnosed?
Hi spiking fever of 39° or 102.2°F for five days or longer. Bilateral conjunctivitis without exudate. Intense erythema of by cal and pharyngeal surfaces with dry swollen cracked and fissuring lips with strawberry tongue. Dermatitis of the extremities. Dermatitis of the trunk. Acute cervical lymphadenopathy
What is the acute stage of Kawasaki’s
Fever, conjunctival hypermedia, Red throat, swollen hands and feet, rash on trunk, and large cervical lymph nodes, diarrhea, hepatic dysfunction
What is the subacute stage of Kawasaki’s?
Cracking lips and fishers, desquamation of the skin on tips of fingers and toes, joint pain, cardiac disease, thrombocytosis
What is the convalescent stage of Kawasaki’s?
6 to 8 weeks after disease on fat child may appear normal but may have lingering signs of inflammation
What are supporting lab findings for Kawasaki syndrome?
Increased ESR, increased WBC, mild anemia, thrombocytosis, increased platelet count, increased C/reactive protein
What is treatment for Kawasaki’s disease
IV immunoglobulin, oral aspirin. This reduces the incidence of coronary artery lesions and aneurysms most effective treatment is started before 10th day of fever
In Kawasaki disease how long are children hospitalized?
As long as fever persists
What is rheumatic fever?
An inflammatory connective tissue disorder that follows an initial infection by some strains of group A B hemolytic streptococci
What does rheumatic fever effect
Heart, joints, brain, and skin tissue
What are the clinical manifestation of rheumatic fever?
Carditis, 50 to 70% of cases, arthritis in large joints, subcutaneous nodule’s probable near joints, skin rash on trunk and extremities, Sydenham’s chorea
What is the treatment for rheumatic fever?
Diagnosed based on evidence of proceeding strap infection and two major manifestations. Treatment: antibiotics for strep infection, aspirin for anti-inflammation, joint pain, fever. Steroids for severe carditis, long term prophylaxis treatment
What is Sydenham’s chorea
Stainless movements of extremities/facial grimacing
