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Peds Final Exam > Cardiac Diseases (WEDNESDAY) > Flashcards

Cardiac Diseases (WEDNESDAY) Flashcards

1
Q

Differentiate between congenital heart defects and 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

Discuss the signs of cardiac dysfunction in an infant

PDT-FRD

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

Discuss the signs of cardiac dysfunction in a Child
AFFCC

A

Activity intolerance

Fatigue

Fainting with exercise

Chest pain

Cardiac murmur

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4
Q

Echocardiogram?

A

Size of heart and chambers

Movement of valves

Blood flow-normal vs turbulence

Presence or absence of structures

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5
Q

What does Chest x ray measure?

A

Heart size

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6
Q

Cardiac catheterization

Can be what?
Procedure?
What does diagnostic assess?
What does Interventional assess?

A

Diagnostic or Interventional

Procedure
-Radiopaque catheter inserted through a peripheral blood vessel (e.g., femoral vein) into the heart; may include angiography (injection of dye)

Diagnostic
-Assess oxygen saturation and pressure in chambers, cardiac output, blood flow, anatomic abnormalities

Interventional
-Balloon catheter dilates vessels/valves
-Insertion of valves or stents

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7
Q

Post Cardiac Catheterization Care

A

Child must lay flat and supine, with affected leg straight for 4-6 hours.

Vital signs, check distal pulses, (are the pulses strong) temperature (is the extremity warm) and color extremities, vs q 15 minutes initially.

Observe for bleeding at insertion site
-If bleeding occurs, apply continuous pressure over the catherization site.

Observe for reactions to dye (vomiting, rash, increased creatinine, decreased urinary output)

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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8
Q

Pulse oximeter to detect critical congenital heart disease

When is it performed?
What does it measure?

A

Performed after 24 hours of age or before discharge if baby is less than 24-hours-old.

*Difference in oxygen saturation between right hand and foot

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9
Q

Increased Pulmonary Blood Flow Left to right cardiac defects?
3

A

Atrial septal defect

Ventricular septal defect

patent ductus arteriosus

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10
Q

Atrial Septal Defect (ASD)

What is it?

What way does it go?

What happens due to increased workload?

What does increased blood flow lead to?

Symptoms?

Undiagnosed ASD can result in?

Treatment?

A

Abnormal opening between the atria

**Left to right shunt

**Right atrial and ventricular hypertrophy due to increased workload

**Increased pulmonary blood flow = pulmonary hypertension

May be asymptomatic and close spontaneously

Undiagnosed ASD can result in:
Heart failure in 3rd or 4th decade of life
Atrial arrhythmias
Emboli

Treatment: Cath lab or open heart surgery

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11
Q

Ventricular Septal Defect (VSD)

What is it?
What way does it go?
What due to increased workload?
increased blood flow leads to?
Symptoms?
watchful waiting?
Tretament?

A

Abnormal opening between the ventricles

Left to right shunt

Right ventricular hypertrophy due to increased workload

Increased pulmonary blood flow pulmonary hypertension

May be asymptomatic and close spontaneously

Watchful waiting: 75% of small VSD close within 1st year of life.

Treatment: Surgical dacron patch, Cath lab or open heart surgery

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12
Q

Patent Ductus Arteriosus (PDA)

A

Ductus arteriosus: Normal fetal connection between the aorta and the pulmonary artery. - should close at 72hrs.

Patent Ductus Arteriosus occurs when the connection remains after 72 hours.

Common in preterm infants

Left to right shunt (aorta to pulmonary artery)

Increased pulmonary blood flow = pulmonary hypertension

LEFT VENTRICULAR HYPERTROPHY

Medical Management:
Indomethacin IV in preemies
surgery or cardiac cath

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13
Q

Coarctation of the Aorta

What is it?
Blood pressure?
Pulses in arms?
Pulses in lower extremity?
What kind of hypertrophy
Treatment?

A

Narrowing (coarctation) of the aorta

Hypertension in the upper body

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

LEFT VENTRICULAR HYPERTROPHY

Surgical treatment: Removal of
constricted area and reconnection to unaffected aorta

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14
Q

Decreased Pulmonary Blood Flow Right to Left cardiac defect is called?

A

Tetralogy of Fallot (TOF)

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15
Q

Tetralogy of Fallot

4 defects?

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

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

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16
Q

TetrAlogy of Fallot clinical manifestations? 3

Tetralogy of Fallot treatment

A

Cyanosis
Dyspnea
Hypercyanotic (TET) spells

Repair through open heart surgery

17
Q

TET (HYPERCYANOTIC ) SPELL

Occurs in children?
How is it triggered?

A

occur in children with unrepaired Tetralogy of Fallot (TOF).

TET spell is triggered by any event that slightly decreases oxygen saturation (eg, crying, having a bowel movement) or decreases systemic vascular resistance. (increased heart rate, kicking of legs).

18
Q

Causes of tet spell?

Hypercyanotic (TET) spells clinical presentation?

A

DEHYDRATION, AGITATION

*Rapid breathing
*Cyanosis
*Unusual irritability

19
Q

TET spell treatment

5 steps

what do u do first?

A

1.First-Knee to chest position-increases SVR and blood flow to pulmonary artery.

2.Administer oxygen

3.Give Morphine subq or through existing IV line (decreases HR)

4.Begin IV fluids (Increase preload)

5.Phenylephrine - vasoconstriction -increases SVR

20
Q

Review the clinical manifestations of heart failure in an infant

8

A

Difficulty feeding or poor feeding

Sweating with feeding

Tachypnea

Fatigue or excessive sleepiness

Irritability

Poor weight gain, failure to thrive

Decreased urinary output

Crackles, rales in lungs -related to pulmonary congestion

21
Q

Review the clinical manifestations of heart failure in a child

5

A

Shortness of breath, especially with exertion

Fatigue or decreased exercise tolerance

Swelling legs and feet

Poor growth, failure to thrive

Crackles, rales in lungs -related to pulmonary congestion

22
Q

Management of Pediatric Congenital heart failure

medications

A

Diuretics (e.g., Furosemide (Lasix) to reduce preload

Ace inhibitors to reduce afterload/hypertension (e.g., Captopril)

Beta blockers to decrease the workload of the heart by decreasing the amount of pressure against which it has to pump (e.g., Propanolol)

Digoxin- increases contractility (strength of the contraction) to pump blood more efficiently

*Oxygen - improve tissue oxygenation

23
Q

Digoxin Considerations

What to do before administering?
when do u stop?
Don’t repeat dose when?

A

Measure apical pulse (for 1 minute) prior to administering 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

24
Q

Feeding Interventions 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

25
Q

Rheumatic Heart Disease

What is it?
Fever is caused by?
Affects what?
What ages are affected?

A

Rheumatic Heart Disease is a complication of Rheumatic Fever (RF).

Rheumatic Fever is caused by an untreated or poorly treated strep throat infection caused by Group A Streptococcus bacteria.

Widespread inflammatory response affects connective tissues, especially in the heart, joints, skin, and brain.

Ages 5-15

26
Q

Rheumatic Heart Disease

What does it cause?
What valve is damaged?

A

Cardiac valve stenosis and scarring

Mitral valve is the most common valve damaged.

27
Q

Treatment of Rheumatic Heart Disease
two

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

28
Q

Acute Rheumatic Fever

Most common manifestation?

Other symptoms? 3

A

Fever of 38.2-38.9 °C (100.8-102.0 °F),

CARDITIS: INFLAMMATION OF THE HEART MUSCLE (most common manifestation)

POLYARTHRITIS: Migrating inflammation of the large joints, usually starting in the legs and migrating upwards.

SUBCUTANEOUS NODULES: Painless, firm collections of collagen fibers over bones or tendons.

ERYTHEMA MARGINATUM: Reddish ring-shaped rash

29
Q

Social Determinants of Health and Rheumatic Fever

Disease of what?
spread through?
higher diagnoses in what people?

A

Rheumatic Heart Disease is a Disease of Poverty

Household crowding - Group A strep pharyngitis is spread through direct person-to-person transmission.

-Limited access to healthcare
-Low education and health literacy.
-Limited access to cardiologists and cardiothoracic surgeons.

Australia-Aboriginal population
-RHD is the greatest cause of disparity in cardiovascular health between Aboriginal and and non-Indigenous people.

-RHD 61.4 times higher in Aboriginal than non‐Indigenous people

30
Q

Establishing History of recent streptococcal infection

A

Positive ASO (Antistreptolysin)-streptococcal antibody titer

Positive throat culture or rapid antigen detection test

31
Q

Kawasaki Disease

What does it affect?
etiology?
Common in ages?

A

Acute febrile syndrome with generalized vasculitis affecting blood vessels throughout the body, including the coronary arteries

Unknown Etiology

Self-limiting

Commonly seen in children less than 5 years of age

32
Q

Kawasaki Disease Symptoms

Most important symptom?

BRISC E

A

Abrupt onset of fever > 5 days
(unresponsive to antibiotics)

-Bilateral conjunctivitis (nonpurulent)

-Red cracked lips

-Irritability

-Strawberry)tongue

Cervical Lymphadenopathy

-Edema and erythema of hands and feet with peeling skin

33
Q

Kawasaki Disease complications? 2

Kawasaki Disease management? 4

A

Coronary artery aneurysms and abnormalities

Echocardiogram (serial)

Intravenous immunoglobulin (IVIG)

High dose aspirin 6-8 weeks-decrease
inflammation and antiplatelet

Activity restriction for 6-8 weeks

Peds Final Exam (14 decks)

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