Cardiac Diseases (WEDNESDAY) Flashcards
Differentiate between congenital heart defects and 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.
Discuss the signs of cardiac dysfunction in an infant
PDT-FRD
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
Discuss the signs of cardiac dysfunction in a Child
AFFCC
Activity intolerance
Fatigue
Fainting with exercise
Chest pain
Cardiac murmur
Echocardiogram?
Size of heart and chambers
Movement of valves
Blood flow-normal vs turbulence
Presence or absence of structures
What does Chest x ray measure?
Heart size
Cardiac catheterization
Can be what?
Procedure?
What does diagnostic assess?
What does Interventional assess?
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
Post Cardiac Catheterization Care
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
Pulse oximeter to detect critical congenital heart disease
When is it performed?
What does it measure?
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
Increased Pulmonary Blood Flow Left to right cardiac defects?
3
Atrial septal defect
Ventricular septal defect
patent ductus arteriosus
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?
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
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?
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
Patent Ductus Arteriosus (PDA)
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
Coarctation of the Aorta
What is it?
Blood pressure?
Pulses in arms?
Pulses in lower extremity?
What kind of hypertrophy
Treatment?
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
Decreased Pulmonary Blood Flow Right to Left cardiac defect is called?
Tetralogy of Fallot (TOF)
Tetralogy of Fallot
4 defects?
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
TetrAlogy of Fallot clinical manifestations? 3
Tetralogy of Fallot treatment
Cyanosis
Dyspnea
Hypercyanotic (TET) spells
Repair through open heart surgery
TET (HYPERCYANOTIC ) SPELL
Occurs in children?
How is it triggered?
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).
Causes of tet spell?
Hypercyanotic (TET) spells clinical presentation?
DEHYDRATION, AGITATION
*Rapid breathing
*Cyanosis
*Unusual irritability
TET spell treatment
5 steps
what do u do first?
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
Review the clinical manifestations of heart failure in an infant
8
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
Review the clinical manifestations of heart failure in a child
5
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
Management of Pediatric Congenital heart failure
medications
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
Digoxin Considerations
What to do before administering?
when do u stop?
Don’t repeat dose when?
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
Feeding Interventions 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
Rheumatic Heart Disease
What is it?
Fever is caused by?
Affects what?
What ages are affected?
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
Rheumatic Heart Disease
What does it cause?
What valve is damaged?
Cardiac valve stenosis and scarring
Mitral valve is the most common valve damaged.
Treatment of Rheumatic Heart Disease
two
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
Acute Rheumatic Fever
Most common manifestation?
Other symptoms? 3
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
Social Determinants of Health and Rheumatic Fever
Disease of what?
spread through?
higher diagnoses in what people?
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
Establishing History of recent streptococcal infection
Positive ASO (Antistreptolysin)-streptococcal antibody titer
Positive throat culture or rapid antigen detection test
Kawasaki Disease
What does it affect?
etiology?
Common in ages?
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
Kawasaki Disease Symptoms
Most important symptom?
BRISC E
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
Kawasaki Disease complications? 2
Kawasaki Disease management? 4
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
