Cardiac Dysfunction Flashcards
Define Atresia.
Congenital absence or pathological closure
Define stenosis.
anatomic narrowing
What are the four most important parts of the normal cardiac anatomy?
- chambers
- major vessels
- valves
- flow
Which direction do arteries pump the blood?
away from the heart
Which side of the heart is the high pressure side?
left
Which heart disease is present at birth?
congenital heart disease
Which heart disease occurs after birth?
acquired heart disease
What can heart diseases be a result of?
- infection
- autoimmune responses
- environmental factors
- familial tendencies
What can a cardiac cath be useful for?
- diagnostic
- interventional
- electrophysiology
What is electrophysiology be useful for?
to identify, locate, and destroy electro dysrhythmias
What is the amount of blood being shunted dependent upon?
size of the defect
Describe a right to left shunt.
change in pressure so that the blood is shunted from the right side of the heart to the left
Describe a left to right shunt.
If there is a defect, such as a hole between the ventricles, then blood from the left would flow into the right because there is lower pressure on the right side of the heart
What are the four hemodynamic characteristics that affect the way blood flows within the heart?
- increased pulmonary blood flow
- decreased pulmonary blood flow
- obstruction to blood flow out of the heart
- mixed blood flow
What does increased pulmonary blood flow cause?
- left to right shunting of blood
- increased blood volume on the right side of the heart
- increased pulmonary blood flow
What are the three common heart defects associated with INCREASED pulmonary blood flow?
- atrial septal defect
- ventricular septal defect
- patent ductus arteriosus
What are two important cardiac things that a baby gets from mom?
oxygen and prostaglandin
What do high levels of prostaglandin cause?
The patent ductus arteriosus not to close
What medication can be prescribed to a newborn or a premie to help close a patent ductus arteriosus?
Indomethacin (indocin)-prostaglandin inhibitor
What congenital heart defects are associated with decreased pulmonary blood flow?
- tetralogy of fallot
- tricuspid atresia
What are hypercyanotic spells caused by?
Infundibular spasm
What do hypercyanotic spells cause an increased risk for?
Emboli, seizures, loss of consciousness, or sudden death
What does the knee to chest position do?
Reduces systemic venous return which lowers pressure on the right side of the heart
Increases systemic vascular resistance which increases pressure to the lungs for oxygenation
(balancing act)
What do obstructive defects cause?
- Coartication of the aorta
- Aortic stenosis
- Pulmonic stenosis
What is the hallmark sign of aortic stenosis?
Heart murmur
What must be given to keep open the patent ductus arteriosus in HLHS?
Prostaglandin infusion
What are the normal 02 ranges for a patient with HLHS?
75-85%
What are two clinical consequences of congenital heart defects?
• Congestive heart failure
-heart can’t pump enough blood to meet the body’s demand for energy
• Hypoxemia
-cyanosis
What is a common issue in children with CHF?
Right and left sided heart failure
When should you hold digoxin in an infant? An older child?
Infant-heart rate less than 90-110 bpm
Older child-heart rate less than 70
What should you monitor when giving diuretics?
- I&O
- S/S of dehydration
- Serum electrolytes
- S/S of adverse reactions
- Potassium losing?-encourage patient to eat foods high in potassium
What should you monitor when your patient is on a fluid restriction?
Document fluid intake and output
What should you monitor when your patient is on a sodium restriction?
Educate parents, check tray every meal
What are two results of chronic hypoxemia?
Polycythemica and clubbing
Who is at the highest risk for infective endocarditis?
- Valvular abnormalities
- Prosthetic valves
- Conduits (shunts)
What are a few major and minor manifestations of rheumatic fever?
- Polyarthritis
- Erythema marginatum
- Chorea
- Arthraligia
What is the hallmark sign of Kawasaki disease?
Very irritable
What type of blood flow are congential heart defects associated with?
decreased pulmonary blood flow
How is decreased pulmonary blood flow manifested?
obstruction of pulmonary blood flow with ASD or VSD
What are the two main clinical manifestations associated with decreased pulmonary blood flow?
hypoxemia and cyanosis
What are the two main heart defects associated with decreased pulmonary blood flow?
- tetralogy of fallot
- tricupsid atresia
What four defects are in tetralogy of fallot?
- VSD
- pulmonary stenosis
- overriding aorta
- right ventricular hypertrophy
What happens with obstructive heart defects?
blood exiting heart meets area of anatomic narrowing (stenosis) causing obstruction to blood flow
What three defects are associated with obstructive defects?
- coarctication of the aorta
- aortic stenosis
- pulmonic stenosis
Define aortic stenosis.
narrowing of the aortic valve
What four things does aortic stenosis cause?
- left ventricular enlargement
- decreased cardiac output
- left ventricular hypertrophy
- increased atrial pressure
Define pulmonic stenosis
narrowing of pulmonary valve or artery
What two things does pulmonic stenosis cause?
- decreased pulmonary blood flow
- right ventricular hypertrophy
What is characterized as complex cardiac anomalies in which survival in postnatal period depends on mixing of blood from pulmonary and systemic circulations within heart chambers?
Mixed defects
Which heart defect is associated with mixed defects?
hypoplastic left heart syndrome
Define hypoplastic left heart syndrome.
underdevelopment of the left side of the heart
What is the oxygenation in HLHS depenant on?
ASD or patent foramen ovale
What is systemic blood flow in HLHS dependent on?
patent ductus arteriosus
