Cardiac Textbook Information Flashcards
Cardiovascular disorders in children are divided into two major groups
Which are?
Congenital and acquired heart disease
What is congenital heart defects?
Anatomic abnormalities present at birth that result in abnormal cardiac function
What are the 2 congenital heart defects ?
Heart failure
Hypoxemia
Acquired cardiac disorders is what?
Disease process or abnormalities that occur after birth and can be seen in the normal heart or in the presence of congenital heart defects
What is the heart function?
To pump blood throughout the body
What does the heart develop in the pregnancy phase?
And completely formed?
4-5th week of gestation
8th week of gestation
What is the process of fetal circulation?
In which the infant is dependent on the mother for nutrients and circulation throughout the body.
Placenta -> fetal system through umbilicus -> liver ( divided into two ) and IVC
From inferior vena cava by the ductus venosus -> RA -> foramen ovalue to the LA
After the aorta, where does the blood go!?
Placenta from the descending aorta through two umbilical arteries
Are the lungs functioning in a fetus?
No
Postnatal circulation
After the baby is born, how do they breathe? Like what is the initiation?
Clamping of the umbilical cord and expansion of the lungs
This causes Hemodynamic changes that will let the baby respiratate and circulate on their own
The patent ductus arteriosclerosis starts to close within what day and how?
First day of birth via the construction of smooth muscles in the vessels
How does the PDA work for preterm babies?
Usually at what week does it close for them?
It usually is less responsive to oxygen and higher levels of prostaglandins, which both can delay the ductwork closer
2-3 weeks
What are functions of arteries?
What are function of veins?
And how do they work on fetal too?
Thick wall filled with oxygen and push blood away from heart
Thin wall with deoxygenated blood and comes towards the heart
In the fetus
This is opposite !
The arteries and veins work together to help maintain our what?
Blood pressure !
The heart is the first organ to receive blood what comes after that? Like what next organ gets blood?
The brain
What does tachycardia mean?
Fast heart rate
What does bradycardia mean?
Slow heart heart
What does Tachypnea mean and typically a warning sign for what?
Fast breathing
Heart failure
What does murmurs mean?
Heart sounds that reflect the flow of the blood within the heart
Audible whooshing
Cardiac catherterization!
What is cardiac catheterization?
An invasive diagnostic procedure in which a radiopaque catheter is inserted through a peripheral blood vessel into the heart
How is the catheter usually introduced ?
Through a Percutaneous puncture into the femoral vein
And then guided through the vessel into the heart
It’s important to note that cardiac Catherization may be performed for diagnostic, interventional or electrophysiologic purposes.
What are the two types of diagnostic cardiac catheter?
Right sided ( venous )
Left sided ( arterial )
How does right side and left sided catheter differ?
Right side - goes through vein into RA
Left side - goes through artery into aorta and LV
What’s the most common Cath. Site
Left or right?
Right sided as it’s easier to get into because septal ductus permit entry into the left side of the heart
Notes
Common interventions surgeries are
Ballon atrial septostomy
Balloon dilation
Stent placements
Coil occlusions
Transcatheter device closure
Transcatheeter pulmonary valve replacement
Radiofrequency ablation
What is interventional cardiac Catherization?
Example?
Use of catheter delivered device to treat heart disease
Balloon catheter to dilate narrowed valves and vessels
What is electrophysiologic studies used for?
To evaluate and treat Dysrthymias
Notes
Pre procedural care
- accurate height and weight to properly decide which size cath
- history of allergies
( iodine based )
- signs and symptoms of infection
- diaper rash is contraindicated as it’s a site for femoral entry
- pulses present
- oxygen baseline
- preparation of surgery understanding
Post procedural care
- pulses
- temperature for coolness and blanching may indicate arterial obstruction
- vital signs
- BP hypotension -> hemorrhage
- dressing site
- fluid intake
Infants are at high risk for hypoglycemia
Do they should receive dextrose and blood glucose should be checked out
Stroke assessments!
If bleeding occurs direct continous pressure is applied 1inch above the site of injection
Usually they should remain in bed for 4-6 hours
Congenital heart disease !
Notes
The incidence of congenital heart disease in children is 1 in 110 birth in the United States
25% of these babies will need treatment first year of life
What is congenital heart defect? Like how do we know it’s this?
Usually from a single defect in the septum, heart valve, arteries or veins
But often a combination of all or one
What is the cause of congenital heart defects?
The main cause is unknown
However many say
Maternal risk of uncontrolled diabetes, alcohol, tetagenic exposure
Genetics of family members
What is the syndrome many kids with this have usually end up getting congenital heart defects?
Others are like
Digeorge syndrome
Williams syndrome
Noonan syndrome
Down syndrome sadly :(
The physiology of heart defects is defined as what?
Pressure gradients, blood flow and resistance within circulation
How does septal defect work?
Blood flow from higher pressure from left side to one of lower pressure, which is right side
This is a left to right shunt
How does a normal blood flow work?
Low pressure on the right side
To a high pressure on left side
So low pressure to bring up the deoxygen
High pressure to push oxygen to body
It’s important to note with altered hemodyanmics that any blood flow from an area of high pressure to a low pressure because it will always take the path of least resistances
However with heart defect it’s?
It doesn’t do that, it usually results in an alter dynamic and changes it
Like the left right shunt
Now
Tell me how much oxygen and saturation should be in each section
SVC/IVC?
RA,RV,PA
Low oxygen saturation
Equal both & most oxygen
Depending on the type of defect
Typically the saturated and desaturated blood may?
Mix
And this results in the defect where improper heart beats and such occur
What are some clinical consequences of congenital heart disease?
But what are the 2 main ones?
It’s truly all depends on the severity of the defect and the alerted Hemodynamic?
Congenital heart failure & hypoxemia
Typically defects that result in left to right shunting of blood causes symptoms of?
Congenital heart failure
Typically defects that result in decreased pulmonary blood flow causes?
Cyanosis
Notes
It’s also important that congenital heart disease can have one or multiple things going on.
So even with surgical repair more complications can occur
- usually uncommon
But it a very sad thing to see
Onto the slides information regarding congenital heart disease
What’s the most common anomaly?
VSD
According to dr.rickerby.
Maternal and environmental play a huge role in what causes CHD.
So what is the main maternal issue with CHD?
What are some environmental factors? (3)
Alcohol syndrome
Rubella, CMV, Toxoplasmopis
Rubella in the first 7 weeks of pregnancy will increase the risk by 50% of defects to occur
Main ones being?
PDA
pulmonary branch stenosis
What changes occurred during development, what are the 4 main things we can help diagnose a child with CHD. Like what do we look at?
Think of the shape of the heart
Hole or no hole
Explain
Did not form - atresia ( no hole )
Did not space - great vessels together
Did not fuse - holes like ASD
( think of how like ovalume is still open )
Did not differentiate - TAPVR
So we know there are congenital CHD
Which is from birth
What is acquired example of CHD?
Infections
Autoimmune response
Environmental factors
Familial tendencies
What are the 2 types of congenital heart defects?
Cyanotic heart disease
Acyanotic heart disease
What are the 2 cyanotic heart disease?
Decreased pulmonary flow
Increase pulmonary flow
What is decreased pulmonary flow for cyanotic heart disease examples that we are going to review? (3)
Tetralogy of fallot
Tricuspid atresia
Other univentricular heart with pulmonary stenosis
Anything reducing and or increasing blood flow to the heart
What are the 2 examples of increased pulmonary flow for cyanotic heart disease?
Transposition of great artieries
Total anomalous pulmonary venous return
( so the heart is providing too much blood flow and goes into the lungs for a second round)
Over circulation!
What are the 2 examples of acyanotic heart disease?
Left & right shunt lesions
Obstructive lesions
What is left right shunt lesion examples for acyanotic heart disease? (4)
Ventricular septal defect
Atrial septal defect
Atrioventricular septal defect
Patent ductus arteriosis
If it stays open, by overflowing of blood on the body side
What is the obstructive lesions of acyanotic heart diseases ? (3)
Aortic stenosis
Pulmonary valve stenosis
Coarctation of aorta
Anything obstructing the actual blood flow to the heart and body
Acyanotic heart disease is a what?
And example what this means too?
Left side to right shunt
So too much pressure on the left side of the heart.
We understand that the left side of the heart should have received full oxygen from the heart, however
With acyanotic it is going to come back to the left side
( overall circulate on the lungs )
So this can result in a lot of lungs problems
Acyanotic heart defect is also known as those that cause increased what?
And has an increased risk for?
Pulmonary blood flow
Pulmonary congestion
With the severe risk of pulmonary congestion, it can lead to kids getting?
Congestive heart failure
From that left to right shunting
For acyanotic heart defect, the ones that obstruct the blood flow from the ventricular
What is the biggest worry and how does it present?
Patient has severe obstruction of pulmonary blood flow
And can lead to cyanosis
Meaning no circulation of blood due to that obstruction
Now onto cyanotic
This is often known as what type of shunt?
Explain this
Right to left shunting
So we understand that our body pumps deoxygenated blood from the right side and moves to oxygens to the left
In this case
It comes up as deoxygenated blood and still is deoxygenated blood when reaching the left side of the body
So the baby isn’t getting oxygen
And presents with that cyanosis look
Blue toes and fingers
PowerPoint question
Which way does blood shunt in acyanotic heart defects?
What condition does this cause long term?
Example this?
Left to right
Pulmonary hypertension
( excessive blood flow on the left, because those pulmonary arteries will have narrowing because of how much blood is being forced into there )
Think of how the oxygen keeps coming back and causing trauma to the area
This area becomes narrowed and that blood pressure will increase
Pulmonary hypertension because it’s all happening in the lungs
For the physical examination for CHD
No matter if it’s cyanotic or acyanotic
We will look at what?
Think basic
But what are the 2 big things to look at 100% to differnaate the two
Heart rate
Blood pressure
Pulses
Upper and lower extremities if we see oxygen reaching them or not
What are diagnostic testing for CHD
What’s the structural check for it ??
Chest x-ray
ECH
Echocardiography !! This one
Cardiac catheterization
Before a baby gets discharged home
We look at the?
Test question !
pre and post ducal saturation in all babies
What is pre ductal saturation?
How do we do it?
What does it tell us?
So before the ductus ( PDA )
Looking for a patent ductus
Oxygen saturation on the Right hand
Much lower on the right hand and lower extremities
It’s suggestive it’s a CHD
What are the 3 clinical presentation of CHD?
Shock
Cyanosis
Congestive heart failure
What are symptoms of shock in CHD baby? And signs?
What are the potential problem?
Poor feeding
Fussiness
Progression to lethargy
Extreme tachycardia
Pallor
Weak peripherally pulses
Delayed capillary refill
Hypotension
Obstruction!!!
What is cyanosis for symptoms and signs of CHD!?
What usually is the CHD problem with this?
Fussiness
Cyanosis
Hypoxia
Decreased pulmonary flow
What is congestive heart failure sign and symptoms for CHD patients?
Usually this is with?
Feeding difficulty
Sweating with feeds
Failure to thrive
Fussiness
Tachypnea
Takes
Hepatmegaloy
Left to right shunt
Acynatoic issues
Question!
If there is a problem with congenital heart defects, what limb would you see a normal oxygen saturation?
Right upper extremity
Now think of birth
What happens when the pressure changes ? Doors slam shut!?
Describe what she means
So when the umbilical cord is clamped
The lungs at birth should trigger to breathe and allow blood to finally circulate into the lungs
In a normal baby
PDA and formaen ovale should shut!!
This pressure of the left atrium exceeds pressure in the right atrium to close
PDA
Closes in the presence of increase oxygen
Question
What two structure close with pressure changes in the heart?
Formen ovale
Ductus arteriosa
How many arteries and veins are in the umbilical cord?
2 arteries
1 vein
:) smile remember !
What are the biggest clinical manifestation of heart problem!?
Sweating!!!!!!!!!!
Tachypnea and tachycardia
Failure to thrive & weight loss
Developmental daily
Why do we seriously look at weight with heart failure or congenital heart disease patients?
Because the amount of oxygen their trying to get, which is why their Tachypnea is taking up all their calories
So many children lose a lot of weight and fail to gain it
O2 administration and shunting
Oxygen is a really dangerous and can worsen pulmonary over circulation
Aka flooding of the lungs of blood
So who and why do you think these type of babies ( name the l to r or r to l shunt ) shouldn’t it receive large amount of 02?
Right to left shunts
If their body is pumping deoxygenated blood already into their lungs
And if we shove more oxygen in them
It increase the amount of blood flow going
So deoxygenate and oxygen blood
And we potentially drowned them in blood in their lungs essentially
What would be the better alternative for those kids with right to left shunts who can’t receive a lot of oxygen?
Better to do like 1-2L of oxygen nasal cannula really
I’m going to come right back to congenital heart disease with the specific defects but let’s talk about
CONGESTIVEHEART FAILURE
What is congestive heart failure?
The heart inability to pump adequate amount of blood to the systemic circulation at normal filling pressure to meet the body’s metabolic demands
Usually we see congestive heart failure with which type of shunts?
Left to right shunt
Because typically oxygen is either being obstructive from the lungs and rest of the body
Or the oxygen doesn’t get distributed right and comes back for the second round causing an increase pulmonary blood flow and increased pulmonary congestion
Making the child breathe too much and the body starts to shunt down and that breathing is altered truly
We can divide heart failure into two groups
Right and left
What’s the difference?
Left heart failure is can’t pump enough blood for the body
Right can’t pump enough blood into the lungs to get oxygen
How does the body first compensate for the heart failure?
Cardiac reverse
Hypertrophy
Dilation
Increase BP
Increase RR
What are the 3 big clinical manifestation of heart failure?
- Impaired myocardial function
( fancy, sweating , fatigue ) - Pulmonary congestion
( Tachypnea, falling nares, retractions ) - Systemic venous congestion
( weight gain, hepatomeglay, peripheral edema )
Notes
Heart failure ( HR )
Volume overload
Pressure overload
Decreased contractility
High cardiac output demands
Right side
- reduce function
( hard to push blood into lungs )
Left side
- increased pressure & lung congestion
( hard to push blood into body )
What are some things we will use to diagnose heart failure?
Echocardiogram
Chest x ray
What are the 4 goals we have for heart failure patients?
Improve cardiac function
Remove accumulated fluid & edema
Decrease cardiac demands
Improve tissue oxygenation & decrease oxygen consumption
How are we going to remove accumulated fluid
So that water and sodium?
Diuretics!!
What are the two important diuretics for remember for heart failure?
Furosemide ( lasix )
Spironolactone ( aldactone )
- potassium spraing^
What is the biggest ting to remember with diuretics? What are we looking out for?
Our potassium!! ( any other is hypokalemia !! )
If spironolactone( hyperkalemia )
What medication we will use to help reduce the after losd of the heart for heart failure?
Ace inhibitors
- vasodilator !!
( this is potassium sparing!! Hyperkalmiea !! Watch out !! )
How can we improve tissue oxygenation for heart failure?
Usually with a humidifiers or oxygen tanks
Something to note
With diuretics, you want to be careful with their intake and output as dehydration can occur frequently
So we need to monitor what?
Notes
- if it’s losing a lot of potassium, usually eat bananas oranges and whole grains to help!
- potassium sparing dorueircs, avoid them
There daily weight too!
What are signs of hypokalemia?
Hyperkalemia?
Muscle weakness
Hypotension
Dysthymias
Tachy or braid
Twitching
Bradycardia
V-fib
Oliguria
What is the drug that can improve cardiac function?
Digoxin
Digoxin is famous of its narrow therapeutic window
So toxic levels need to be assessed.
Also check pulse and heart rate before the dosage.
How do we know digoxin is toxic for a kid!?
Bradycardia
Visual disturbances ( like halo in light )
What is the average digoxin dosing for infants?
1Ml ( 50mcg, 0.05 mg )
What’s the antidote for digoxin?
Digoxin immune fab fragment ( digiband )
Digoxin and furosemide cause?
Hypokalemia!!!
Bradycardia !!
Now onto hypoxemia!!
What is hypoxemia?
Reduction in tissue oxygenation
Cyanosis
Lower than normal arterial oxygen tension
What’s the biggest example of hypoxemia for CHD?
Tetralogy of fallot
What are the 3 biggest signs of hypoxemia?
Clubbing
Polycythemia
Hypercyanotic spells ( tet spells )
In theory, persistent hypoxemia stimulates erythropoiesis, which results in that polycyhemia or increase red blood cell
But why does this not help in hypoxemia?
Because the body isn’t going to have enough iron to behind the oxygen, resulting in literally anemia
And since we don’t oxygen being binded, really clubbing is gonna occur
Why is hypoxia?
Reduction in tissue oxygenation
What is the difference between hypoxemia and hypoxia?
Hypoxemia - Low oxygen in the body
Hypoxia - that low oxygen in body starts to show outside the body with cyanosis cause tissues turn blue
How do we treat these hypercyanotic spells, tet spells?
Knee to chest
Changes the pressure from the chest, to now into the abdomen
So it opens the chest up to get more fluid going
What is the diagnostic evaluation behind hypoxemia?
Oxygen saturation
Cyanosis looking
CBC
What’s the treatment for these kids who are hypoxemic? (3)
It’s super important to know
100% oxygen via face mask
Knee chest positioning
Morphine for pain
Notes
There are shunt procedures for children with cardiac defects
Modified blakock tassuig shunt
Sano modification
Central shunt
Usually these procedures are performed to help increase that oxyegn due to the cyanotic congenital heart defects
Now we are coming back to the acyanotic congenital heart defects
Lets talk about defects with increase pulmonary blood flow
What are the 4 acyanotic defects with left to right shunt
Atrial septal defect
Ventricular septal defect
Atrioventricular canal defect
Patent ductus arteriosus
What is atrial septal defect? Provide a description?
abnormal opening between the atria
Allowing blood from the higher pressure left atrium flow into low pressure right atrium
What is the patho behind atrial septal defect?
Blood flows from left to right cause increasing oxygenated blood into the right side of the heart.
It kinda circulates backwards and causes the patient to take another “breathe” think of it like that
There is a hole that doesn’t differentiate left and right side
It literally is reoxgenated blood that’s already been oxygenated causing extra pressure on the lungs
What is the main clinical manifestation of atrial septal defect?
Murmurs !
What is the treatment of atrial septal defect?
Surgical closure
Or TCC ( transcatheter closure )
What is ventricular spatial defect description?
Most common!
Abnormal opening between the ventricles
What is the patho of ventricular septal defect?
The hole between ventricles
( really just ventricles difference )
Left to right shunt
Left = lungs
So once again oxygenated blood is kinda just sitting there and has to re pump it again
What is the clinical manifestation of ventricle septal defect? (2)
Heart failure and murmur
What is the treatment for ventricular septal defect?
Surgical and TCC
What is atrioventicular canal defect description & patho?
incomplete fusion of the endocardial cushions
Most common in Down syndrome
Two holes !!
So hole in atrium & ventriculars
Really is the levels of how much blood is being pumped out from right to left
But this is left to right
So it kinda is just the AV node being really big and allowing this to happen
What is the 2 clinical manifestation of atrioventriculae canal defect?
Heart failure / murmur
Pulmonary vascular obstruct disease
How do we treat atrioventriculae canal defect?
Surgery
What is description of patent ductus ateriosus & patho?
Failure of the ductus arteriosus to close within the first weeks of life
This opening allows for the oxygenated blood to re enter again into the lungsand fill the lungs up
- meaning double the amount of work
What are the clinical manifestation of patent ductus arteriosus? (3)
Murmur
Heart failure
Hypertension may occur
What is the medication administration we can give for patent ductus ateruosis?
If not this
Surgery and TCC
Indomenthacin ( prostaglandin inhibitor )
Helps promote that closure
Notes
Patent formen ovale is normally closed
So the blood flows back again !!
Same thing like everything else truly
Name the defect that connects the pulmonary artery to the aorta?
Ductus ateriosia
Now onto the acyanotic obstructive defects!
What are the 4 obstructive acyanotic defects?
Coarcatation of the aorta
Aortic stenosis
Valvular aortic stenosis
Pulmonic stenosis
What is coarctation of the aorta description & patho!
Localized narrowing near the insertion of the ductus arteriosus
Causing the obstruction
Narrowing of the aorta
What is the clinical manifestation of coarctation of the aorta?
High blood pressure
Bounding pulses
Heart failure
Cyanosis of the lower extremities !!!
Severe
- hypotension
How do we treat coarctation of the aorta?
Surgery & TCC
What is aortic stenosis & valvular aortic stenosis description and patho?
Narrowing of the aorta valve causing obstruction
Or valve
And this on exertion causes to eject blood from the left ventricle
Clinical manifestation of aortic / vavular stenosis?
Hypotension
Weak pulses
Tachycardia
What is the treatment for aortic and valvular aortic stenosis?
Surgery
Balloon angioplasty which is a cath procedure
What is pulmonary stenosis description and patho?
Narrowing of the pulmonary artery
Causing resistance of blood flow
Doesn’t allow blood to really circulate in the body or lungs
What is the clinical manifestation of pulmonaey stenosis?
Usually asymptotic
Bug severe can lead to cyanosis
What is the treatment for pulmonary stenosis?
Surgery
Now onto the cyanotic congestion heart defects !
What are the decreased pulmonary blood flow for cyanotic ? (2)
Tetralogy of fallot
Tricuspid atresia
What is the description & patho of tetralogy of fallot!? (4)
Teta = 4
Explain each too !
The classic form includes 4 defects
1. Ventricular septal defect
( opening between the heart left and right lower chambers )
- Pulmonary stenosis
( narrowing of the pathway that carried blood from heart to lungs ) - Displaced aorta / overriding
( rise father on the right side of the heart )
Mixing of oxygen and deoxygenated
- so purple blood going out to the body - Ventricular hypertrophy
- thickening of the heart muscle in lower right ventricle
What is the x ray for fallout tetralogy?
Boot shaped heart
Why do we see this boot shaped heart in tetra of fallot?
Because of that intensive right ventricular hypertrophy
That causes it come way over and misshape the heart
What is the clinical manifestation of tetralogy of fallot?
Tet spells or blue spells
Hypoxia !!
Murmur
What is the recommendation for treatment for teta fallot?
Surgery!
What a sign of chronic hypoxia?
Clubbing
( oxygen is not reaching in fingers )
Boblous
- capillaries try to save itself and ghags the bobs in the fingertips
A child will put themselves in a certain position, also known as a tet spell
So they will get extremely agitated, super blue, Tachypnea, limp,
Murmur
What is this position
Teta spell = turning more blue !!!
Knee chest position
Do we let the children with teta stay in a knee chest position!?
YES!!
What is the biggest nursing management for teta?
Knee chest positioning!
What is tricuspid atresia patho and description?
So tricuspid valve doesn’t develops and that manes there is no connection to the right atrium to right ventricular
Causing decrease blood flow
What is the clinical manifestation of tricuspid atresia?
Usually give them prostaglandin or surgery!
Cyanosis
Now onto the cyanotic mixed defects!!
That increasing!
What are the 4 mixed defects for cyanosis?
Transposition of great vessels & arteries
Total anomalous pulmonary venous connection/return ( tapvr )
Truncus atreisous
Hypo plastic left heart syndrome
What is transposition of the great arteries or transposition of great vessels description and patho!?
Pulmonary artery leaves left ventricle
Aorta exits from right ventricle
They literally swapped
Unoxygenated blood goes into the body
Oxygenated blood goes into lungs
Switch!
Clinical manifestation for this great vessels and arteries
Treatment is just surgical treatment
Arterial switch operation
Cyanosis
What is total anomalous pulmonary venous return ( TAPVR ), patho and description?
Simply where the veins are not in the right spot
So like pulmonary veins go into the right atrium instead of the left atrium!
Then from right atrium goes back into the lungs
And then repeats
Really really hard to get blood out to the body
So it causes blood mixture
What is the surgery to help with this?
Simply switch pulmonary veins from the right atrium to the correct spot to the left atrium
What is truncus ateriosus?
Notes!!!
Failure to normal separation and division of the embryonic bulbar
Blood ejected from lefts to right ventricles mix togethe
Severe heart failure & murmur
Surgery
What is hypo plastic left heart syndrome??
A single ventricle left ventricle did not form comepletey
Just one ventricle ( just the right )
Usually missing the left one
Since the left ventricle isn’t formed
The right ventricle has too do a lot more and isn’t used
- so what can happen to it?
(3)
Surgery is instant needed!
Myopathy ( enlargement )
Aorta is small and now allowing much blood to the body
Cyanosis
What are defects of the boot shaped heart?
Pulmonary stenosis!?
VSD?
Ventricular hypertrophy?
Overriding aorta?
Ventricle hypertrophy
What defects is most common in children with Down syndrome?
AV canal
Additional information!
Murmurs !!
Innocent murmurs
- usually is normal cause cardiac anatomy and function
It’s 50% good and bad
So send them off to CARDIO
What is a thrill mean?
Soft vibration over the heart that reflects the transmittes sound of a heart murmur
What are some surgical procedures we can for congenital heart disease?
Dont over think it
Open heart
Closed heart
Staged procedures
Post operative care for the child
!!
What is properly one of the most important things for postoperative care for a child?
Urine output!!
Notes
Monitor vital signs and blood pressure
Respiratory needs
Rest, comfort and pain management
Fluid management
Progression of activity
Chest tubes after cardiac
Monitor tube drainage
- bright blood start off first
- it should graduate change to a serious color
WHAT HAPPENS IF IY GOES BACKWARDS SO BRIGHT RED TO LIKE BROWN SND THEN GO BAXK TI RED?
Literally we need to intervene
What is the drainage greater than
___ml/kg/hr X3 consecutive hours
Or
__to__’ml/kg in any 1
This means what?
Be alert for cardiac tamponade ( life threatening)
3
5-10
Hemorrhage
Once again monitor those fluids
I&O!!
What would renal failure indicate?
___ml/kg:hr
1
Notes
ASPRIN is normally for cardiac kids
But be careful cause reye sundrome !!
Now onto ineffective endocarditis
Infection of the valve !!
What is infective endocarditis!?
An infection of the inner lining of the heart, endocardium, involving the valves
What’s the most common cause of these infective endocarditis?
Streptococcus & staphy
What are the clinical manifestation for infective endocarditis?!(4)
Low grade fever
New murmur!!
Splenomegaly!!
Older nodes- red painful nodes on pads of fingers !!
Janeway spots - painless spots on hands and feet !!
How do we avoid infective endocarditis?
Usually with prophalaxis 1 hour before procedures
Dental work typically
How do we treat infective endocarditis?
What’s the diagnosis?
If we do surgical intervention what do we do?
Antibiotics 2-8 weeks
Culture
Replace the valve with prosthetic ( pig valves, watch out with Muslims ! )
Now onto rhenumatic fever !!
What is rheumatic fever ?
And can turn into rheumatic heart disease?
Abnormal immune response to group A strep pharyngitis ( not treated strep )
Usually not treated and turns into heart disease
Usually this is seen where?
In forgein countries and low income families
What are the clinical manifestations of rheumatic fever? (7)
Carditis - affects muscle layers of the heart & mitral valve !!!
Polyartheitis - reversible affecting large joints of the body
Erythema - redness
Rash in chest and truck
Non itching
Crops over body promiscuous
Subcutaneous nodules
Cardititis for rheumatic fever is mainly found where?
MITRAL VALVE !!
How do we treat RHD?
Penicillin & sulfa
If allergies used macrolides like erythromycin
How do we prevent RHD?
Treatment of strep and tonsillitis
What procedures should patient at risk be treated preventatively with antibiotics?
- invasive dental procedures
- surgery
- major injuries
- concerns for sepsis
- major illness including fever
- artificial joints
Now onto Kawasaki disease !!
What is Kawasaki disease?
How long is the time for this?
Acute systemic vasculitis
Unknown cause
6-8 weeks and self limited really
Systemic inflammation of the small and medium sized blood vessels
What are the symptoms of the Kawasaki disease ? (4)
Carditis - affects muscle layers of the heart - mitral valve
Polyarthritis - pain in joints
Erythema marginatum
- truck and chest
- not itchy
Subcutaneous nodules
- crops bony places
What is the peak incidence of Kawasaki diseases?
Toddlers ages
What are the clinical manifestation of Kawasaki diseases? (7)
High fever
Strawberry tongue
Edema on hands and feet
Extreme irritability
Periungual desquamatiom
Arthritis
Coronary complication
Strawberry tongue is the VERY COMMON
PEELING ON THE FINGERS
CONJUCTIVE
LIPS CHAPPED AND BLEEDINF
LARGEE LYMPH NODES!!
What is the treatment for Kawasaki disease?
High dose of IVIG along with salicylate therapy
Iys shown to help lowers fever and coronary artery abnormalities
Usually ASPRIN as well is given as a initial treatment for the inflammatory and fever reducing aspects
What is the main death for Kawasaki diseases?
The enrage of coronary aneurysm
What is the prognosis for Kawasaki disease?
Usually positive and doesn’t need any transplant of valve
Just early diagnosis is the best
3 stage Kawasaki
Acute stage
- irritable and inconsable
- fever
- strawberry tongue
Subacute
- fever
- enlargment of the heart
Convalescent phase
- everything resolves but labs may be abnormal
- arthritis may continue
- baseline
