Cardio Flashcards
Frank-Starling law/curve
An increase in ventricular end-diastolic volume will increase stroke volume
CHF etiology: 3 factors of fetal heart development
Gene interaction, environment, chance.
Risk factors associated with CHD
- Maternal diabetes; greater if she receives insulin.
- Genetics: family hx of; chromosomal defects (Down, Williams, DiGeorge)
DiGeorge diagnosed pt can’t receive…
Live vaccines
WIlliams syndrome: need to do what? why? and mostly where?
Ultra sound because of propensity of arterial stenosis in the kidneys.
Acyanotic defects
Left to right shunting (ASD, VSD)
Obstructive defects
Coarctation of the Aorta
Cyanotic defects
Tetralogy of Fallot
Tetralogy of fallot
VSD
Pulmonary stenosis
RV hypertrophy
Over-riding aorta
Preload
is the volume of blood returning to the heart, or the circulating blood volume
Afterload
Refers to the resistance against which the ventricles must pump when ejecting blood
Pulmonary Congestion of blood vessels leads to
- Tachypnea (RR>60)
- Rrespiratory distress- intercostal retractions
- Mild cyanosis
- Dyspnea and orthopnea (HOB 30%)
- Activity/feeding intolerance
- Pulmonary edema: wheeze, dry cough
Assessment of Hypoxemia in CHF & Congenital defects
- Cyanosis- see above
- Shunts present—see handout
- Polycythemia (to many red blood cells = trying to compensate)»_space; increased blood viscosity/ CVA risk
- Clubbing
- Hypercyanotic spells (“Tet Spell”) with acute r»L shunt; caused by crying, feeding, defacating. Interventions:
a. Knee/Chest position
b. Other interventions- (O2, morphine, propanolol. Baby is not in pain, is to vasodialate) - Risk for infection ( Bacterial endocarditis). Lots of cardiac turbulence.
General assessments for all cardiac kids
- Caloric demands/ increased BMR
- Poor feeders r/t breath/suck coordination
- Poor wt. Gain for muscle mass development
a) . Preop- need some weight gain before procedure if possible. - Developmental delays: cognitive and motor usually can be risk factors.
Osler nodes
Red, painful intradermal nodes with white centers found on the hand and feet pads of the phalanges
Roth’s spots
Retinal hemorrhages with white or pale centers.
Petechiae
Pinpoint, round spots that appear on the skin as a result of bleeding
Janeway lessions
Non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are indicative of infective endocarditis.
Jones criteria
The diagnosis of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria.
Jones Criteria: Major s/sx
a. Carditis- NEW murmur, CHF, tachy
b. Polyarthritis
c. Chorea (involuntary movements)
d. Erythema marginatum (trunk general rash)
e. Subcutaneous nodules
Jones Criteria: Minor s/sx
a. Arthralgia
b. Fever
c. Increased sed rate
d. C-reactive protein. Mitral valve regurg
Rheumatic Fever Tx
Prevention- Penicillin for strep pharyngitis
i. Penicillin- IV therapy for acute infection
ii. Prohphylaxis- monthly IM Penicillin after infection, 5-10 years depending on involvement of carditis
iii. Saclicylates (baby aspirin), prednisone. Coronay arteries can be inflame after this episode. By taking aspirin, it helps to perfuse coronary arteries,
Kawasaki disease
Is a condition that causes inflammation in the walls of medium-sized arteries throughout the body, including the coronary arteries, which supply blood to the heart muscle
Kawasaki Disease patho:
i. Small and medium size vessels
ii. Inflammation in CA» aneurysms (15-25%) and microaneurysms of peripheral vessels
iii. Myocarditis, CHF complications, MI
iv. Acute phase- 5 out of 6 of the following:
1. Fever for 5 days or more
2. bulbar conjunctivae (puffy eyes)- exudate and inflamed
3. oral mucosa: strawberry tongue-
fissures of lips- pealing skin
4. peripheral edema with desquamation (peally skin)
5. Polymorphous rash
6. Cervical lymphadenopopathy
v. Other s/s: arthritis, GI s/s, hypercoagulopathies
