Cardio

Question 1

Frank-Starling law/curve

Answer 1

An increase in ventricular end-diastolic volume will increase stroke volume

Question 2

CHF etiology: 3 factors of fetal heart development

Answer 2

Gene interaction, environment, chance.

Question 3

Risk factors associated with CHD

Answer 3

• Maternal diabetes; greater if she receives insulin.

- Genetics: family hx of; chromosomal defects (Down, Williams, DiGeorge)

Question 4

DiGeorge diagnosed pt can’t receive…

Answer 4

Live vaccines

Question 5

WIlliams syndrome: need to do what? why? and mostly where?

Answer 5

Ultra sound because of propensity of arterial stenosis in the kidneys.

Question 6

Acyanotic defects

Answer 6

Left to right shunting (ASD, VSD)

Question 7

Obstructive defects

Answer 7

Coarctation of the Aorta

Question 8

Cyanotic defects

Answer 8

Tetralogy of Fallot

Question 9

Tetralogy of fallot

Answer 9

VSD
Pulmonary stenosis
RV hypertrophy
Over-riding aorta

Question 10

Preload

Answer 10

is the volume of blood returning to the heart, or the circulating blood volume

Question 11

Afterload

Answer 11

Refers to the resistance against which the ventricles must pump when ejecting blood

Question 12

Pulmonary Congestion of blood vessels leads to

Answer 12

1. Tachypnea (RR>60)
2. Rrespiratory distress- intercostal retractions
3. Mild cyanosis
4. Dyspnea and orthopnea (HOB 30%)
5. Activity/feeding intolerance
6. Pulmonary edema: wheeze, dry cough

Question 13

Assessment of Hypoxemia in CHF & Congenital defects

Answer 13

1. Cyanosis- see above
2. Shunts present—see handout
3. Polycythemia (to many red blood cells = trying to compensate)&raquo_space; increased blood viscosity/ CVA risk
4. Clubbing
5. 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)
6. Risk for infection ( Bacterial endocarditis). Lots of cardiac turbulence.

Question 14

General assessments for all cardiac kids

Answer 14

1. Caloric demands/ increased BMR
2. Poor feeders r/t breath/suck coordination
3. Poor wt. Gain for muscle mass development
   a) . Preop- need some weight gain before procedure if possible.
4. Developmental delays: cognitive and motor usually can be risk factors.

Question 15

Osler nodes

Answer 15

Red, painful intradermal nodes with white centers found on the hand and feet pads of the phalanges

Question 16

Roth’s spots

Answer 16

Retinal hemorrhages with white or pale centers.

Question 17

Petechiae

Answer 17

Pinpoint, round spots that appear on the skin as a result of bleeding

Question 18

Janeway lessions

Answer 18

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.

Question 19

Jones criteria

Answer 19

The diagnosis of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria.

Question 20

Jones Criteria: Major s/sx

Answer 20

a. Carditis- NEW murmur, CHF, tachy
b. Polyarthritis
c. Chorea (involuntary movements)
d. Erythema marginatum (trunk general rash)
e. Subcutaneous nodules

Question 21

Jones Criteria: Minor s/sx

Answer 21

a. Arthralgia
b. Fever
c. Increased sed rate
d. C-reactive protein. Mitral valve regurg

Question 22

Rheumatic Fever Tx

Answer 22

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,

Question 23

Kawasaki disease

Answer 23

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

Question 24

Kawasaki Disease patho:

Answer 24

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