Cardio

Question 1

systolic murmurs

Answer 1

aortic stenosis and mitral regurg

Question 2

diastolic murmurs

Answer 2

mitral stenosis and aortic regurg

Question 3

innocent (functional) murmurs

Answer 3

• do not change in intensity over time
• do not affect growth or well- being
• are frequently low pitched and may disappear when the child changes position
• may hear it when child is sick- if first time hearing a murmur when kid is sick, as long as they are growing normally its ok

Question 4

cyanotic congenital heart dx

Answer 4

cause patients to be blue because decrease in pulm blood flow, causes volume overload, so cardiac workload increases. includes tetrology of fallot, tricuspid, transposition, trunkus arteriosis, hypoplastic left heart(not compatible w/ life)
- usually lots of problems with these kids- need to be repaired ASAP

Question 5

acyanotic

Answer 5

do no cause deoxygenation- child not blue- left to right shunting- (blood already has been profused by lungs but its shunting back to the right side. patent ductus arteriosis, atrial septal defect, ventricular septal defect, AV septal defect.

Question 6

some risk factors for birth defects

Answer 6

sibling/ family with chromosomal defect
DM/ insulin dependent mom
mom w/ maternal rubella
mom age 40+, or ETOH abuse
cleft palate

Question 7

grading of murmurs

Answer 7

0/6 no murmur
1/6 faint
2/6 easily discernible
3/6 louder in intesity
4/6 louder, may have thrill
5/6 louder, thrill can be heard with scope partially of chest- should palpate for thrill
6/6 loudest, can be heard without scope on chest- usually very significant heart problems like tetrology of fallot

Question 8

obstructive or stenotic lesions

Answer 8

stenotic leions- heart structurally sound but there is a stenosis somwhere.
pulm stenosis- narrowing of the pulmonary valve
aortic stenosis- narrowing of aortic valve
coartation of aorta- diagnosis by lower BP found in the lower extremities when compared to upper- ejection click, systolic murmur- easy to fix, use a balloon to open area

Question 9

atrial septal defect ASD

Answer 9

hole in between the atria- depending on the size of the hole/ septum, can have 0 symptoms as child but then when they get older 6 or 7 yrs old they get tired easily on soccer field etc, should send for echo, may have chf s/s. may need cardiac cath to put patch on hole- need abx prophylaxis to prevent bacterial endocarditis

Question 10

patent ductus arteriosus PDA

Answer 10

acyanotic defect- its the failure of the fetal ductus arteriosus (bridge b/w the aorta & pulmonary artery) to close completely at birth (15- 18 hrs) causing some blood to return to lungs even though its already been oxygenated. Short circuits the normal pulmonary vascular system and allows blood to mix b/w the pulmonary artery and the aorta.

Question 11

ventricular septal defect VSD

Answer 11

hole between right and left ventricles- left to right shunting, goes back into pulmonary system (so acyanotic defect) causes extra volume to be pumped into the lungs, possibly causing congestion- may show s/s of CHF, could need lasix. Need surgery soon

Question 12

cyanotic lesions with decreased pulmonary blood flow

Answer 12

tetrology of fallot- 4 characteristics

1. ventral septal defect
2. pulmonary stenosis
3. overriding of the aorta (into right inside of left)
4. right ventricular hypertrophy (secondary to pulmonary stenosis)

Question 13

tetrology of fallot

Answer 13

cyanotic defect- decreased pulmonary blood flow- s/s: decreased weight gain, polycythemia causing blood to get thick and cause secondary CVA, TET spells- kid turns blue- kids will squat to decrease perioheral vascular resistance from lower extremitites, if your holding a smaller kid push lower legs up toward their chest.
- will need surgery (but not right away, wait for them to be a certain weight), sometimes need a couple surgeries throughout life- usually kids do very well

Question 14

chest pain

Answer 14

common complaint, physically and emotionally distressing sx with long list of differentials. need focused hx- get from child as much as possible as opposed to parent OLDCART
if indicated testing- EKG, CXR, refer to cardio with any concerns or abnormalities

Question 15

hyperlipidemia

Answer 15

relative to childhood obesity
cholesterol levels in children and adolescents aged 2- 19
total

Question 16

tx of hyperlipidemia

Answer 16

kids younger than 2 should not be restricted from foods containing fat or cholesterol. bc their rapid growth and development require high energy intakes from food.
children 2-5 through 18 yrs- diet with no less than 20% and no more than 30% of calories from fat
less than 7% of total calories should come from saturated fats- should eat no more than 200mg per day of cholesterol
exercise!
weight control
switch to skim milk at age 2

Question 17

meds for hyperlipidemia

Answer 17

children older than 10 yrs of age
LDL remains >160 w/ family hx of heart dx OR LDL >190 w/o family hx
6- 12 months of lifestyle modification, if no change refer to cardio
high trigs- treat w/ diet

Question 18

hypertension

Answer 18

start screening at age 3

primary- rare in kids (

Question 19

hypertension meds

Answer 19

No ACE or ARB- teratogenic
thiazide diuretics used, beta blockers, calcium channel blockers.
make sure its not white coat syndrome, take BP laying down, sitting up, on multiple occasions. refer if several increased BP and blood work all normal and no obvious causes for hypertension

Question 20

Rheumatic fever

Answer 20

acquired cardiac problem.

systemic inflammatory disease- involves the heart and joints, CNS and connective tissue involvement may occur

Question 21

patho of rheumatic fever

Answer 21

follows 2- 6 weeks after a group A beta- hemolytic strep infection, autoimmune rxn against beta- hemolytic strep.

• acute phase lasts 2- 3 weeks- inflammation of connective tissue in the heart, joints and skin
• proliferative phase affects the heart with Aschoff bodiews developing on the heart valves (valvular stenosis and regurgitation)
• episode can last up to 3 mos, self limiting (treat w/ high dose abx, comfort measures, usually self limiting)

Question 22

rheumatic fever minor criteria

Answer 22

fever, arthlagia, elevated ESR, c- reactive protein, prolonged P- R and/ or Q- T interval.

Question 23

supporting evidence for rheumatic fever

Answer 23

H/o strep, h/o scarlet fever, positive throat culture for strep, elevated ASO titer

Question 24

management for rheumatic fever

Answer 24

BR until ESR returns to normal, ASA and prednisone, monitor cardiac function, PCN (or erythromycin if pcn allergy) after recover from rheumatic heart disease, promote rest, BR with BRP.

Question 25

what is kawasaki disease, etiology?

Answer 25

acquired disease (not congenital) multi- system disorder involving vasculitis- inflammation of inner lining of arteries and veins. causes significantly increased platelet count and possible cardiac pathology including MI and CHF. Etiology unknown, most frequently effects boys

Question 26

3 phases of kawasaki disease

Answer 26

acute phase- fever, conjunctival hyperemia, swollen hands and feet, rash and enlarger cervical lymph nodes
subacute phase- cracking of lips, desquamation of skin on tips of fingers and toes, cardiac disease and thrombocytosis
convalescent phase- has lingering signs of inflammation

Question 27

kawasaki disease- assessment findings of phase 1

Answer 27

Days 1- 10. fever lasting longer than 5 days that is unresponsive to antipyretics, conjunctivitis, swelling of hands and feet, erythema, (very red tongue/ lips) lymphadenopathy. will have increased sed rate and c- reactive protein, and joint pain- miserable kids!

Question 28

kawasaki’s disease- assessment findings of phase 2

Answer 28

days 10- 25. fever diminishes, irritable, anorexia, desquamation of hands and feet, arthritis and arthralgia, cardiovascular manifestations

Question 29

kawasaki’s disease- assessment findings of phase 3

Answer 29

days 26- 40. drop in ESR, diminishing signs of illness

Question 30

interventions for kawasaki disease

Answer 30

administer high dose ASA (80- 100mg/ kg/ day) while temp is elevated
administer gamma globulin (IVIG) to reduce risk of coronary artery lesion and aneurysms
treat in hospital obvi

Question 31

nursing management of kawasaki disease

Answer 31

promote comfort, small frequent feedings, passive ROM, cool baths, gentle oral care, encourage fluids, monitor for complications- aneurysms, s/e of ASA like bleeding, GI upset, s/e of IVIG therapy like high BP, facial flushing, tightness in chest. monitor temp, monitor eyes for conjunctivitis

Question 32

infective endocarditis (bacterial) prophylaxis

Answer 32

bacterial endocarditis occurs when bacteria enter the bloodstream and lodge inside the heart, where they multiply and cause infection
guidelines from AHA have changed ( see article) med recommendations- amoxil 50mg/kg single dose before procedure, azithromycin 15mg/kg single dose before procedure

Question 33

new guidelines for endocarditis prophylaxis

Answer 33

an artificial heart valve, or have had a valve repaired with artificial material, h/o endocarditis, heart transplant w/ or w/o abnormal heart valve, certain congenital heart defects (such as tetrology of fallot)

Question 34

bradydysrythmia

Answer 34

could be d/t heart block, or in response to hypoxia, hypotension. Can occur after heart surgery. tx- pacemaker (not too common)

Question 35

tachydysrythmia

Answer 35

SVT (most likely) heart rate 200- 300 bpm, may need digoxin. can use ice in the office while waiting for ambulance, ablation surgery

Question 36

rhythm disturbances Long QT syndrome

Answer 36

can potentially cause fast, chaotic heart beats, may trigger a sudden fainting spell or seizure. The heart may beat erratically for so long that it can cause sudden death. Most common symptom- fainting- concern in athletes

Question 37

syncopal episodes

Answer 37

common, especially in adolescent girls. asses and listen to patient and family, focused hx, focused physical exam (orthostatic vital signs, neuro exam, detailed cardiac exam- EKG- f/u with cardio

Question 38

blood flow of heart when in utero

Answer 38

blood from SVC to right atria through foramen ovale to left atria down to aorta to body (70%) of blood OR
from SVC to righ atria to right ventricle to pulmonary artery to ductus arteriosis to aorta to body.
When baby comes out and takes first breath, body in negative pressure so FO and DA should close up- we want them to be closed by the time they leave the hospital.

Question 39

red flags that may mean a cardiac defect

Answer 39

child not eating well, fatigue easy, lose weight

Question 40

atrial septal defect

Answer 40

would be our patent foramen ovale. sometimes we miss this- may not have any symptoms

Question 41

ventrical septal defect

Answer 41

sicker kids- CHF sx, creates congestion in the lungs, may need multiple surgeries as they get older

Question 42

most common dx w/ chest pain in kids

Answer 42

costochondritis aka muscle pain, give tylenol