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Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How is the fetal blood oxygenated?

A

Fetal blood is oxygenated by placenta instead of lungs.

Fetal lung are currently collapsed at this time

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2
Q

What are the three structural differences in a fetal heart?

A
  1. Ductus venosus
  2. Foramen ovale
  3. Patent ductus arteriosus
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3
Q

Define

Cardiac output

A

volume of blood ejected by heart in 1 minute

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4
Q

What do neonates and infants depend on to maintain cardiac output?

A

Heart rate and rhythm

Do not have the capacity to ↑ stroke volume yet

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5
Q

Define

Preload

A

The amount to which the ventricles stretch to be filled during diastole.

volume of blood returning to the heart

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6
Q

Define

Afterload

A

Afterload is the pressure that the heart must work against to eject blood during systole

Hypertension is common adult reason for increased afterload.

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7
Q

Neonatal & infant myocardial muscle is less efficient & has fewer organized myocardial fibers, so it is very dependent on what three factors for adequate cardiac output.

A
  1. calcium
  2. glucose
  3. volume
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8
Q

What are the differences in heart sounds between a newborn and an adult?

A

Newborn heart sounds are higher pitched and greater intensity

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9
Q

What is the function of the ductus venosus?

A

carry oxygenated blood from the umbilical vein to the the IVC

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10
Q
  1. What is the function of foramen ovale during fetal circulation?
  2. Why is it needed?
A
  • Shunts blood from the RA → LA during fetal circulation.
  • Allows oxygenated blood to by pass the lung

decreases pressure on fetal heart needed to pump blood out

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11
Q

What three maternal conditions increase the risk of heart disease in infants?

A
  1. Type 1 Diabetes
  2. Lupus erythematosus
  3. PKU
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12
Q

What is the purpose of the four extremity BP in infants?

A

Assessing for differences in upper and lower extremity BP

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13
Q

Sign and symptom of?

Large differences in upper and lower extremity BP

A

Coarctation of the aorta

Narrowing of the aorta

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14
Q

Sign and symptom of?

If there is a > 2% difference in pre-ductal (hand) and postductal (foot) SpO2

Assessed 24 hours after being born

A

Right to left shunting

deoxygenated blood is going over to left side into systemic.

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15
Q
  1. Where would you find the PMI and apical impulse in child ≤ 7?
  2. How about child ≥ 8
A
  1. Fourth intercostal space
  2. Fifth intercostal space
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16
Q

Sign and symptom of?

Presence of a thrill

A

Can indicate valvular anomaly (heart murmurs)

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17
Q

How does blood flow in relation to pressure?

A

Blood flows from higher pressure to lower pressure

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18
Q
  1. Where is the pressure normally higher in the heart left or right side?
  2. When is it normally the opposite?
A
  1. Left side has higher pressure
  2. Right side during fetal circulation
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19
Q

What are the four hemodynamic classifications of congenital heart disease?

A
  1. Increased pulmonary blood flow
  2. Decrease pulmonary blood flow
  3. Obstruction to blood flow out of the heart
  4. Mixed blood flow
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20
Q

*Which direction does blow flow in ASD?
*what hemodynamic classification does it fall under?

atrial septal defect

A

*Hole in the atria septum that causes blood to shunt from LA → RA.
*increased pulmonary blow flow

Occurs due to left side having higher pressure

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21
Q

What symptoms can occur w/ ASD?

atrial septal defect

A
  • Right side hypertrophy
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22
Q
  1. What direction does blood flow in VSD?
  2. What type of hemodynamic blood defect is it?

ventricular septal defect

A
  1. Hole in the ventricle septum that causes blood to shunt from LV → RV.
  2. Increased pulmonary blood flow

Occurs due to left side having higher pressure

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23
Q

What is the most common type of atrial septal defect?

A

Secundum

center of septum

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24
Q

Eisenmenger syndrome is seen in which heart defects?

A
  1. Untreated VSD
  2. Can occur in AV Canal
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25
Q

Define

Eisenmenger syndrome

A
  • Increased blood flow to PA causes pulmonary HTN.
  • RV pressure increases which causes deoxy blood to shunt to LV out into circulation.
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26
Q

What is the most common congential heart defect?

A

Ventricular Septic Defect (VSD)

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27
Q

What defects are associated with AV Canal Defect?
What hemodynamic classification does it fall under?

Atrioventricular

A
  • Incomplete closure of atria and ventricle septum causing an ASD and VSD.
  • Also, defects in both AV valves.
  • ↑ pulmonary flow
28
Q

AV canal defect is most common in which people?

Atrioventricular

A

People w/ down syndrome

29
Q
  1. What direction does PDA defect cause blood to flow abnormally?
  2. What hemodynamic classification is this?

Patent Ductus Arteriosus

A
  1. Failure of the PDA to close, causing blood to shunt out of aorta → PA.
  2. Increased pulmonary blood flow
30
Q

What is the purpose of Indomethacin?

Prostaglandin inhibitor

A

Closes the PDA (patent ductus arteriosus)

31
Q

What are the four types of heart defects associated with increased pulmonary blood flow?

A
  1. Atrial septic defect (ASD)
  2. Ventricle septic defect (VSD)
  3. AV canal
  4. Patent Ductus Arteriosus (PDA)
32
Q

What are the three types of obstructive defects?

A
  1. Coarctation of the Aorta (COA)
  2. Aortic stenosis
  3. Pulmonic stenosis
33
Q
  1. What is occuring with COA?
  2. What hemodynamic classification is it?

coaractation of the aorta

A
  1. Localized narrowing near insertion of ductus arteriosus
  2. Obstructive blood flow
34
Q

What is the expected difference in BP and pulses w/ COA?

coaractation of the aorta

A

Increase BP/pulse in head and upper extremities and decreased BP/pulse in trunk and lower extremities

35
Q

Collateral circulation are capillaries that formed to increase blood flow to lower extremities is associated w/ which heart defect?

A

Coaractation of the aorta

COA

36
Q

What causes the obstructive defect for Aortic Stenosis?

A

Narrowing or stricture of aortic valve.

37
Q

Why does hypertrophy of the heart occur?

Heart muscle becomes thickened (thickening of the wall)

A

Persistant increased pressure required in the atrium or ventricle

Due to valve stenosis or increased blood flow in that atrium/ventricle

38
Q

What S&S are expected to be seen w/ Aortic Stenosis

A
  1. Decreased CO
  2. LV hypertrophy
  3. Pulmonary vascular congestion*

Blood on left side backs up to the lungs due to stenosis

39
Q
  1. What causes Pulmonic Stenosis?
  2. What type of hemodynamic classification is it?
A
  1. Narrowing of entrance to pulmonary artery
  2. Obstructive blood flow
40
Q

What can occur w/ severe pulmonic stenosis?

A
  • Blood backs up to RA and increased pressure causes foramen ovale to reopen.
  • Deoxy blood shunts RA → Left (out into circulation)
41
Q

What are the two types of defects with decreased pulmonary blood flow?

A
  1. Tetralogy of Fallot (TOF)*
  2. Tricuspid Atresia

due to pulmonic stenosis

42
Q

What are the four defects of TOF that causes the decreased pulmonary blood flow?

Tetralogy of Fallot (TOF)

A

Four defects:
1. Overriding Aorta
2. VSD
3. pulmonic stenosis, and
4. RV hypertrophy.

43
Q
  1. What is tricuspid atresia?
  2. Which hemodynamic classification is it?
A
  1. Tricuspid valve is missing
  2. Decreased pulmonary blood flow
44
Q
  1. What occurs with w/ TGV?
  2. What hemodynamic classification is it?

Transposition of the Great Vessels

A
  1. Aorta connects to RV and PA connect w/ LV.
  2. Mixed defect
45
Q

What are the two defects in Hypoplastic Left Heart that causes mixed defect?

A
  1. underdevelopment of LV and Aorta
  2. Aortic atresia
46
Q

What causes the defect in truncus arteriosus?

A

When the Aorta and Pulmonary Artery fail to separate.

47
Q

What causes Total Anomalous Pulmonary Venous Connection?

A

Pulmonary veins do not connect to LA.

48
Q
  1. Which heart defect is associated w/ “TET” spells?
  2. What does it present as?
A
  1. TETralogy of Fallot (TOF)
  2. Suddenly developing cyanosis after crying or feeding, or when agitated.

deep blue skin, nails and lips

49
Q

What interventions can be utilized for “TET” spells?

A
  1. Knee-chest position (reduces venous return of desat blood)
  2. Morphine IV push (calms child; relieves pulmonary stenosis spasms)
50
Q

What is the purpose of prostaglandin E?

A

Keeps the PDA open after birth

51
Q

Which heart defect is immediately incompatiable w/ life and needs surgery

A

Tricuspid Atresia

52
Q

Which three heart defects are treated w/ Prostaglandin E?

Keeps PDA open

A
  1. Tricuspid Atresia
  2. Transposition of the Great Vessels (TGV)
  3. Hypoplastic Left Heart
53
Q

What are the four causes of congestive heart failure?

A
  1. Volume overload from left to right shunting (VSD)
  2. Pressure overload from obstructive defects
  3. Decreased cardiac contractility (cardiomyopathy)
  4. High CO demand (sepsis, anemia)
54
Q

Edema and/or Hepatomegaly is a symptom of right or left sided heart failure?

A

Right sided heart failure

55
Q

Respiratory Distress and/or congestion is a symptom of right or left sided heart failure?

A

Left sided heart failure
(When the left side is not pumping correctly, blood backs up in the blood vessels of the lungs)

S&S retractions, grunting, wheezing, cough

56
Q

Which heart defects need ASD or Foramen Ovale and PDA for palliative care until surgery?

A
  1. Tricuspid Atresia
  2. Transposition of Great Vessels
  3. Hypoplastic Left Heart
57
Q

Which condition requires a permanent diet if diagnosed?

A

PKU
(low-protein diet)

Phenylketonuria

58
Q

Exposure to Coxsackievirus A or B during pregnancy is associated myocarditis, encephalopathy, congenital heart defect?

A

Coxsackievirus B

59
Q

What is the grading of murmurs?

A
  1. Very faint
  2. slightly louder than grade I: audible in all positions
  3. Loud, but not accompanied by a thrill
  4. Loud, **accompanied by a thrill **
  5. Loud enough to be heard with a stethoscope barely touching the chest; accompanied by a thrill
  6. Loud enough to be heard without stethoscope; accompanied by thrill
60
Q

Which two heart defects may resolve on their own?

A
  1. ASD
  2. VSD

Atrial Septal Defect and Ventricular Septal Defect

61
Q

What medication can be used to improve cardiac contractibility in heart failure?

aka as congestestive heart failure

A

Digoxin

62
Q

What medication can be used to decrease blood pressure in heart failure?

aka as congestestive heart failure

A

ACEi
(Captopril, Enalapril)

Check BP before administration

63
Q

What medication can be used to decrease volume overload in heart failure?

aka as congestestive heart failure

A

Diuretics
(Lasix, Aldactone)

Aldactone is potassium sparing

64
Q
  1. What are the two major risks of digoxin
  2. What must be done before Digoxin administration?
A
  1. Bradycardia and Hypokalemia
  2. Ascultate heart for full min and check potassium levels

arrythmias may also occur; 2nd nurse for dose check

65
Q

What are two physiological changes with chronic hypoxemia?

Decreased arterial O2 saturation

A
  1. polycythemia*
  2. clubbing

excess production of RBC; causes blood to be viscious

Pediatrics (10 decks)

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