Cardiology Blueprint Flashcards
What does a chest x-ray evaluate? (hint: 3)
Can visualize → size & contour of the heart
Identifies enlarged heart
Visualizes characteristics of pulmonary vascular markings
What does an electrocardiogram record?
the quality of major electrical activity of the heart
What does an electrocardiogram detect? (hint: 3)
Help in Dx and monitoring heart conditions:
- Abnormal rhythms (arrhythmias/ dysrhythmias)
- Congenital heart defects
- Effectiveness of medications or procedures
What diagnostic test is done after exercise?
stress electrocardiogram
What information does an echocardiogram provide? (hint: 2)
Shows cardiac (heart) structures
Identifies pattern of movement:
- Allows visualization of blood flow movement
- Allows visualization of heart movement
What diagnostic test is similar to an electrocardiogram and how does it differ?
holter monitor
worn longer up to 48 hours (ongoing monitoring)
What does holter monitor do and what is it used for?
It continuously records child’s heart activity for an extended period of time to help Dx abnormal heart rhythms (arrhythmias)
ASD is characterized by the opening between what?
left and right atria
VSD is the abnormal opening between what?
left and right ventricles
what are the two types of VSD?
membranous and muscular
What is Patent Ductus Arteriosus (PDA)?
Failure for the ductus arteriosus to close after the first weeks of life
What type of murmur is expected in PDA?
machine-like murmur
What does a left to right shunt mean?
A congenital defect where blood flows from the high pressure on the left side to the lower pressure of the right side
What does left to right shunt lead to?
Pulmonary congestion / CHF
What does a left to right shunt increase?
Increase in the blood volume under high pressure on the right side
Increase resistance of blood flow to the lungs
A left to right shunt causes an increase in the blood volume under high pressure on the right side. What sx does this lead to? (hint: 3)
Tachypnea
dyspnea
pulmonary edema
A left to right shunt increases the resistance of blood flow to the lungs. What does this cause?
pulmonary hypertension
List the sx of pulmonary hypertension in children (hint: 8)
Tachycardia
Tachypnea
S3 & S4 heart sounds
Dyspnea
Diaphoresis
Easily fatigued
Difficulty eating
Enlarged spleen/ Enlarged liver
What are the symptoms of atrial septal defect? (hint: 7)
Symptoms vary on the size of opening:
Fatigue
Difficulty breathing
Recurrent respiratory infections
Poor weight gain
Heart murmur
Atrial dysrhythmias
CHF Sx’s
What does right to left shunt mean?
A congenital defect where there is abnormal flow of blood from the right to left side of the heart without passing through the lungs for oxygenation
In right to left shunt, when the blood bypasses the lungs and is shunted directly from the right side to the left side of the heart, what happens?
deoxygenated blood mixes with oxygenated blood and gets pumped out to the body causing a reduced supply of oxygen rich blood
what does right to left shunt result in? (hint: 2)
Hypoxemia (this bypasses the lungs)
cyanosis
What can sometimes happen in right to left shunt?
Sometimes can have Polycythemia → increase in viscosity of blood
Right to left shunt can be seen in acute phase of what?
Massive pulmonary embolism
What conditions are associated with right to left shunt? (hint: 7)
Eisenmenger Syndrome
Tricuspid atresia
Tetralogy of Fallot
Transposition of the Great Arteries
Total anomalous pulmonary venous return
Truncus arteriosus
Hypoplastic left heart syndrome
what is Eisenmenger Syndrome?
the development of pulmonary HTN due to an untreated congenital heart defect
The pulmonary HTN eventually causes long standing left to right shunt to flip to right to left shunt
what is pulmonary atresia?
a birth defect of the pulmonary valve
Right to Left Shunt = ?
Left to Right Shunt = ?
Right to Left Shunt = hypoxemia
Left to Right Shunt = pulmonary congestion
which shunt is acyanotic vs cyanotic and why?
(I looked this up because I was confused so you can skip if you want!)
Left-to-right (acyanotic): This type of shunt doesn’t affect the process of oxygenation in your lungs.
Right-to-left (cyanotic): This type of shunt interrupts blood flow and oxygenation in your lungs. In these situations, you may have lower oxygen saturation in your blood or a bluish tinge to your skin.
what conditions are associated with left to right shunts? (Hint: 3)
Patent Foramen Ovale (PFO)
Atrial septal defect (ASD).
Ventricular septal defect (VSD).
What is the most common cyanotic heart defect?
TOF (tetralogy of Fallot)
What is tetralogy of fallot (TOF)?
When the RV contracts there is resistance of blood relating to pulmonary stenosis
The blood is shunted across the VSD into the aorta & LV giving persistent arterial unsaturation & cyanosis
What are the four main defects of TOF (tetralogy of Fallot)?
Pulmonary stenosis
VSD
Overriding Aorta
Right ventricular hypertrophy
The four defects of TOF collectively lead to what which causes what?
Leads to: mixing of oxygenated & deoxygenated blood
Causes: Cyanosis; Varying degrees of O2 saturation in the blood
What can surgical repair of TOF do?
Correct the anatomical abnormalities
Improve blood flow & oxygenation
List the clinical manifestations of TOF (hint: 5)
Cyanosis
Clubbing
Systolic murmur
Delayed growth
Hypoxia “tet” spells (squatting)
what are the risks associated with TOF?
Emboli
Brain abscess
Seizures
LOC
Sudden death
Why is it called a “boot sign” on X-ray with TOF?
Boot like shape seen on the X-ray is due to the right ventricular hypertrophy seen in TOF
what is the definition of valvular endocarditis?
an infection of the inner lining of the heart & the valves that can enter the bloodstream
Valvular endocarditis mainly affects which valve?
mitral
what is the hallmark sign of Valvular endocarditis?
NEW murmur
How many blood cultures are needed for confirmatory Dx of valvular endocarditis?
3 or more in 24 hour period
List the clinical manifestations of coarctation of the aorta (hint: overall 4, shortly after birth 3, older children 6)
Overall:
- Increased BP & bounding pulses in arms
- weak or absence femoral pulses
- cool lower extremities
- increased deterioration of sx’s -> severe acidotic and hypotensive
Shortly after birth:
- poor feeding
- difficulty breathing
- weak pulses in lower extremities
Older children:
- dizziness
- faintness
- headaches
- leg cramps
- epistaxis (inc. BP)
- exercise intolerance
What are the expected exam findings for pre & post ductal pulse ox in coarctation of the aorta?
upper extremity is higher than lower extremity
Greater than 3% difference in hand to foot
In Coarctation of the aorta, what are the expected exam findings for upper & lower extremity BPs & pulses?
increased BP and bounding pulses in arms
weak or absent femoral pulses
In mild cases of coarctation of the aorta, what is the tx?
medication management for BP
In severe cases of coarctation of the aorta, what is the tx?
often require surgical intervention to repair or remove the constriction & restore normal blood flow
in hypoplastic left heart syndrome, what nursing assessment that may help identify CHF?
daily weights
In hypoplastic left heart syndrome, what happens if the patent ductus arteriosus closes?
the infant will progressively deteriorate with worsening cyanosis, decreased cardiac output and eventual cardiac collapse (assess for these things)
what visualizes the defect in hypoplastic left heart syndrome?
echocardiogram
(From Ricci Book) List what should be included in the nursing assessment of hypoplastic left heart syndrome (hint: 6)
- Obtain the health history, noting onset of cyanosis
- Note poor feeding & hx of tiring easily.
- Evaluate vitals noting tachycardia, tachypnea, and hypothermia
- Observe for increased work of breathing & gradually increasing cyanosis.
- Note pallor of the extremities & decreased oxygen saturation
- Auscultate the heart and lungs. Note adventitious breath sounds, a gallop rhythm, a single second heart sound, and a soft systolic ejection or holosystolic murmur.
(From Ricci Book) What is included in the nursing management of hypoplastic left heart syndrome? (hint: 6)
- Improving oxygenation
- Promoting adequate nutrition
- Assisting the child and family with coping
- Providing postoperative nursing care
- Preventing infection
- Providing child and family education
(From Ricci Book) List the nursing interventions for relieving hyper-cyanotic spells that occur with hypoplastic left heart syndrome
- Use a calm, comforting approach.
- Place the infant or child in a knee-to-chest position.
- Provide supplemental oxygen.
- Administer morphine sulfate (0.1 mg/kg IV, IM, or SQ).
- Supply IV fluids.
- Administer propranolol
How does fetal circulation work?
The fetus relies on the placenta for gas exchange → it bypasses the lungs (they are non-functional)
Fetal circulation is dependent of three bypass shunts → one at the liver, one at the heart & one at the great vessels
What are the three bypass shunts in fetal circulation?
Ductus Venosus
Foramen Ovale
Ductus Arteriosus
Ductus Venosus: How does fetal circulation differ from post-birth circulation when the placenta is clamped?
Umbilical vein carries oxygenated blood from placenta to infant; bypasses the liver through DV
when umbilical cord is clamped– & blood flow ceases & DV closes; blood then flows into the liver
Foramen Ovale: How does fetal circulation differ from post-birth circulation when the placenta is clamped?
Systemic blood enter the RA; oxygenated blood flows from right atria to left atria through FO; blood bypasses the nonfunctional fetal lungs; blood flows from the left atria to LV and out to aorta
FO closes after birth with changes in pressure in cardiac chambers with baby’s first breath
Ductus Arteriosus: How does fetal circulation differ from post-birth circulation when the placenta is clamped?
A fistula between the aorta & pulmonary artery that allows for mixing of blood; blood flowing through pulmonary artery can enter the aorta through the patent DA
DA closes after birth– but may take up to 3-4 days
what happens in post-birth circulation?
With the clamping of the umbilical cord & the baby’s first breaths; the shunts close and the baby’s lungs take over the role of oxygenation
Similar to circulation pattern of adults
