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CCRN > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

In fetal circulation where is the foramen ovale located?

A

Between right and left atrium

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2
Q

How does fetal circulation work?

A

IVC ➡️ RA ➡️ foramen ovale ➡️ Aorta

SVC ➡️ PDA ➡️ aorta

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3
Q

What causes fetal shunts to close?

A
  1. Increased arterial oxygen tension
  2. Decreased prostaglandins
  3. Decreased adenosine levels
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4
Q

When does the fetal shunts start to close?

A

When baby takes its first breath due to increased PVR

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5
Q

When does the PDA start to close?

A

Closure is within 10 to 24 hours

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6
Q

When does foramen ovale start to close?

A

When the pressure in the RA is less than the pressure in the LA

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7
Q

What is cardiac output?

A
  1. Volume of blood pumped by the heart and one minute
  2. Measures hearts efficiency
  3. Stroke Volume x Heart Rate
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8
Q

What is the cardiac output in a normal newborn?

A

200 mL/kg/min

Children has higher CO then adult due to increased heart rate

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9
Q

What is preload?

A
  1. End of diastole
  2. Elasticity when the ventricles are filled to the maximum
  3. Volume
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10
Q

What can cause decrease in preload?

A

Dehydration

Vasodilation

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11
Q

What is afterload?

A
  1. Pump
  2. Resistance against which the ventricles must pump
  3. The work that the heart has to do to push blood into the aorta and around the body or into the lungs
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12
Q

What is contractility?

A
  1. Squeeze

2. Amount of force exerted with each contraction

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13
Q

What causes contractility?

A

Hypoxemia

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13
Q

What is the conduction of the heart?

A

SA node
AV node
Bundle of His
Purkinje fibers

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14
Q

What does the Purkinje fibers do?

A

It causes LV to contract

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15
Q

What is congestive heart failure?

A

A syndrome in which the heart cannot pump an adequate amount of oxygenated blood to meet the metabolic needs of the body

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16
Q

What are the two types of heart failure?

A

Right sided heart failure

Left sided heart failure

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17
Q

What is right-sided heart failure?

A

The right ventricle is not able to efficiently pump blood into the pulmonary artery therefore the right side of the heart becomes congested and backs up into the veins and the body

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18
Q

What is left-sided failure?

A

Left ventricle is not able to pump blood into the aorta and systemic circulation resulting in increased pressure in the left atrium and pulmonary veins and goes back into the lungs

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19
Q

Causes of CHF in children

A
  1. Structural abnormalities
  2. Myocardial failure
  3. Excessive demands on the normal heart muscle
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20
Q

Hypoxemia

A

An arterial oxygen tension (of pressure, PaO2) that is less than normal and can be identified by a decreased arterial oxygen saturation or a decreased PaO2

21
Q

Hypoxia

A

Reduction in tissue oxygenation that results from low oxygen sats and paO2 and results in impaired cellular processes

22
Q

Define shock

A

Circulatory failure - inadequate perfusion to meet metabolic needs of the body

23
Q

What would happen to the BP on initial shock?

A

Increased BP d/t initial vasoconstriction

24
Q

3 signs of shock

A

Hypotension
Hypoxemia
Metabolic acidosis

25
Q

Compensated shock

A

Vasoconstriction caused by sympathetic nervous system
Normal BP, might be a little high
Provides blood to vital organs
Cold, clammy skin
Decreased bowel sounds
Decreased urinary output
Lactic acid increases - inc metabolic acidosis

26
Q

Uncompensated shock

A

Compensation fails and the cv system can no longer maintain perfusion to the microvasculature

27
Q

Manifestations of uncompensated shock

A 
Hypotension
Rapid respiration 
Tachycardia
Mental status changes
Increased BUN and creatinine
Liver enzymes increase
DIC
28
Q

Types of shock

A

Cardiogenic shock
Hypovolemic shock
Obstructive shock
Distributive shock

29
Q

Cardiogenic shock

A

Ineffective pumping mechanism of the heart

Decreased CO and increased SVR caused by inc afterload, dec contractility

30
Q

Hypovolemic shock

A 
Most common type in children
Dec in intra vascular body by 15-25%
⬇️ preload
⬆️ afterload 
No change in contractility
31
Q

Obstructive shock

A

Severe obstruction to ventricular filling or outflow

Ex. Tension pneumothorax or PE

32
Q

Distributive shock

A

Abnormal distribution of blood volume
⬇️ SVR d/t massive vasodilation
Blood shunts pass capillary beds

33
Q

Three types of distributive shock

A

Septic
Anaphylactic
Neurogenic

34
Q

What is anaphylactic shock

A 
Vasodilation from release of mediators:
IgE
Histamine
Serotonin 
Bradykinin 
PGR
35
Q

Neurogenic shock

A

Loss of sympathetic vasomotor tone leads to extreme visit dilation

Can be a complication of brain or spinal cord injury

36
Q

In a child diagnosed with cardiac hypertrophy, the heart muscle enlarges due to:

A

⬆️ in the size of myocytes

37
Q

Cardiomyopathy

A

Disease of the heart muscle

38
Q

Myocyte degeneration occurs because of

A

Changes in the myocardium

39
Q

Decreased contractility occurs because of

A

Scarring

40
Q

The most common cause of sudden cardiac death and young healthy athlete is

A

Hypertrophic cardiomyopathy

41
Q

Three types of cardiomyopathy

A

Hypertrophic
Dilated
Restrictive

42
Q

What is commotio Cordis

A

Sudden hit in chest that causes lethal arrhythmia

43
Q 
40%
Most often seen in infants and teens
Autosomal dominant
Hypertrophied nondilated left ventricle
Left ventricular outflow tract obstruction
⬆️ size and thickness of left ventricle
⬇️ LV filling
Syncope is most common sign d/t arrhythmia
A

Hypertrophic cardiomyopathy

44
Q

Name a few causes of dilated cardiomyopathy

A

Idiopathic
Myocarditis
Genetic

45
Q 
CHF from dilated left ventricle and systolic dysfunction
⬆️ ventricular chamber size
⬆️ myocardial stretch
⬇️ contractile force
⬆️ ventricular end diastolic pressure
⬆️ diastolic volume
⬇️ stroke volume
A

Dilated cardiomyopathy

46
Q

Least common type of cardiomyopathy
Minimal contractile movement
Ventricular walls become stiff and prevent the heart from filling with blood
⬇️ ventricular compliance

A

Restrictive cardiomyopathy

47
Q

Manifestations of cardiomyopathy

A 
Enlarged heart
Contractility changes
Signs of CHF
Poor perfusion
Changes in heart sounds especially Gallop 
Arrhythmias
risk of emboli
Chest pain
Syncope
48
Q

Medicines for hypertrophic cardiomyopathy

A

Beta adrenergic agonist ⬇️ ventricular workload

Inotropes: used cautiously

Ca Channel blocker ⬇️ afterload and Contractility

49
Q

Medicines for dilated cardiomyopathy

A

Digoxin: ➕ inotropes: ⬆️ contractility

Beta blockers: counter sympathetic stimulation

50
Q

Surgery for cardiomyopathy includes

A

Ventricular septal myotomy
Pacing
Fluid and Na restrictions
Transplantation

CCRN (9 decks)

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