Cardiovascular Dysfunction Flashcards
atresia
congenital absence or pathological closure
Stenosis
anatomic narrowing
Normal cardiac flow
S/IVC - RA - Tricuspid valve - RV - Pulmonary valve - pulmonary artery - lungs - pulmonary veins - LA - mitral valve - LV - aortic valve - aorta - body
high pressure side prenatally
right side
high pressure side after birth
left side
blood follows the path of
least resistance
congenital heart disease
abnormalities present at birth
acquired heart disease
occur after birth
biggest cause of death in the first year of life
congenital heart defects
most common congenital heart defect
VSD
cause of congenital heart defects
etiology unknown in 90% of cases
FAS relation to congenital heart defects
50% of FAS kids have a heart defect
what chromosomal abnormality is associated with heart defects
downs syndrome
diagnostic procedures for cardiac abnormalities X4
EKG, CXR, ECHO, cardiac cath
CXR shows X3
size, cardiomegaly, pulmonary congestion
what is an echo
high frequency sound waves to produce real time image
cardiac cath as a diagnostic
defines a defect prior to surgery by determining blood flow patterns
cardiac cath as interventional
balloon to correct aorta/valve issues or mesh devices to close septal defects
cardiac cath electrophysiology
stimulate different areas of the heart to determine which area is causing arrhythmia then cauterize it
cardiac cath pre procedural care
mark pulses prior to cath in case it is hard to find after procedure
cardiac cath post procedure
pulses for equality and symmetry
how long do you keep extremity straight for venous caths
4-6 hours
how long do you keep extremity straight for arterial caths
6-8 hours
for bleeding at cath entry site
apply direct continuous pressure 1 inch above entry site
how long should activity be limited following a cardiac cath
24 hours
left to right shunt
blood flows from systemic circulation to pulmonary leading to increased pulmonary blood flow
right to left shunt
blood flows from pulmonary circulation to systemic, allowing deoxygenated blood to flow into body
atrial septal defect shunting
left to right - increased pulmonary blood flow
ASD patho
abnormal opening between the atria
small ASD defect s/s
potentially asymptomatic
large ASD defect s/s X3
fatigue, SOB, respiratory infections
ASD treatment - spontaneous closure
depends on the size of the defect and the age of the child
ASD treatment - catheter closure
septal occluders - smaller defects
ASD treatment - surgical closure
pericardial/dacron patch for moderate to large defects
sutures for smaller defects
Ventricular Septal Defect shunting
left to right shunt
VSD patho
abnormal opening between the right and left ventricle
VSD s/s small defect
probably asymptomatic. no physical restrictions. only requires reassurance and periodic follow-ups
VSD s/s moderate to large defect
CHF common
VSD treatment - spontaneous closure
occurs 20-60% of the time - depends on size of defect and the age of the child
VSD treatment small defects
sutures
VSD treatment large defects
patches
VSD palliative care
pulmonary artery banding with the goal to decrease pulmonary blood flow
preferred approach in VSD
complete repair in infancy
PDA shunting
left to right shunt
PDA patho
failure of the ductus arteriosus to close within the first 3 weeks of life
small PDA s/s
asymptomatic
large PDA s/s
CHF, FTT, machinery like murmur with frequent respiratory infections
PDA non surgical treatment
indomethacin (close), prostaglandin (open) and coils
indomethacin is used in X2
premature infants and some newborns
PDA surgical treatment
ligation
tetraology of fallot patho
4 cardiac defects - VSD, pulmonary stenosis, overriding aorta, right ventricular hypertrophy
tetraology of fallot s/s X4
cyanosis, tachypnea, clubbing and growth retardation
tet spells preceded by
feeding, crying, defecation or stressful procedures
tet of fallot shunting
right to left shunt
tet spells occur during X YOL before X months old and usually at X time of day
1st year of life, usually before 2 months old and usually in the morning
what are tet spells
acute episodes of cyanosis and hypoxia
tet spells nursing interventions X4
knee chest positioning, blow by 100% O2, morphine, IVF replacement
tet of fallot treatemtn
prevent infections, monitor/treat anemia, surgical correction
surgery for tet of fallot
palliative shunt with complete repair at 6 mo-1 yr
coarctation of aorta patho
narrowing of aorta at or near the ductus arteriosus
coarctation of aorta s/s
elevated BP in arms with bounding pulses, decreased BP in legs with weak/no pulses, cool lower extremities
coarctation of aorta treatment - non surgical
infants and children - balloon angioplasty
adolescents - stent placement
coarctation of aorta treatment - surgical post op complications
HTN and recoarctation
aortic stenosis patho
narrowing of the aortic valve from 3 to 2 leaflets
aortic stenosis leads to X4
left ventricular enlargement, decreased cardiac output, left ventricular hypertrophy, increased left atrial pressure
aortic stenosis s/s mild to moderate
asymptomatic
aortic stenosis s/s severe in newborns
decreased cardiac output, faint pulses, hypotension, tachycardia, poor feeding
aortic stenosis s/s severe children
chest pain, SOB, syncope, exercise intolerance, dizziness
aortic stenosis physical restrictions in mild cases
able to participate in most sports and activities
aortic stenosis physical restrictions in mod-severe cases
no sustained strenuous activities, no competitive sports
the only heart defect where activity may be restricted
aortic stenosis
non-surgical aortic stenosis treatment
balloon valvuloplasty
surgical aortic stenosis treatment
valvotomy, valve replacement
pulmonic stenosis patho
narrowing of pulmonary valve or artery
mild pulmonic stenosis s/s
asymptomatic or mild cyanosis
mod-severe pulmonic stenosis s/s
CHF and requires elective treatment
non-surgical pulmonic steonsis tx
balloon valvuloplasty
surgical pulmonic stenosis tx
valvotomy and valve replacement
hypoplastic left heart syndrome patho
underdevelopment of the left side of the heart d/t hypoplastic left ventricle, aortic atresia with oxygenation dependent on ASD or PFO and systemic blood flow is dependent on PDA
HLHS s/s
mild cyanosis, heart failure, lethargy, cold hands and feet
normal O2 level in HLHS
75-80%
HLHS treatment
staged reconstruction (3 operations), heart transplant
HLHS prognosis without treatment
fatal within 3 weeks of life
HLHS medication
prostaglandin infusion
right sided failure
right ventricle is unable to pump blood effectively into pulmonary artery
left sided failure
left ventricle is unable to pump blood into the systemic circulation
digoxin method of action
effects the rate and power of contraction
DNU digoxin in infants when X
90-110
DNU digoxin in children when X
below 70
captopril
ACE inhibitor
enalapril
ACE inhibitor
lisinopril
ACE inhibitor
carvediolol
beta blocker
furosemide
diuretic
chlorothiazide
diuretic
spirnolactone
diuretic
infection endocarditis patho
infection of the valves and inner lining of the heart caused by bacteria that enter the blood stream and settle in the heart lining, heart valve or blood vessel
infective endocarditis treatment
blood cultures, abx, surgery, echo
highest risk for infective endocarditis
children who have undergone surgical repair/palliative surgery for valvular abnormalities, prothetic valves, conduits/shunts
infective endocarditis prognosis
fatal if untreated
infective endocarditis s/s
hx of dental procedure with a new murmur or change in existing one
infective endocarditis prevention
good oral hygiene and amoxicillin 1 hr before dental procedures
rheumatic fever patho
inflammatory disease that occurs as a rxn to GABHS pharyngitis
rheumatic fever s/s
usually 2-4 weeks after a strep throat infection, elevated ASO titer, polyarthritis, erythema marginatum, chorea, arthralgia
erythema marginatum
round, 2 circle rash - characteristic for rheumatic fever
rheumatic fever complications
inflammation in joints, skin, brain, serous surfaces, and heart - most common mitral valve damage
rheumatic fever treatment
10 day PCN with aspirin and prednisone
kawasaki disease patho
acute systemic vasculitis
kawasaki risk factors
males, asians, kids under 5
kawasaki diagnostic
elevated CRp and ESR and Plt
kawasaki acute phase
fever for 5+ very irritable, erythema/edema of hands/feet, strawberry tongue
kawasaki subacute phase
desquamation of fingers/toes
kawasaki convalescent phase
begins when all clinical signs start to resolve 6-8 weeks after onset
kawasaki treatment
IVGG - high doses, aspirin,
