Cardiovascular Dysfunction Flashcards
What are some signs of cardiac dysfunction during H&P?
poor feeding
rapid breathing
difficulty keeping up with friends
What aspects of the mother’s health history could cause cardiac dysfunction in the infant?
diabetes
lupus
phenytoin
alcohol
drugs
infections (rubella)
how does low birth weight affect cardiac function?
increased risk of congenital anomalies
how does high birth weight affect cardiac function?
increased risk of heart disease
what family history might increase risk of cardiac dysfunction?
parents or siblings with heart defects
marfan syndrome
fetal loss
SIDS
Down syndrome
turner syndrome
what nutritional signs might indicate cardiac dysfunction?
failure to thrive
poor weight gain
what skin colours (2) might indicate cardiac dysfunction?
cyanosis = congenital heart defect
pallor = poor perfusion
what does an abnormal chest shape indicate?
enlarged heart
what are some respiratory signs of cardiac dysfunction?
tachypnea
dyspnea
expiratory grunt
clubbing is associated with ________
cyanosis
upon inspection, what signs might indicate cardiac dysfunction?
failure to thrive
poor weight gain
cyanosis
pallor
abnormal chest shape
tachypnea
dyspnea
expiratory grunt
visible neck vein pulsations
clubbing
upon palpation, what signs might indicate cardiac dysfunction?
thrills (chest)
hepatomegaly
splenomegaly
upon auscultation, what signs might indicate cardiac dysfunction?
tachycardia
bradycardia
irregular rhythms
murmurs
extra sounds
What are the diagnostic tests for cardiac dysfunction?
chest x-ray
ECG
echocardiography
cardiac catheterization
exercise stress test
What does a chest x-ray show?
heart size
blood flow
What does an ECG show?
electrical activity
detect dysrhythmias
What does na echocardiogram show?
cardiac structures
what does cardiac catheterization measure?
pressure and oxygen in heart chambers
cardiac structures
blood flow
what does an exercise stress test measure?
HR, BP, ECG and O2 consumption at rest and during exercise
what are the 2 types of cardiac defects?
- congenital heart disease
- acquired
what is congenital heart disease?
anatomical, abnormal function
what is the cause of congenital heart disease?
unknown
what is congenital heart disease associated with?
chromosomal abnormalities
Trisomy 21, 13, and 18
what is the most common anomaly with congenital heart disease?
ventricular septal defect
what is a ventricular septal defect?
hole between right and left ventricles
what is the foramen Ovale?
when does it close?
shunts blood from RA to LA
closes when LA pressure exceeds RA pressure
what is the ductus arteriosus?
when does it close?
shunts blood from pulmonary artery to aorta
bypasses lungs
closes when baby takes first breath
blood oxygen concentration increases
what happens if the FO and DA don’t close after birth?
congenital heart defects
what causes cyanosis (CHD)?
change in pressure
right to left shunt
deoxygenated blood bypasses lungs
decreased oxygen delivery
acyanosis (CHD)
presence of CHD
but O2 delivery unaffected
no cyanosis
what are the 4 types of congenital heart defects?
are they cyanotic or acyanotic?
- increased pulmonary blood flow (acyanotic)
- decreased pulmonary blood flow (cyanotic)
- obstruction (acyanotic)
- mixed blood flow (cyanotic)
increased pulmonary blood flow congenital heart defect
opening between atria
blood flows L to R
increased blood volume on R side
increased pulmonary blood flow
decreased systemic blood flow
what are the signs and symptoms of increased pulmonary blood flow congenital heart defect?
asymptomatic
heart failure
murmurs
atrial dysrhythmias
what are some examples of increased pulmonary blood flow congenital heart defect?
atrial septal defect
ventricular septal defect
patent ductus arteriosus
decreased pulmonary blood flow congenital heart defect
pulmonary blood flow obstruction + anatomical defect
blood has difficulty leaving heart through pulmonary artery
blood shunts right –> left bypassing lungs
deoxygenated blood enters systemic circulation
what are the signs and symptoms of decreased pulmonary blood flow congenital heart defect?
hypoxemia
cyanosis
what are some examples of decreased pulmonary blood flow congenital heart defect?
tetralogy of fallot
tricuspid atresia
what is tetralogy of fallot?
4 structural defects
- ventricular septal defect
- pulmonic stenosis
- overriding aorta
- RV hypertrophy
what is tricuspid atresia?
tricuspid valve fails to develop
obstruction of blood flow congenital heart defect
blood exiting heart meets stenosis
pressure before obstruction increases (in ventricle)
pressure after obstruction decreases
occurs near valve
what are the signs and symptoms of obstruction of blood flow congenital heart defect?
decreased CO
heart failure
hypoxemia
asymptomatic
what are some examples of obstruction of blood flow congenital heart defect?
coarctation of aorta
(narrowing of aortic arch)
aortic stenosis
pulmonic stenosis
mixed blood flow congenital heart defect
oxygenated and unoxygenated blood mix
causes desaturation of systemic blood flow
decreased CO
what are the signs and symptoms of mixed blood flow congenital heart defect?
cyanosis
heart failure
what are some examples of mixed blood flow congenital heart defects?
transposition of great arteries
total anomalous pulmonary venous connection
truncus arteriosus
hypo plastic left heart syndrome
what is transposition of great arteries?
arteries switch
pulmonary artery leaves LV
aorta leaves RV
what is total anomalous pulmonary venous connection?
pulmonary veins connect to R side of heart instead of LA
what is truncus arteriosus?
only one artery leaves the heart instead of the pulmonary artery and aorta
what is hypo plastic left heart syndrome?
underdeveloped L side of heart
what are the 2 consequences of congenital heart defects?
- heart failure
- hypoxemia
what is heart failure?
inability of heart to pump adequate blood into systemic circulation
what is R sided HF?
RV fails to pump blood into pulmonary artery
increased pressure in RV and systemic circulation
what are some signs and symptoms of R sided HF?
hepatosplenomegaly
edema
what is L sided HF?
failure of LV to pump blood into systemic circulation
increased pressure in LA and pulmonary veins
what are some signs and symptoms of L sided HF?
pulmonary edema
crackles
what are the consequences of HF?
myocardial damage
decreased CO
decreased kidney perfusion
how do the kidneys respond in HF?
decreased kidney perfusion
kidneys think fluid volume is low
reabsorb more sodium and water
fluid overload
what are the 4 goals of treatment for HF?
- improve cardiac function
- decrease fluid
- improve oxygenation
- decrease cardiac demand
what 3 medications can be used in HF to improve cardiac function?
- digitalis (digoxin)
- ACE inhibitors
- beta blockers
what are the effects of digitalis (digoxin)?
increases contractility without increasing HR
increases CO
decreases heart size
do not administer digoxin if HR is < _____________
< 90 bpm
what are the effects of ACE inhibitors?
vasodilation
decreased aldosterone
decreased sodium and water reabsorption
what are the adverse effects of ACE inhibitors?
hypotension
cough
renal dysfunction
what are the adverse effects of beta blockers?
hypotension
dizziness
what medication is used to decrease fluid in HF?
diuretics
- thiazide
- furosemide
what are the interventions for decreasing fluid in HF?
diuretics
fluid and sodium restriction
monitor intake and output
prevent dehydration
what are the interventions for decreasing cardiac demand in HF?
decrease WOB
encourage sleep
schedule feeds around sleep
- prevent hunger
maintain body temp
what is hypoxemia?
decreased arterial oxygen saturation
what are the 2 clinical manifestations of hypoxemia?
hypoxia
cyanosis
what is hypoxia?
decreased tissue oxygenation
what are the 2 physiological changes in response to chronic hypoxemia?
polycythemia
clubbing
what is polycythemia?
increased RBCs to compensate for hypoxemia
increased O2 carrying capacity
what is the risk associated with polycythemia?
increased blood viscosity
increased risk of clotting
mild hypoxemia is ____________
asymptomatic
what are some signs of severe hypoxemia?
fatigue with feeding
poor weight gain
tachypnea
dyspnea
what are some complications of hypoxemia?
mostly neurological
- CVA
- stroke
- abscesses
- developmental delays
what is the goal of hypoxemia diagnosis?
distinguish between cardiac or pulmonary cause
PaO2 > 100 mmHg = lung disease
PaO2 < 100 mmHg = cardiac disease
what is the treatment for hypoxemia?
IV prostaglandin E
what are the effects of prostaglandin E?
vasodilation
what are hypercyanotic spells?
severe cyanotic episodes
what causes hypercyanotic spells?
what are some triggers?
spontaneous
OR
decreased SVR
triggers
- feeding
- crying
- defecation
- stress
hypercyanotic spells are associated with ___________
tetralogy of fallot
what are the treatments for hypercyanotic spells?
knee to chest position
oxygen therapy
morphine
IV fluid replacement
what does the knee to chest position do?
increases systemic vascular resistance
what is acquired cardiac defect?
caused by a disease process
what are some causes of acquired cardiac defects?
infection
autoimmune response
familial tendencies
medications
environmental
what are the 2 acquired cardiac defects?
endocarditis
cardiomyopathy
what is endocarditis?
infection of endocardium
what are the causes of endocarditis?
bacteremia
congenital anomalies
dental work
invasive procedures
central lines
IV drug use
what are the common pathogens that cause endocarditis?
S. aureus
streptococcus
fungi
what are the clinical manifestations of endocarditis?
fever
malaise
weight loss
janeway lesions
osler nodes
roth spots
what are janeway lesions?
nontender erythematous macule
on palms and feet
janeway lesions are more common in ___________ endocarditis
acute
what are Osler nodes?
tender subcutaneous violet nodules
on pads of fingers and toes
what are Roth spots?
exudative edematous hemorrhagic lesions of the retina
what are the treatments for endocarditis?
IV antibiotics
surgery
high risk: antibiotic prophylaxis
what is cardiomyopathy?
myocardial abnormality causing impaired cardiac muscle contraction
what are the causes of cardiomyopathy?
familial or genetic
infection
deficiencies
hemochromatosis
Duchenne muscular dystrophy
Kawasaki disease
collagen vascular disease
thyroid dysfunction
what are the 3 types of cardiomyopathy?
- dilated
- hypertrophic
- restrictive
what is dilated cardiomyopathy?
decreased contractility
what is the most common form of cardiomyopathy in children?
dilated
what are the symptoms of dilated cardiomyopathy?
HF symptoms
what is hypertrophic cardiomyopathy?
LV hypertrophy causes abnormal filling
what is restrictive cardiomyopathy?
decreased ventricular filling
how is cardiomyopathy diagnosed?
ECG
exercise stress test
MRI
genetic testing
what is the goal of treatment for cardiomyopathy?
correct underlying cause
what is the first line of treatment for cardiomyopathy?
beta blocckers
what are the other treatment options for cardiomyopathy?
diuretics
Ca2+ channel blockers
implantable cardioverter or defib
anticoagulants
heart transplant (if severe)
what medication should NOT be given for cardiomyopathy?
digoxin
what are the 3 main vascular dysfunctions?
hypertension
Kawasaki disease
shock
what is primary hypertension?
no identifiable cause
what is secondary hypertension?
identifiable cause
what are the possible causes of HTN?
renal disease
CVD
endocrine disorder
neurological disorder
what is Kawasaki Disease?
mucocutaneous lymph node syndrome
acute systemic vasculitis of medium sized arteries
especially coronary arteries
what is the cause of Kawasaki disease?
unknown
Kawasaki disease most seriously affects ____________
infants < 1 year
what is the main clinical manifestation of Kawasaki?
inflammation of medium sized arteries
what are the 3 phases of Kawasaki disease?
- acute
- subacute
- convalescent
what is the acute phase of Kawasaki disease?
high fever
unresponsive to antibiotics and antipyretics
what is the subacute phase of Kawasaki disease?
fever resolves
high risk for aneurysms
lasts until clinical signs resolve
what is the convalescence phase of Kawasaki disease?
clinical signs resolved
abnormal lab values
lasts until temp and lab values are normal
how is Kawasaki disease diagnosed?
no tests
based on clinical findings
echocardiogram
what are 2 good indicators of possible Kawasaki disease?
prolonged fever
unresponsive to antibiotics
the diagnostic criteria for Kawasaki disease should be used as a ____________
guideline
what is the diagnostic criteria for Kawasaki disease?
fever for 5+ days and 4/5 criteria
- bulbar conjunctival injection
- oral mucous membrane changes
- injected or fissured lips
- injected pharynx
- strawberry tongue - peripheral extremity changes
- edema
- erythema - polymorphous rash
- cervical lymphadenopathy
when should treatment for Kawasaki disease start?
within 10 days of symptom onset
how is Kawasaki disease treated?
IV immunoglobulin
aspirin
salicylate
anticoagulants
what is shock?
inadequate perfusion leads to organ failure
what are the 3 types of shock?
- hypovolemic
- distributive
- cardiogenic
what are the causes of hypovolemic shock?
burns
trauma
hemorrhagic
diarrhea
vomiting
what are the causes of distributive shock?
anaphylaxis
sepsis
myocardial depression
what are the causes of cardiogenic shock?
heart failure
dysrhythmias
what are the 3 stages of shock?
- compensated
- decompensated
- irreversible
what is compensated shock?
vital organ function maintained by compensatory mechanisms
what is decompensated shock?
decreased cardiovascular function
what is irreversible shock?
vital organ damage
what are some complications of shock?
cerebral edema
hemorrhage
renal ischemia
resp distress
GI bleeding
hypoglycemia
hypoclacemia
what are the 3 treatments for shock?
- ventilation
- fluids
- improve cardiac function
how do we improve ventilation during shock?
tracheal intubation + positive pressure
supplemental oxygen
what fluids should be administered for shock?
crystalloids
colloids
