Cardiovascular Dysfunction

Question 1

Heart starts to beat and blood begins circulating at ____ of gestation

Answer 1

21 days

Question 2

Foramen ovale

Answer 2

Opening between the atria that allows blood flow from the right atrium directly to the left - closes after birth

Question 3

Ductus arteriosus

Answer 3

Conduit between the pulmonary artery and the aorta that shunts blood away from pulmonary circulation - closes after birth

Question 4

Risk factors of cardiovascular issues

Answer 4

Medications - corticosteroids, contraceptives, Acutane, anticonvulsants
Tobacco, alcohol
Viral illness - coxsackievirus, CMV, influenza, mumps, rubella
Maternal age greater than 40
Radiation
Chromosome abnormalities
Autoimmune disorders

Question 5

Cardiac issues treatment

Answer 5

Decrease cardiac workload - prevent excessive crying, activities that limit energy expenditure
Evaluate food/fluid intake, weight gain - diet rich in iron and potassium, low in sodium

Question 6

Defects with increased pulmonary blood flow (4)

Answer 6

Patent ductus arteriosus (PDA), atrial septal defect (ASD), ventricular septal defect (VSD), atrioventricular canal defect

Question 7

Patent ductus arteriosus (PDA)

Answer 7

Fetal ductus arteriosus fails to close completely after birth - blood flows from aorta through PDA into the pulmonary artery and lungs
Causes increased left ventricular workload and increased pulmonary vascular congestion

Question 8

PDA signs

Answer 8

Loud machine like murmur, poor feeding, fatigue, HF, hepatosplenomegaly, poor weight gain, tachypnea, irritability, widened pulse pressure, bounding pulse rate

Question 9

PDA treatment

Answer 9

May spontaneously close
Indomethacin, ibuprofen
Surgery

Question 10

Atrial septal defect (ASD)

Answer 10

Abnormal communication between the atria - pressure is higher in the left atrium than the right, causing blood to shunt from left to right
Causes right ventricle and pulmonary artery to enlarge

Question 11

Ventricular septal defect (VSD)

Answer 11

Abnormal opening between the right and left ventricles - pressure from left ventricle causes blood to flow through the defect into right ventricle
Causes increased pulmonary vascular resistance and enlarged right side of heart

Question 12

Atrioventricular canal defect

Answer 12

Results from incomplete fusion of endocardial cushions - consists of a low atrial septal defect that is continuous with a high ventricular septal defect, clefts of mitral valve and tricuspid valve creating a large central AV valve that allows blood to flow between all chambers
Associated with Down syndrome

Question 13

AV canal defect signs

Answer 13

Moderate to severe HF, mild cyanosis that increases with crying, holosystolic murmur

Question 14

Obstructive defects (8)

Answer 14

Coarctation of aorta, aortic stenosis, pulmonic stenosis, tricuspid atresia, tetralogy of Fallot, transposition of the great vessels, truncus arteriosus, hypoplastic left heart syndrome

Question 15

Coarctation of aorta

Answer 15

Narrowing of the aorta - characterized by increased pressure proximal to the defect and decreased pressure distal to it
Restricted blood flow through the narrowed aorta increases pressure on the left ventricle and causes dilation of the proximal aorta and left ventricular hypertrophy –> left-sided HF

Question 16

Coarctation of aorta signs

Answer 16

Difference in BP between upper and lower extremities - higher in arms that lower extremities
Epistaxis, headaches, fainting, lower leg muscle cramps

Question 17

Aortic stenosis

Answer 17

Involves an obstruction to the left ventricular outflow of the valves - left ventricular pressure increases to overcome resistance of the obstructed valve and allow blood to flow into the aorta
Eventually produces left ventricular hypertrophy - myocardial ischemia may develop

Question 18

Pulmonic stenosis

Answer 18

Involves obstruction of blood flow from the right ventricle
Right ventricular pressure increases and can cause right ventricular hypertrophy and right-sided HF
Systolic murmur

Question 19

Tricuspid atresia

Answer 19

Tricuspid valve fails to develop - no communication between right atria and right ventricle
Causes cyanosis, hypoxia

Question 20

Tetralogy of Fallot

Answer 20

Combination of four heart defects:

1. ventricular septal defect
2. right ventricular hypertrophy
3. pulmonic stenosis
4. overriding aorta (overrides VSD)

Question 21

Tetralogy of Fallot signs

Answer 21

Hypercyanotic episodes (tet spells), transient cerebral ischemia, irritability, pallor, blackouts, convulsions

Question 22

Tet spell treatment

Answer 22

Squatting posture or knees to chest position for infants - increases systemic vascular resistance which increases pulmonary blood blow and eases respiratory effort

Question 23

Transposition of the great vessels

Answer 23

Pulmonary artery leaves the left ventricle (instead of right) and aorta leaves the right ventricle (instead of left)
Can cause HF, infective endocarditis, brain abscess, stroke

Question 24

Transposition of the great vessels signs

Answer 24

Severe respiratory depression and cyanosis at birth

Question 25

Truncus arteriosus

Answer 25

Failure of normal septation and division of the embryonic bulbar trunk into the pulmonary artery and aorta - results in single vessel that overrides both ventricles
Causes severe pulmonary edema and heart failure

Question 26

Hypoplastic left heart syndrome

Answer 26

Underdevelopment of the left side of the heart and involves various left sided defects - severe coarctation of the aorta, severe aortic valve stenosis/atresia, severe mitral valve stenosis/atresia

Question 27

Heart failure

Answer 27

Circular congestion due to decreased myocardial contractility, which results in the heart’s inability to pump sufficient blood to meet the body’s needs
Due to volume overload, pressure overload, decreased contractility, or high cardiac output

Question 28

Heart failure treatment

Answer 28

Digoxin
Reduce cardiac demands - keep child warm, schedule nursing interventions for rest, only feed for 45 minutes at a time, provide gavage feedings if infant becomes tired
Maintain high calorie, low sodium diet

Question 29

Digoxin therapeutic range

Answer 29

0.8-2 ng/ml

Question 30

Digoxin toxicity

Answer 30

Bradycardia, anorexia, nausea/vomiting

Question 31

Rheumatic fever

Answer 31

Autoimmune inflammatory process that occurs as a result of naturally acquired immunity to group A beta-hemolytic streptococcal infection - cardiac involvement in 50% of cases
Occurs 2-4 weeks after an untreated RTI with group A beta-hemolytic streptococci - begins to attack connective tissue, producing inflammation that affects the heart, joints, CNS, subcutaneous tissue

Question 32

Carditis in rheumatic fever

Answer 32

Lesions/plaque called Aschoff bodies form on heart valves causing edema and inflammation - when healed areas become fibrous and scarred, valve leaflets fuse, causing inefficiency and leakage
Mitral and aortic valves are most commonly affected

Question 33

Carditis signs

Answer 33

Jones Criteria
Tachycardia, cardiomegaly, murmur, pericardial friction rub, prolonged P-R interval, polyarthritis, chorea (involuntary irregular movements), erythema marginatum (non-pruritic macules with clear center, red defined border), subcutaneous nodules

Question 34

Rheumatic fever treatment

Answer 34

Assess cardiac and neurological status
Compliance with bedrest and activity restrictions
Penicillin
Promote prevention of rheumatic fever by encouraging proper evaluation and treatment of streptococcal infections

Question 35

Kawasaki disease

Answer 35

An acute systemic vasculitis - most common cause of acquired heart disease in children
Affected vessels enlarge until they reach their largest diameter in 4-6 weeks
Without treatment, can develop cardiac sequelae - dilation of coronary arteries resulting in aneurysm

Question 36

Kawasaki disease signs

Answer 36

fever unresponsive to antipyretics or antibiotics, conjunctival hyperemia, pharyngitis, strawberry tongue, swollen hands and feet, truncal rash, enlarged cervical nodes, diarrhea, hepatic dysfunction

Question 37

Kawasaki disease medications

Answer 37

Aspirin
IVIG - reduces immune response
Steroids