Cardiovascular Issues and Disorders Flashcards
Blood flow through the heart:
a) Superior vena cava —>
b) _____ ______ —>
c) tricuspid valve —>
d) Right ventricle —>
e) Pulmonic valve —>
f) lungs —>
g) Pulmonary veins —>
h) ____ ____ —>
i) mitral valve —>
j) Left ventricle —>
k) aortic valve —>
l) ______ —>
m) body —>
b) Right Atrium
h) Left atrium
l) aorta
Mitral/tricuspid (AV) valves closure, aortic/pulmonic (semilunar) valve open
S1
Aortic/ pulmonic (semilunar) valves closure, mitral/ tricuspid (AV) valves open
S2
Period between S1 and S2
Systole
Period between S2 and S1
Diastole
” Ken-tuck’ -y”; increased fluid states
S3
“Ten-ne-ssee”; stiff ventricluar wall
S4
Right upper sternal border (RUSB)
Aortic
Left upper sternal border (LUSB)
Pulmonic
Apex (Erb’s point)
Aortic or mitral
Left lower sternal border (LLSB)
Ventricular septal defect or tricuspid
Blood flows from ____ to lower pressure
higher
Resistance and flow
_____:
[ Increased pulmonary vascular resistance (PVR)
decreased systemic vascular resistance (SVR)] > no lung flow
Fetal
Resistance and flow
______:
(Decreased PVR, increased SVR) > lung flow
Neonatal
_____ loudness scale: 1 to 4 systolic
Murmur
Ventricular septal defect (VSD): _____
Thrill
Obstructive defect:
a) ______ click due to turbulence
b) Referred or radiated sound noted
Ejection
There is a variety of cardiovascular malformations resulting from abnormal structure development in the ____ trimester
first
The etiology of congenital heart disease multifactorial Includes ________ abnormalities, Adverse environment conditions, and unknown factors
chromosomal
Overall congenital heart disease occurs in ______ births
8: 1,000
Ventricular Septal defect (VSD) comprises up to ___ of all cogenital Heart defects
30%
Heart defects Noted Cogenitally:
a) ______ Lesions (Left to right shunting)
b) _______ Lesions (Right to left shunting)
c) _________ Lesions
a) Acyanotic
b) Cyanotic
c) Obstructive
________________________ (______ __ ___ ___)
1) Murmur
a) Grade 2 or 3/4 systolic ejection murmur
b) Heard best at the left upper sternal border (LUSB)
2) ECG: Right ventricular hypertrophy (RVH)
3) X-ray; Cardiomegaly, increase pulmonary vascular makings
Acyanotic defects (left to right shunting)
_____ ____ ____ (___)
1) Murmur
a) Grade 2 to 5/ 6 systolic ejection murmur
b) holosystolic thrill may be felt at the LLSB
2) ECG: Left ventricular hypertrophy (LVH) progressing to
biventricular hypertrophy if large VSD
3) X-ray; Cardiomegaly, increased pulmonary vascular markings
Ventricular Septal Defect (VSD)
5% to 10% of a congenital heart defect in term infants; very common in premature infants
1) Murmur: LUSB
a) 2 to 4/ 6 holosystolic
b) “machinery” sound
2) ECG findings: Left ventricular hypertrophy (LVH) to biventricular hypertrophy
3) X-ray findings: Cardiomegaly and increased pulmonary vascular markings
Patent ductus arterioles (PDA)
\_\_\_\_\_\_ \_\_\_\_ (Right to left shunting) Transposition of the Great Arteries
1) Murmur
a) Same as VSD
2) ECG findings: RVH
3) X-ray: “Egg on a string” with cardiomegaly, and increased pulmonary vascular markings
Cyanotic heart defect
____ _____ (Right to left shunting)
1) Four defects
a) Large VSD
b) Pulmonary Stenosis
c) Overriding aorta
d) RVH
2) Murmur: Loud systolic ejection click at the middle and upper left sternal border (M-LUSB)
3) ECG findings: Right axis deviation and right ventricular hypertrophy
4) X-ray findings: Boot-shaped heart, no cardiomegaly or pulmonary vascular markings
Tet Spell: Hypercaynaotic episodes
Tetralogy of Fallot
Obstructive Lesions
____ _____
1) Murmur
a) Systolic thrill at the right upper sternal border (RUSB)
b) Systolic ejection click present which does not vary with
respirations
c) Grade 2 and 4/ 5
2) ECG findings: LVH
3) X-ray findings: Usually normal, CHF if severe
Aortic Stenosis
Obstructive Lesions
\_\_\_\_\_ \_\_\_\_\_
1) Murmur:
a) Systolic, loudest at the LUSB
b) Grade 2 to 4/ 5 ejection click
c) The intensity of click decreases with inspiration and
increases with expiration
d) Thrill at the LUSB radiating to the back and sides
2) ECG findings: RVH
3) X-ray findings: Usually normalPulmonary Stenosis
- Murmur
a) 2 or 3/ 4 systolic ejection murmur with radiation to the
left interscapular area
b) may have an ejection click at the apex and RUSB if
the bicuspid valve is involved
2) ECG findings: RVH progressing to LVH
3) X-ray findings:
a) Cardiomegaly
b) pulmonary venous congestion
c) Rib notching dut o collateral circulation
BP in lower extremities will be lower than in upper extremities
Coarctation of the Aorta
_______ syndrome: Aortic arch anomalies
DiGeorge syndrome
Digeorge syndrome is associated with what trisomies?
a) Trisomy 18/ Edward’s
b) Trisome XXI/ Down syndrome
_____ _______: Atrioventricluar septal defects,VSD
Trisomy XXI/ Down syndrome
______ syndrome: Aortic regurgitation, mitral valve prolapse
Marfan syndrome
____ syndrome: Coarctation of the aorta, bicuspid aortic valve
Turner syndrome
Prenatal, birth, and family history of heart defects, and evaluate for the following:
a) ____ _____ ______
b) Exercise intolerance
c) Color changes; cyanosis
d) Tachypnea during sleep
e) ___ _____
f) diaphoresis
g) abnormal heart sounds
h) ______
i) Clubbing
j) Congestive heart failure
a) Frequent respiratory infections
e) Feeding problems
h) Edema
Management of pediatric Cardiac defects:
a) Referral to pediatric _________
b) ensure optimal primary care and anticipatory guidance
a) cardiologist
AKA functional, benign or physiologic murmur
Innocent Murmurs
______ murmurs
1) No associated symptoms, failure to thrive, or cyanosis
2) Occurs in > 50% of children
a) Thin chest wall
b) More angulated great vessels
c) More dynamic circulation
3) Low- intensity systolic murmurs (Grade 1 - 3/ 6)
4) May vary with position (sit > standing)
5) No radiation to neck/ back
6) Sinus arrhythmias: Heart rate varies upon inspiration and expiration
Innocent Murmurs
_______ Murmur
1) Most common innocent murmur
2) Musical systolic murmur
3) Heard best between LLSB and apex
4) Due to turbulence in the left ventricular outflow tract
5) Systolic ejection murmur
Still’s Murmur
______ Hum
1) Continuous humming murmur
2) RUSB
3) heard best in the sitting position; disappears in the
supine position
4) Also obliterated by turning head and/or compressing neck ipsilaterally
Venous Hum
A persistent elevation of average systolic/diastolic blood pressure > 95% with measurements obtained on at least three separate occasions per published tables for age and sex
Hypertension
______ as a symptom of other organ dysfunction is most common in children ( secondary to this)
Hypertension
Signs and symptoms of _________
a) Headache
b) Visual problems
c) Dizziness
d) Respiratory distress
e) Irritability
f) Nosebleed
Hypertension
Laboratory for hypertension:
a) ____ ___ (PA and lateral)
b) Plasma aldosterone level to rule out aldosteronism
c) Morning and evening cortisol level to rule out Cushing’s syndrome
d) UA, basic metabolic panel (BMP), CBC, cholesterol, and triglycerides
e) ECG for dysrhythmias, bundle branch block or LVH
Chest x-ray
Management of Hypertension:
a) Referral to a _________
Cardiologist
A post-infectious inflammatory disease that can affect the heart, joints and central nervous system
Rheumatic fever/ Heart Disease
_____ fever follows a group “A” strep infection of the upper respiratory tract and is most common in ages 6 to 15 years
Rheumatic Fever
The _____ valve is the most commonly affected with Rheumatic fever.
mitral valve
Diagnosis of Rheumatic Fever is fever plus two major or one major and ____ minor Jones criteria
two
Major manifestations for Rheumatic fever are:
a) ______
b) polyarthritis
c) Chorea
d) _____ ________
e) Subcutaneous nodules
a) Carditis
d) Erythema marginatum
Minor Criteria:
a) Arthralgia without objective inflammation
b) Fever > ______
c) Elevated level of acute phase reactants [erthrocyte
sedimentation rate (ESR) and C- reactive protein]
d) Prolonged PR interval on ECG with evidence of a group “A” B-hemolytic Streptococcus infection
> 102.2 degrees F
Laboratory/ Diagnostic fo Rheumatic fever:
1) Acute phase reactants
a) _____ throat culture
b) positive rapid strep assay
c) Increased or rising strep antibody titer
2) ECG
3) Echocardiogram
a) positive
Management of this requires:
a) refer to a pediatric cardiologists
b) aggressive management of the strep infection
c) bed rest if acute carditis is present
d) prophylactic antibiotics for invasive procedures as indicated
Rheumatic Fever
Acute febrile syndrome causing vasculitis cause this disease?
Kawasaki disease
Kawasaki Disease
a) The leading cause of _____ ___ disease in children of an infectious etiology
b) Most commonly noted in children under the age of two
c) Occurs most commonly in children of Asian ethnicity
coronary artery disease
The patient must have a ___, as well as at least four of the criteria listed below if the patient has more than four of the criteria, coronary vessel involvement is most likely.
Kawasaki Disease
Signs and symptoms of this are:
1) Fever for greater than five days
2) Bilateral conjunctival injection without exudate
3) polymorphous rash (urticarial or pruritic)
4) Inflammatory changes of the lips and oral cavity
5) Changes in extremities (erythema, edema)
6) Cervical lymphadenopathy
Kawasaki Disease
Laboratory/ diagnostics for Kawasaki:
a) _____
b) Elevated erythrocyte sedimentation rate (ESR)
c) Positive C- reactive protein
d) ECG changes: Prolonged PR and QT interval
CBC
Management of Kawasaki disease is:
1) Immediate referral to a cardiovascular specialist
2) High dose ____ therapy
a) 80 to 100 mg/kg/day until afebrile for 48 hours
b) Then, lower ASA dose ( 3 to 5 mg/kg/day) for
antiplatelet response
c) Discontinue ASA therapy in collaboration with
cardiologist
ASA
