Cardiovascular Issues & Disorders Flashcards
1
Q
Blood flow through the heart:
From the superior vena cava –> right atrium –> tricuspid valve –> right ventricle –> -1- valve –> -1- artery –> -2- –> -1- veins –> left atrium –> -3- –> left ventricle –> -4- –> -5- –> body
A
- pulmonic/pulmonary
- lungs
- mitral valve
- aortic valve
- aorta
2
Q
Heart Sounds & Anatomical Location
- S1
- S2
- S3
- S4; rare in children, indicative of -5-
A
- “lub,” closure of the “small” valves - mitral and tricuspid; beginning of systole
- “dub,” closure of the “large” valves - pulmonic and aortic; beginning of diastole
- “Arkansas,” Physiologic finding in children
- “Virginia,” indicative of heart failure, so exceedingly rare in children (outside of cardiac critical care)
3
Q
Auscultation Areas
- 1-: Aortic
- 2-: Pulmonic
- 3-: Mitral
- 4-: Tricuspid, where -5- can be heard
A
- RUSB
- LUSB
- Erb’s point (apex)
- LLSB
- ventricular septal defect (VSD)
4
Q
Notable Cardiac Characteristics
Blood flows from -1- to -2-; -3- a lot of pressure to -4-
A
- higher
- lower pressure
- the left ventricles need
- oxygenate the body
5
Q
Notable Cardiac Characteristics
Resistance & flow
- Fetal: -1- <– -2-
- Neonatal: -3- <– -4-
A
- increased pulmonary/decreased systemic vascular resistance
- No lung flow
- decreased PVR/increased SVR
- lung flow!
6
Q
Notable Cardiac Characteristics
-1- loudness scale: -2-
VSD: -3-
A
- Murmur
- I-VI/VI systolic
- Thrill
7
Q
Notable Cardiac Characteristics
-1- defects
> -2- due to -3-
> -4- sound noted
A
- obstructive
- ejection clicks
- turbulence
- Referral/radiation of
8
Q
Murmur grades I: only audible with -1- II - IV: -2- V: loud, heard -3-, thrill palpable VI: very loud, heard -4-, thrill both palpable and visible
A
- specialized tools found in the ICU
- easily audible with steth
- with only part of the stethoscope on the chest wall
- without sethoscope
9
Q
Congenital Heart Diseases/Anomalies
Result from abnormal -1- in the first trimester
Occurs in -2-
-3- most common of all congenital heart defects, indicated by -4-
A
- structural development
- approximately 1% of births/year
- VSD is the
- LLSB thrill
10
Q
Atrial Septal Defect
Grade -1-/VI -2- murmur in the -4-
EKG: -3-
A
- II-III
- Systolic ejection
- Right ventricular hypertrophy (RVH)
- LUSB (pulmonic space)
11
Q
Atrial Septal Defect
Mgmt
> -1- to pediatrician and -2-
> some small ASDs -3-; medium to large require -4-
A
- referral
- pediatric cardiologist
- close spontaneously
- surgical correction
12
Q
Ventricular Septal Defect (VSD) > Murmur -> Grade -1-/VI -2- murmur -> A -3- may be -4- > EKG: -5- progressing to biventricular hypertorphy if VSD is large
A
- II-V
- systolic ejection
- holosystolic thrill
- felt at the LLSB
- LVH
13
Q
VSD
> X-ray: -1-, incrased pulmonary vascular markings
> Mgmt
-> Some small -2-; -3- require -4- (more -5-)
A
- cardiomegaly
- VSDs close spontaneously
- medium to large
- surgical correction
- than for ASD
14
Q
Patent Ductus Arteriosus (PDA) 5-10% of congenital herat defects in term infants; very -1- > Murmur: -2- -> II to IV/VI -3- -> -4- sound (like a -5-)
A
- common among premature infants (Premies are Patent)
- LUSB left upper sternal border
- holosystolic
- Machinery
- washing machine
15
Q
PDA
> EKG: -1- to biventricular
> X-ray findings: -2- and -3-
A
- LVH
- Cardiomegaly
- increased pulmonary vascular markings
16
Q
PDA Mgmt
> referral to pediatrician and -1-
> for preterm infants, -2- inhibitors (ibuprofen, -3-) may be used
> -4- is preferred in -5-
A
- cardiologist
- prostaglandin
- indomethacin
- Percutaneous occlusion
- adolescents
17
Q
Transposition of the Great Arteries
> -1-
-> Same -2-
> EKG: -3-
A
- Murmur
- as VSD (grade II-V systolic ejection)
- RVH
18
Q
Transposition of the Great Arteries
> X-ray: -1- with -2- and increased -3-
> Mgmt
-> Supportive care via a -4-, then -5-
A
- “egg on a string”
- cardiomegaly
- pulmonary vascular markings
- ped cardiologist
- surgical repair
19
Q
Transposition of the Great Arteries
> Mgmt
-> Long-term supportive care, including routine screening for -1- secondary to -2-
A
- developmental delays
2. perioperative hypoxemia
20
Q
Tetralogy of Fallot Definition: -1- > -2- > -3- > -4- > -5-
A
- Four concurrent heart defects (children commonly running and squatting when playing)
- Large VSD
- Pulm stenosis
- overriding aorta
- (those three lead to) RVH
21
Q
Tetralogy of Fallot
> Murmur: -1- at the -2- and -3-
> X-ray findings: -4-, no cardiomegaly or pulmonary vascular markings
A
- loud systolic ejection click
- middle
- upper left sternal border (M-LUSB)
- boot-shaped heart
22
Q
Aortic Stenosis
> systolic -1-
-> Murmur -2- present which -3-
> EKG findings: -4-
A
- thrill at the RUSB
- systolic ejection click
- does not vary with respirations
- LVH
23
Q
Aortic Stenosis Mgmt
> referral to pediatrician & -1-
> balloon -2-
> regular follow up, especially in regard to -3-
A
- pediatric cardiologist
- aortic valvuloplasty
- sports participation
24
Q
Pulmonic Stenosis Murmur
-1-, -2- at the -3-
Grade II to V/VI -4-
Intensity of -5- w/ -6-
A
- Systolic
- Loudest
- LUSB
- ejection click
- click decreases
- inspiration and vice versa
25
Pulmonic Stenosis Murmur
| -1- at the LUSB, -2- and -3-
1. Thrill
2. radiating to the back
3. sides
26
Pulmonic Stenosis
> EKG: -1-
> Mgmt
-> regular follow-up to monitor improvement -3-
-> -4-; further evaluation needed in moderate/severe stenosis
1. RVH
3. every 6 mo. to 2-5 years
4. sports participation generally not restricted
27
Coarctation of the Aorta Murmur
| > II to III/VI -1- murmur with -2- to the -3-
1. systolic ejection
2. *radiation*
3. left interscapular area
28
Coarctation of the Aorta
| > Decreased or absent pulses: -1-; -2- in -3- will be -4- than in -5-
1. CARDINAL FINDING
2. BP
3. lower extremities
4. lower
5. upper extremities
29
Coarctation of the Aorta
> EKG: -1- progressing to -2-
> X-ray: -3- due to -4-
1. RVH
2. LVH
3. rib notching
4. collateral circulation
30
```
Common Genetic Syndromes associated w/ Cardiac Defects
> -1- syndrome: -2-
> Trisomy conditions
-> -3-
-> -4-: -5-
```
1. DiGeorge
2. Aortic arch defects
3. 18/Edward's
4. 21/Down
5. AVSDs, VSD
31
Common Genetic Syndromes associated w/ Cardiac Defects
Marfan: -1-, -2-
Turner: -3-, -4-
1. aortic root disease
2. MVP
3. coarctation of the aorta
4. bicuspid aortic valve
32
```
Cardiac Defect Presentations
Evaluate for these with -1- of heart defects:
> Frequent -2-
> -3- intolerance
> -4- during sleep
```
1. prenatal, birth, and family history
2. respiratory infections
3. exercise
4. tachypnea
33
Cardiac Defect Presentations
- 1- problems
- 2-
- 3- sounds
- 4-
1. feeding
2. diaphoresis
3. abnormal heart
4. (periorbital) edema
34
Cardiac Defect Presentations
- 1-
- 2-
- 3-
1. clubbing
2. heart failure
3. FTT
35
Cardiac Defect MGMT
Referral to -1-
Ensure -2- and AG
1. pediatric cardiologist
| 2. optimal primary care
36
Innocent Murmurs (i.e., -1- or -2-)
No associated sympotms, FTT, or -3-
Occurs in -4- of children
> -5- wall
1. functional, benign
2. physiologic
3. cyanosis
4. up to 50%
5. Thin chest
37
```
Innocent Murmurs
Low-intensity systolic murmurs (-1-/VI)
May vary with position (-2-)
-3- to neck/back/axilla
MGMT: clinical assessment -4- if PCP -5-
```
1. I-III
2. sitting > standing
3. no radiation
4. by a pediatric cardiologist
5. has a concern
38
Still's Murmur
-1- murmur
-2- murmur
Heard during periods of -3-, -4-
1. most common physiologic
2. muscial systolic/vibratory
3. anxiety/stress in older kids
4. fever in infants and toddlers
39
Still's murmur
heard best between -1- & -2-
-3- murmur
louder -4-
1. LLSB
2. apex/Erb's point
3. systolic ejection
4. when supine
40
```
Venous Hum
-1- murmur
-2-/infraclavicular area
-3- in the -4- in the supine position
Also -5- and/or compressing neck ipsilaterally
```
1. continuous humming
2. RUSB
3. heard best
4. sitting position; disappears
5. obliterated by turning head
41
Heart Failure Causes
- 1-: -2- - VSD, PDA, AV canal
- 3- children: -4-, pressure overload
1. Infants
2. volume overload
3. older
4. ventricular dysfunction
42
HF S/S
- 1-
- 2-
- 3-
1. Diaphoresis
2. FTT
3. Rales/crackles
43
HF S/S
-1-
-2-
Poor -3-
1. Tachypnea
2. Tachycardia
3. perfusion
44
HF S/S in infants/toddlers
Poor/prolonged -1-
-2-
1. feedings
| 2. lethargy/irritability
45
```
HF S/S in Older children/adolescents
-1-
-2-
-3-
-4-
HF MGMT
Referral to -5- for long-term follow up
```
1. exercise intolerance
2. abdominal pain
3. chest pain
4. syncope
5. pediatric cardiologist
46
Acquired Heart Disease
HTN
> Primary: a persistent elevation of average blood pressure -1- with measurements obtained on -2- occasions per -3- w/o known cause
> HTN is most common in children -4- of -5-
1. > 95th percentile
2. 3+ separate
3. (published tables for) age and sex
4. as a symptom
5. other organ dysfunction (secondary hypertension)
47
```
HTN S/S
-1-
-2-
-3-
Physical exam: -4-; peripheral edema may be present
```
1. HA, dizziness
2. visual problems
3. nosebleed (epistaxis)
4. S4 may be present
48
HTN Labs/Dx
-1- (PA & lateral)
Plasma -2- level to rule out -2-ism
morning and evening -3- to rule out -4-
1. CXR
2. aldosteron/e
3. cortisol levels
4. Cushing's syndrome
49
HTN Labs/Dx
-1-, -2-, -3-, and -4-
EKG for dysrhythmias, i.e., -5-
1. UA
2. BMP
3. lipid panel
4. complete blood count (CBC)
5. BBB, or LVH
50
HTN MGMT
Referral to a -1-
-2- diet
1. cardiologist
| 2. Dietary Approaches to Stop Hypertension (DASH)
51
Rheumatic Fever/Heart Disease
Definition: A -1- that can affect the heart, joints, and CNS
> RF -2- URI, and is most common in children 5-15 years of age
> *The -3- is most commonly affected*
> Prevention with -4-
1. post-infectious inflammatory disease
2. follows a GABHS
3. *mitral valve*
4. adequate treatment of GABHS
52
RF/HD S/S
| Diagnosis of an intial attack of rheumatic fever plus -1- or -2-
1. two major
| 2. one major & 2 minor Jones' criteria
53
RF/HD Major Jones' criteria
| -1-, -2-, -3-, -4-, -5-
1. carditis
2. polyarthritis
3. subq nodules
4. chorea
5. erythema marginatum
"CaPiSCE?"
54
RF/HD Minor Jones' criteria
-1- objective -2-
-3-
Elevated levels of acute phase reactants (i.e., -4- and -5-)
1. arthralgia w/o
2. inflammation
3. Fever > 39C (102.2F)
4. erythrocyte sed rate (ESR)
5. C-reactive protein (CRP)
55
```
RF/HD Labs/Dx
Acute phase reactants
> Rapid strep assay
-> -1-, -2-
> Increased or rising -3-
-4-
-5-
```
1. if positive
2. throat culture
3. strep Ab titer (ASO)
4. EKG
5. Echo
56
RF/HD Mgmt
Referral to a -1-
Aggressive -2-
-3- following completion of Ab therapy with a -4- to evaluate for the presence of RBCs which may indicate -5-
1. peds cardiologist
2. Tx of GABHS infection
3. follow up 2 weeks
4. UA
5. secondary glomerulonephritis
57
RF/HD Mgmt
- 1- if acute -2- is present
- 3- for -4-, as indicated
1. Bed rest
2. carditis
3. prophylactic abx
4. invasive procedures
58
Kawasaki Disease
Defnition: -1- causing -2-
> The leading cause of -3- in children of an infectious etiology
> Most commonly noted in -4- years of age
> Occurs most commonly in children of -5-
1. acute febrile syndrome
2. vasculitis
3. coronoary artery disease
4. children under 2
5. asian ethnicity, but much more diverse than other ethnically endemic disorders
59
Kawasaki Dx Criteria
Patient must -1-, as well as -2-; if pt has > -2-, coronary vessel involvement is likely
> -3- for at least -4-
1. have a fever
2. 4+ of the criteria
3. fever
4. 5 days
60
Kawasaki Dx Criteria
- 1- without -2-
- 3- which is -4-
1. bilateral conjuctival injection
2. exudate
3. polymorphous rash
4. confluent on extremities
61
Kawasaki Dx Criteria
> Inflammatory -1- (e.g., -2-)
> Changes in extremities (e.g., erythema of -3-, edema, -4-)
> -5-
1. changes of the lips and oral cavity
2. peeling (not chapped) lips
3. soles/palms
4. peeling skin
5. cervical lymphadenopathy
62
Kawasaki Labs/Dx
- 1-
- 2-
- 3-
1. CBC
2. ESR
3. positive CRP
63
Kawasaki Labs/Dx
| -1-: -2- or -3- interval
1. EKG
2. prolonged PR
3. QT
64
Kawasaki mgmt
Immediate referral to -1-
-2-: 2 g/kg as a single infusion, usually given over -3-
High-dose -4-
> 80-100 mg/kg/day until afebrile for 48 hours
> Then -5- for antiplatelet response
1. peds cardiologist/ED
2. IVIG
3. 10-12 hours
4. ASA therapy
5. lower ASA dose (3-5 mg/kg/day)
65
Kawasaki mgmt
| Sometimes -1- to poor -2- to -3- to the -4-
1. requires hospitalization due
2. oral intake related
3. inflammatory changes
4. lips/oral cavity
66
When diagnosing hypertension in pediatric patients, the physiologic blood pressure range shifts based on the child's -1-; therefore, a nurse practitioner would need to know the child's -1- in addition to blood pressure measurement to determine if the child has hypertension. -2- and -3- are used to determine metabolic syndrome. -4- can be used to detect malnutrition in infants.
1. height
2. Waist circumference
3. weight
4. Mid upper-arm circumference
