Chapter 23: Cardiovascular Dysfunction Flashcards
What is the 2nd biggest cause of death for the first year of life?
congenital heart disease (prematurity is 1st)
What is the most common cardiac anomaly in pediatrics?
ventricular septal defect
What are the 3 major changes to fetal circulation that take place at birth?
– when a newborn takes first breath, 3 abrupt changes:
1. change from fetal circulation (with umbilical vein and umbilical arteries) to postnatal circulation
2. closure of foramen ovale – d/t pressure in L atrium > pressure in R atrium
3. beginning of closure of ductus arteriosus – d/t increased oxygen
What are the 4 categories of cardiac defects?
- acyanotic
- obstructive
- cyanotic
- acquired
What are acyanotic heart defects?
- AKA increased pulmonary blood flow defects
- L to R shunt –> increased volume on R side of heart –> R side hypertrophy and increased blood flow to lungs
What are the 3 acyanotic defects?
- atrial septal
- ventricular septal
- patent ductus arteriosus
What is an atrial septal defect (ASD)?
3 aspects
- opening in septum between L and R atria –> causes mixing of oxygenated and deoxygenated blood
- s/s:
– usually asymptomatic
– can develop CHF - treatments:
– surgical repair
– cardiac catheter in early childhood
– can close spontaenously
What is a ventricular septal defect (VSD)?
4 aspects
- opening in septum between L and R ventricles –> causes mixing of oxygenated and deoxygenated blood
- more common than ASD
- s/s:
– commonly causes CHF
– may be asymptomatic, but depends on size - treatments:
– surgical repair
– cardiac catheter
– sponatenous closing if small
What is a patent ductus arteriosus (PDA)?
3 aspects
- ductus arteriosus (shunt between ascending aorta and pulmonary artery) fails to close after birth –> causes shunting to pulmonary artery and increased fluid to lungs and L side of heart
- s/s:
– murmur
– bounding pulses
– may be asymptomatic
– can have signs of CHF - treatments:
– meds: indomethicin or ibuprofen (only ibuprofen is clinically indicated for PDA closure, but both are used)
– PDA ligation using cardiac catheter
What are obstructive heart defects?
oxygenated blood is unable to flow to the rest of the body
What are the 4 types of obstructive defects?
- coarctation of the aorta
- aortic stenosis
- pulmonic stenosis
- hypoplastic left heart syndrome (HLHS)
What is a coarctation of the aorta?
4 aspects
- narrowing of the aorta –> causes restricted amount of oxygenated blood that travels to the rest of the body
- varying degrees of narrowing can occur
- s/s:
– increased pressure in upper extremities (BP, bounding pulses, warm) and decreased pressure in lower extremities (BP, weak pulses, cool)
– signs of CHF
– at risk for aneurysm or stroke - treatments:
– surgical repair
– cardiac catheter
What is aortic stenosis?
3 aspects
- narrowing or fusion of the aortic valves –> causes decreased L ventricular outflow and L side hypertrophy
- s/s:
– L side HF
– pulmonary edema - treatment:
– surgical repair
– cardiac catheter
What is pulmonic stenosis?
3 aspects
- stiffening of pulmonic valve –> causes R ventricular hypertrophy and decreased pulmonary blood flow d/t resistance
- this is often a component of tetralogy of Fallot
- s/s:
– can be asymptomatic
– cyanosis
– CHF
– at risk for developing endocarditis
What is hypoplastic left-sided heart syndrome (HLHS)?
4 aspects
- L side of heart is underdeveloped –> restriction of blood flow to rest of body
- higher mortality rates
- s/s:
– mild cyanosis, but death will occur if not treated/ductal closure not prevented - treatment:
– maintenance of patent ductus arteriosus (PDA) to allow oxygenated blood from R ventricle to enter aorta to flow to rest of body
– maintenance of patent foramen ovale (ASD) to improve mixing of oxygenated and deoxygenated blood in R atria –> R ventricle can help pump oxygenated blood to aorta via PDA
– surgery
– heart transplant
What are cyanotic heart defects?
cardiac anomaly where oxygenated blood entering aorta is mixed with deoxygenated blood
What are the 2 types of cyanotic defects?
- tetralogy of Fallot
- transposition of the great arteries
What is tetralogy of Fallot (TOF)?
3 aspects
- condition involving 4 congenital defects:
– VSD – allows mixing of oxygenated and deoxygenated blood
– pulmonic stenosis – decreases blood flow to lungs
– overriding aorta – aortic valve sits right above ventricular septal defect (VSD), further allowing mixing of oxygenated and deoxygenated blood when entering aorta from both ventricles
– R ventricular hypertrophy - s/s:
– cyanosis that may progress
– murmur
– tet/blue spells – acute episodes of cyanosis and hypoxia
– clubbing of fingers
– poor growth – FTT
– fatigue - treatments:
– surgery
– squatting positions (knee-to-chest) – for tet spells; decreases return of systemic venous blood to heart
What is transposition of the great arteries (TGA)?
4 aspects
- aorta and pulmonary artery are attached to opposite chambers of the heart (aorta to R ventricle, pulmonary artery to L ventricle), creating 2 completely separate circulations
- not sustainable with life unless mixing of blood is established
- s/s:
– rapid/labored breathing
– tachycardia
– cool, clammy skin
– cyanosis
– cardiomegaly - treatments:
– surgery – switch procedure
– balloon atrial septostomy
– prostaglandin E – keeps foramen ovale/PDA open to allow blood mixing
What are acquired heart defects/diseases?
heart anomalies that the child was not born with; includes infectious and inflammatory disorders
What are the 6 types of acquired heart defects/diseases?
- CHF
- endocarditis
- rheumatic fever
- Kawasaki disease
- hyperlipidemia
- hypertension
What is Kawasaki disease?
3 aspects
- inflammation of blood vessels throughout the body and surrounding the heart
- s/s:
– fever lasting 5+ days
– rash
– red bloodshot eyes
– bright red, swollen, cracked lips
– strawberry tongue
– swollen hands and feet
– redness on palms and soles of feet
– swollen lymph nodes - treatments:
– aspirin (ASA) – for fever and inflammation (usually contraindicated in peds d/t Reyes)
– IV immunoglobulin
– antiplatelets
– Remicade – for inflammation
