Exam 2 Flashcards
Name the Obstructive Defects
- Coarctation of the Aorta
- Aortic Stenosis
- Pulmonic Stenosis
Name the Increased Pulmonary Blood Flow defects
- Patent Ductus Arteriosus
- Atrial Septal Defect
- Ventricular Septal Defect
- Atrioventricular canal
Name the Decreased Pulmonary Blood Flow Defects
- Tetralogy of Fallot
- Tricuspid Atresia
Coarctation of the Aorta
- Narrowing of the aorta, usually distal to the ascending vessels
- Markedly higher blood pressures and pulses in the upper extremities (compared to the lower extremities)
- If left uncorrected, older children will have recurrent episodes of epistaxis + complaints of leg cramps/leg pain (especially during periods of activity)
Aortic stenosis
- Narrowing of the aorta or aortic valve
- Symptoms may only be a murmur or as severe as CHF (depending on size of defect)
- Needs a balloon angioplasty or surgical repair
Pulmonic Stenosis
Obstructive heart defect
- Narrowing of the pulmonary artery or valve
- May have cyanosis during activity or severe CHF (depending on size of defect)
- Needs balloon angioplasty or surgical repair
Patent Ductus Arteriosus
- Fetal duct b/t the pulmonary artery and the aorta fails to close
- May have no symptoms, but a murmur may be heard, and child develop CHF
- May close spontaneously, if not, it may be closed medically with the administration of indomethacin, a prostaglandin inhibitor
- If medication is unsuccessful, surgery may be needed (No ibuprofen during pregnancy!!)
Atrial Septal Defect
- Hole b/t the atria. May be a foramen ovale that didn’t close at birth, or a defect unrelated to the fetal duct
- Most have no symptoms, but may develop CHF, if the ASD is large.
- A murmur may be heard
- Many ASDs close spontaneously. If not, surgery or interventional cardiology may be performed
Ventricular Septal Defect
- Most common congenital heart defect!
- Hole between the ventricles
- May have no symptoms, but a murmur may be heard, and the child may develop CHF
- May close spontaneously, if not, it may be closed medically with administration of indomethacin (indocin).
- If medication is unsuccessful, surgery may be needed.
Atrioventricular canal
- large hole in the middle of the heart
- Signs and symptoms of progressively worsening CHF
- Surgical repair is required
- Heavily associated with down syndrome
Tetralogy of Fallot
Most common decreased pulmonary blood flow defect
- Comprised of four defects: VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy
- Right ventricular hypertrophy develops over time because the ventricle is working extra hard to circulate the blood
- TET spells, child becomes cyanosis especially when crying/eating/during play
- Polycythemia (increased # of circulating RBC)
- Clubbing of the fingers may develop due to chronic hypoxia
- If defect not repaired, older children usually squat instinctively
- Treatment includes:
Surgical repair
Cyanosis from TET spell can be relieved when legs + knees are bent, resulting in reduced blood flow to the lower body and improved blood flow to the vital organs, infants should be placed in a knee-chest position
Tricuspid Atresia
- Closed tricuspid valve after birth
- No movement of blood from the right atrium to the right ventricle
- Incompatible with life unless another defect is present that allows mixing of the blood
- Rapid and sustained cyanosis
- IMMEDIATE SURGICAL REPAIR NEEDED
Cardiac catheterization care
PRE CATH
- check for allergies (latex, iodine)
- Mark pulses pre-procedure
- diaper rash = may cancel/reschedule
- baseline O2 sat
POST CATH
- Stop bleeding; if bleeding at site, apply pressure 1 inch above the site
- immobilize the extremity for 6hr
- VS, neuro checks of the extremity
Digoxin
- Increases force of contraction and decreases heart rate
- indirect diuresis
- Half-life is short; takes 1.5 days to work
- Take apical heart rate for FULL 1 min before administering
- Low potassium levels increase effects of digoxin
- HOLD if heart rate is <90 in small child + <70 in older child
Digoxin toxicity
side effects/toxicity
- Bradycardia and dysrhythmias
- Anorexia, N/V
- (if child vomits up med, do not give another dose! wait until it is scheduled again to give again)
- visual disturbances
