EXAM 3 CARDIO Flashcards
Cyanotic classification of heart defects
Decreased pulmonary blood flow
Mixed blood flow
Acyanotic classification of heart defects
Increased pulmonary blood flow
obstruction to blood flow from ventricles
Describe Atrial Septal Defect
Increased pulmonary blood flow (acyanotic)
LA pressure greater than RA, so blood flows through abnormal opening in the atrial septum which distends the RA. RV tolerates well although there may be some hypertrophy after several decades.
Pt is usually asymptomatic and often spontaneously close in first year of life.
Describe Ventricular Septal Defect
Increased pulmonary blood flow (acyanotic)
Hole in ventricle septum. Symptoms depend on how big the hole is. 20-60% close spontaneously during first year of life. The bigger the hole the more blood volume overwhelms pulmonary system, resulting in pulmonary vascular resistance. Right side of heart may hypertrophy if not fixed.
Clinical manifestations mirror those of heart failure
Describe Patent Ductus Arteriosus
Increased pulmonary blood flow (acyanotic)
Artery that connects the aorta and pulmonary artery in utero (fetal ductus arteriosus) doesn’t close within the first few weeks of life causing left to right shunt.
Machinery-like murmur. Moderate to large PDAs may present as left-sided volume overload or pulmonary arterial hypertension
Describe Coarctation of Aorta
Obstruction to blood flow from ventricles (acyanotic)
The entrance to the aorta is small and the upper part of the descending aorta is narrowed so the upper extremities have bounding pulses whereas lower extremities have weak pulses. Is really serious in infants, often requires mechanical ventilation. Older children get dizzy and have nose bleeds.
Aortic Stenosis
Obstruction to blood flow from ventricles (acyanotic)
Aortic valve is weird looking and/or small which makes the LV hypertrophy, cardiac output less. VALVULAR AS is the worst version of aortic stenosis because it causes random episodes of MI. No exercising.
Often have increased HR, faint pulses, hypotensive, poor feeding, exercise intolerance. At risk for infective endocarditis and heart attacks.
Pulmonic Stenosis
Obstruction to blood flow from ventricles (acyanotic)
Pulmonary artery entrance is small so blood backs up in RV which cause RV hypertrophy and decreased pulmonary blood flow. PULMONARY ATRESIA is the total occlusion of the pulmonary artery. May make the RV hypoplastic. Foramen ovale may be opened back up if the pressure on the right side of the heart exceeds the left side, which would push deoxygenated blood into the LA.
Sx include mild cyanosis, HF, cardiomegaly, systemic venous engorgement
Describe Tetrology of Fallot
Decreased pulmonary blood flow (cyanotic)
Pulmonary artery is small (pulmonic stenosis), right ventricle is hypertrophied (right ventricular hypertrophy), the septum isn’t between the L/R ventricle (ventricular septal defect), the aorta is taking up both oxygenated and deoxygenated blood (overriding aorta)
Sx: “tets spells”: baby suddenly has blue lips, skin, nails after feeding, crying, or waking up
Tricuspid Atresia
Decreased pulmonary blood flow (cyanotic)
Tricuspid (r side valve) doesn’t develop so pressurized venous blood moves either through a patent foramen ovale or a atrial septal defect to the left side of the heart. The left side of the heart pumps mixed blood throughout the body. There are usually other malformed parts of the heart like transposition of the great arteries or narrowed pulmonary artery.
Sx include cyanosis, tachycardia, dyspnea clubbing
Transposition of Great Arteries
Mixed blood flow (cyanotic)
The pulmonary artery is where the aorta should be (leaving left ventricle) and the aorta is where the pulmonary artery should be (leaving the right ventricle). There is usually a patent foramen ovale or other holes in the heart.
Sx depends on if there are any holes. Holes actually help the baby be less cyanotic. If there are no holes in the septum, the baby will be severely cyanotic and cardiomegaly will be present within the first few weeks of life.
Total Anomalous Pulmonary Venous Return
Mixed blood flow (cyanotic)
Instead of the pulmonary veins sending oxygenated blood to the left atrium, it sends it back into the venous system of the heart or the right atrium. The heart has to have some sort of hole in the septum. The right side of the heart gets bigger and the left side gets smaller. The blood on both sides of the heart contain the same oxygenation level.
The patient’s level of cyanosis depends on how much blood is pumped through the pulmonary artery. The more blood pumped, the less cyanosis.
Truncus Arteriosus
Mixed blood flow (cyanotic)
The aorta and pulmonary artery are the same vessel. More blood flows through lungs and less flows systemically.
Severe HF Sx, cyanosis, poor growth, activity intolerance.
Hypoplastic Left Heart Syndrome
Mixed blood flow (cyanotic)
The left side of the heart is completely underdeveloped so blood flows passively through the patent foramen ovale back to deoxygenated right side of heart and uses the non-closed ductus arteriosus to get into the aorta and out to the body.
Milf cyanosis and HF sx until the ductus arteriosus closes then severe cyanosis and decreased CO
Right sided HF Patho/Sx
RV doesn’t pump well into pulm artery which increases pressure in RA and systemic venous circulation. Makes your spleen big and causes peripheral edema.
Left sided HF Patho/Sx
LV can’t pump well into systemic circulation so the pulmonary everything gets backed up and the lungs get congested w/ blood. Sx include cyanosis, fatigue, decreased flow to kidneys causes Na and H2O resorption causing fluid overload
Kids don’t really have specific left or right side heart failure symptoms because the other side of their hearts immediately compensates for what the other lacks, causing a weird mixture of symptoms. SO, what are the three things to look out for to officially diagnose a KID with heart failure?
Impaired myocardial function (increased HR, sweating, decreased urine output, weakness, restlessness, pale cool extremities, gallop rhythm, cardiomegaly)
Pulmonary congestion
Systemic venous congestion: weight gain, big liver, peripheral edema, ascites, JVD
What are the four goals of treatment for children with heart failure
improve cardiac function: (digoxin (xin), ace inhib (pril), beta blocker (ilol) watch for too much K
Remove accumulated fluid and sodium: furosemide/thiazides watch for too little K
Decrease cardiac demands: warm environment, trat infections, semi-fowler position, sedation, decrease stimuli for rest
Improve tissue O2: nasal canula, blow-by
What are the two physiologic changes in the body that would indicate CHRONIC hypoxia
polycythemia (increased RBC count) and clubbing
A PaO2 of 100 mm Hg or higher suggests…
lung disease
A PaO2 lower than 100 mm Hg suggests…
cardiac disease
What is administered IV to infants with ductus-dependent cardiac defects
Prostaglandin E1
Describe Infective Endocarditis
Infection of inner lining of the heart (usually a valve). Usually related to bacteremia from indwelling lines, dental work, surgery.
Need 3 positive blood cultures to Dx. Can usually see vegetations on valve via echo. May be given antibiotic prophylactically after procedure.
Infective Endocarditis is most often caused by what three pathogens
Staphylococcus Aureus or (fungal) candida albicans
Describe Rheumatic Fever
Abnormal immune response to Strep a. Involves joints, skin, brain, heart, and valve damage. If throat infection is left untreated, the body will make antibodies that attack the heart (valves) if the bacteria causes endocarditis.
If a child has an elevated lipid level you should check for…
hypothyroidism
what are risk factors for early cardiovascular disease
family history, smoking, obesity, sedentary, eat bad, male, diabetic, hypertension
what ages should you perform lipid screenings
9-11 and 17-21. over age of 2y if they have risk factos
Dietary recommendations for children to avoid hyperlipidemia
1hr play 5 days a week. less than 2hr a day screen time. only 25-30% of calories from fat.
What drug do you give a kid with high LDL cholesterol
statin. They inhibit enzyme necessary for cholesterol synthesis. Look out for dark urine, muscle spasms/aches
Ezetimibe can be used with a statin to stop gut absorption of cholesterol.
Describe bradydysrhythmias
Ex: Complete AV block
autonomic NS issue, happens after surgery on atrias, might need a permanent pacemaker
Describe tachydysrhythmias
EX: SVT
poor feeding, extreme irritability, pallor. Fix with ice on face, carotid artery massage, valsalva maneuver (hold breath and push). If that doesn’t work digoxin/betablocker. Next adenosine if hemodynamically unstable. Next pace maker.
What are the 3 causes of pulmonary hypertension in the pediatric population
increased pulmonary venous pressures (r/t mitral stenosis/LV noncompliance)
post-tricuspid cardiac shunts
small pulmonary arteries (arteries are too few/narrow)
Sx of pulmonary hypertension
syncope, chest pain, abnormal difficulty breathing with exercise
Cure to pulmonary hypertension
no known cure
be slow. Use O2. Take anti coags and vasodilators
Describe cardiomyopathy
cardiac muscles struggle to contract. rare in children, usually only from KAWASAKI DISEASE. characterized by weird filling of heart chambers.
Tx for children in just managing sx b/c theres no cure. Poor growth, fatigue, big spleen
What kids get heart transplants
Cardiomyopathy and end-stage CHD. Sometimes really congenitally messed up hearts that have a lot of holes.
Difference between essential and secondary hypertension
Essential: no identifiable cause
Secondary: subsequent to an identifiable cause
describe Kawasaki Disease
acute systemic vasculitis of unknown cause. can form coronary artery aneurysms. only sx is a prolonged, unexplained fever with at least one of the following:
weird skin changes in the extremities (swelling, redness, peeling)
red eyes
dry mouth and strawberry tongue
rash
swollen lymph nodes in the neck
Sx last 6-8 weeks. 3 stages (high fever/WBC, fever stops but risk for aneurysms high, last phase all signs resolved
Tx w/ IVIG
Desribe Multisystem Inflammatory Disease
consequence of immune-mediated injury triggered by COVID-19
elevated neutrophils, reduced lymphocytes, and low albumin
Tx w/ IVIG
What are the 3 phases of septic shock
- chills, fever, vasodilation, increase CO
- normodynamic, cool, pulses/bp still normal, less urine output, mental state depression
- hypodynamic/cold, weak pulses, hypotension, no urine, comatose, organ failure
Management involves measures to provide hemodynamic stability, adequate oxygenation to tissues, and antimicrobials to treat infection
