Exam 4 Cardio Flashcards
Most common way to diagnose CHD?
Echo, can be done in utero
Cardiac Cath
Invasive, cath is guided with fluoroscopy to the heart, dye is injected and the path through the heart is followed
Complications of Catheterization
Hemorrhage, fever, n/v, loss of pulse in cathed extremity, transient dysrhythmias
Pre op cath
Sedation, NPO, check allergies, locate and mark pulses
Post op cath
ECG monitor rath and rhythm, BP, pulse ox, frequent monitoring of extremity (pulse, color, temp) I&O
What do you do if bleeding occurs at cath insertion site?
Do not remove dressing. Hold direct pressure 1 in above site, lay child flat, call doc
Leg position after cath
Keep straight for 4-8 hrs
Cath insertion post op care
Keep free from infection (apply diapers) keep clean and dry, pt may shower only. Avoid strenuous exercise, but may attend school
Two types of congenital heart dz
Congestive heart failure and Hypoxemia
Normal pressure flow of heart
Left side has a higher pressure than right side.
Normal resistance of circulation
Pulmonary circulation has less resistance than systemic circulation
Increased pulmonary blood flow leads to what
Congestive heart failure, acyanotic
Decreased pulmonary blood flow leads to what
Cyanosis
Obstruction to blood flow out of the heart leads to what
Congestive heart failure, acyanotic
Mixed blood flow leads to what
Cyanosis, varied s/s
The inability of the heart to pump an adequate amount of blood to the systemic circulation
Congestive heart failure
When does CHF occur in children?
Secondary to structural problems that cause increased blood volume and pressure in the heart
Right sided heart failure
Right ventricle can’t pump effectively into pulmonary artery
Left sided heart failure
Left ventricle can’t pump effectively into systemic circulation
Right sided heart failure causes increased pressure where?
In the right atrium and systemic venous circulation
Left sided heart failure causes increased pressure where?
In the left atrium and pulmonary veins
Manifestations of right sided heart failure
HTN, hypatosplenomegaly, edema
Manifestations of left sided heart failure
Lungs become congested causing pulmonary edema
Polycythemia
Increased number of RBC to increase the oxygen carrying capacity of blood. Increases blood viscosity and increases risk for clots
Polycythemia occurs with what?
Hypoxia
Abnormal opening between the atria which allows blood from the high pressure LA to shut into the RA
Atrial septal defect
Abnormal opening between the right and left ventricle which causes left to right shunting
Ventricular septal defect
A low atrial septal defect and high ventricular septal defect, clefts of the mitral and tricuspid valves causing blood to flow between all chambers of the heart
AV canal defect
Failure of the fetal ductus arteriosus to close within the first few weeks of life, causing blood to flow from high pressure aorta to low pressure pulmonary artery
PDA
Narrowing near the insertion of the ductus arteriosus leading to increased pressure to the hear and upper extremities and decreased pressure to the body and lower extremities
Coarctation of the aorta
Narrowing of the aortic valve causing resistance to blood flow out of the LV, decreased CO, LV hypertrophy, and pulmonary vascular congestion
Aortic stenosis
Narrowing at the entrance to the pulmonary artery causing RV hypertrophy and decreased pulmonary blood flow
Pulmonic stenosis
VSD, pulmonic stenosis, overriding aorta, RV hypertrophy
Tetralogy of Fallot
Tricuspid valve fails to develop resulting in no flow from RA to RV. Blood flows from an ASD or PFO to the left side of the heart. Blood flows through a VSD to the right side and to the lungs. Results in complete mixing of unoxygenated blood and oxygenated blood which leads to systemic desaturation. Varying amounts of pulmonary obstruction leads to decreased pulmonary blood flow
Tricuspid Atresia
Pulmonary artery leaves the left ventricle and the aorta exits from the RV> no communication between systemic and pulmonary circulation. Need an associated defect (septal, PDA) in order for blood to mix
Transposition of the great vessels
Underdevelopment of the left side of the heart leading to hypoplastic LV and aortic atresia. Blood flows from LA through a PFO to the RA>RV>PA. A PDA allows blood to flow to systemic circulation
Hypoplastic left heart syndrome
An infection of the valves or lining of the heart
Bacterial Endocarditis
Inflammatory dz that occurs after a strep infection. Self-limited illness that involves joints, skin, brain, and heart.
Rheumatic Fever
What is the complication of RF?
Cardiac valve damage (Rheumatic heart dz, usually mitral valve)
Acute systemic vasculitis of unknown cause. Self-limited but without intervention have 15-25% developing aneurysms. Extensive inflammation of arterioles, venues, capillaries. Segmental damage to muscular arteries leads to coronary aneurysms
Kawasaki Dz
Acute stage of Kawasaki Dz
Abrupt onset of high fever, unresponsive to antipretics and abx, then gets other s/s, very irritable
Subacute stage of Kawasaki Dz
Resolution of fever and lasts until all s/s have disappeared
Convalescent phase of Kawasaki Dz
All s/s resolved but labs (ESRW) remain elevated, lasts until all are normal (6-8 weeks after onset)
In which stage of Kawasaki Dz is the pt at risk for aneurysms?
Subacute. Monitor serial echo
