Ped Heart Flashcards
What happens to heart rate as one ages?
It slows down.
Is the blood pressure of children higher or lower than adults?
It is lower.
A neonate has a nosebleed and is sweating heavily. What do u suspect?
Heart problems
At what point in a neonate’s life does the foramen ovale close? what causes the foramen ovale to close?
It closes at birth (ideally). It closes because of the rise in BP as baby breathes air.
At what point in the neonates’s life does the ductus arteriousis close?
At about 4 days of life
Where in the chest does a child’s heart lie, relative to an adults?
Children’s hearts lie higher in the chest, and more horizontally, than an adults.
Where is the apex of the heart found in a child?
At the 3rd or 4th intercostal space
What effect does the clamping of the umbilical cord in a neonate have on systemic vascular resistance?
Systemic vascular resistance increases.
What is the purpose of the ductus venosa?
Shunts oxygenated blood past the fetal liver (shortcut from umbilical vein to inferior vena cava.
Where is the foramen ovale?
A portal between the right and left atria
What is the purpose of the foramen ovale?
It allows blood to bypass the high pressure and resistance of the fetal lungs which aren’t oxygenating blood anyway, because the beb is basically underwater.
Where does blood go after passing thru the foramen ovale?
It proceeds to the aorta, and then to brain and body.
When during gestation do congenital heart defects develop?
Between 6-8 weeks gestation.
Is it possible to detect congenital heart defects before infant is born?
Yes, in utero
When during a woman’s pregnancy should rubella vaccine be given?
Trick question NEVER because rubella is a live vaccine.
Should keppra (an anti-seizure medication) be given to pregnant women?
Anti-seizure medications can cause congenital heart anomalies.
What is a functional/innocent heart murmer?
benign
A baby with a congenital heart defect may start to show cyanosis on what day of life?
About 2nd day of life or after
What are 2 MAJOR signs of conjenital heart defects in the neonate?
1) Poor Feeding 2) Diaphoresis
What is the major complication of congential heart deformities?
CHF/crackles
What is an organic heart murmur?
Not benign
What happens to oxygenation with acyanotic heart defects?
There is increased pulmonary blood flow.
What happens to oxygenation with cyanotic heart defects?
There is decreased pulmonary blood flow.
What happens to oxygenation with obstructive systemic blood flow?
Blood cannot get to where it needs to go, whether to the lungs or the body.
Should you restrict fat/salt in the diet of a person with acyanotic heart disease?
Nope
Patent Ductus arterious (PDA) –acyanotic or cyanotic?
Acyanotic. Failure of ductus arteriosis to close soon after birth.
What does the ductus arteriousis do?
It connects the pulmonary artery to the aorta
What drug should be given to pediatric patients with PDA (Patent ductus arteriosis)?
Indocin
Why should indocin be given to pediatric with PDA (Patent ductus arteriosis)?
It blocks prostaglandins, and causes the PDA to close.
What is the second resort if Indocin cannot be used to close the PDA in a pediatric patient?
Surgery, for term infants or infants who indocin did not close the PDA.
Does a (Patent ductus arteriosis) cause left or right sided heart failure? Why?
Right sided heart failure, because R side is pumping and pumping and blood is just leaking out to the aorta instead of going to the pulmonary arteries and lungs.
Atrial septal defect (ASD) – acyanotic or cyanotic heart problem?
Acyanotic
Is Atrial septal defect (ASD) the same as patent forament ovale?
No but symptoms are the same. Oxygenated blood flows from L atrium to R atrium.
What is the treatment of an asymptomatic Atrial Septal Defect?
Monitor to see if spontaneous closure occurs.
Does Atrial septal defect (ASD) cause right sided or left sided heart failure?
Right sided heart failure from increased blood going to the right side of the heart.
Ventricular septal defect (VSD) – acyanotic or cyanotic heart problem?
Acyanotic
How large is the opening between ventricles in a pediatric patient with Ventricular septal defect (VSD)?
It varies from size of pinhole to almost no septum at all.
What is the most common congenital defect?
Ventricular septal defect (VSD)
Does Ventricular septal defect (VSD) cause right sided or left sided heart failure?
Right sided heart failure
What is the tx for an asymptomatic Ventricular septal defect (VSD)?
Spontaneously closes 30-50% of the time; monitor and wait. If non-closing, needs to be surgically closed.
When the patient recieves an umbrella in the heart how long does the patient need antibiotics?
For the rest of life
Transposition of the Great Vessels – cyanotic or acyonatic heart defect?
Cyanotic
What happens to circulation with Transposition of the Great Vessels?
Circulation is reversed – the pulmonary vessels come out of the left ventricle and the aorta comes out of the right ventricle.
What is the prognosis for untreated Transposition of the Great Vessels? With treatment?
Not conducive to life, without intervention. With surgical repair, 90-95% survival rate.
What is the treatment for Transposition of the Great Vessels?
Give PGE_1 infusion to keep the PDA open. Create a septal defect. Correct vessels surgically later.
What is the most common cyanotic heart lesion?
Tetrology of Fallot
Is Tetrology of Fallot a cyanotic or acyanotic heart defect?
Cyanotic
What are the heart defects in a pediatric patient with Tetrology of Fallot?
1) Pumonic stenosis
2) VSD
3) Overriding aorta
4) Right ventricular hypertrophy
What happens to oxygenation during a “Tet spell”??
Hypercyanotic; O2 drops drastically.
What position should a person having a “tet spell” be in?
Knee to chest
What is the purpose of the knee to chest position during a tet spell?
It decreases systemic vascular resistance. It prevents leg blood from getting back up to the heart and overwhelming the heart.
What is the first line of treatment for a tet spell?
Get in knee-chest squat position.
What does a baby with tetralogy of fallot look like while crying or feeding?
Cyanotic at extremities and mouth.
Does obstructed systemic blood flow cause left or right sided heart failure?
Left sided heart failure
Will a person with obstructed systemic blood flow have bounding peripheral pulse?
No, diminished peripheral pulse, delayed capillary refill…low bp in LE
When does coarctation of the aorta develop?
The 2nd week of life
What happens to the heart during coarctation of the aorta?
The aortic arch narros, either before or after the ductus arteriosis.
When the aorta narrows during coarctation of the aorta, does the narrowing usually occur before or after the ductus arteriosis?
After the ductus arteriousis is more common.
What are the 2 risks with coarctation of the aorta?
CVA, AAA (abdominal aortic anyeurism)
Which is more life-threatening: coarctation of the aorta BEFORE the ductus arteriosis, or AFTER?
BEFORE is more dangerous, because blood is obstructed from flowing to the carotids (and brain).
What drug is used to keep the Patent Ductus Arteriosis open, used in coarctation of the aorta and transposition of the great vessels?
Prostaglandin E1.
A child shows epitaxis, high bloodpressure in the upper extremities, low blood pressure in the lower extremities, CHF, and headaches. What do you suspect?
coarctation of the aorta
What type of infection causes rheumatic fever?
group A strep infection
What is painful/tender joints called?
Polyarthritis
Rheumatic fever is an _________________ disease.
Autoimmune.
Painful and tender joints
Chest pain
Chorea (like dyskinesia)
Erythema Marginatum
Major symptoms of Rheumatic fever
What are four major symptoms of rheumatic fever?
Painful/tender joints
Erythema marginatum
Chorea
Chest Pain
What are the consequences to the heart of Rheumatic fever?
Valve stenosis, regurgitation, damage to heart muscle, a-fib, heart failure
What labs might indicate that a child has rheumatic fever?
Eleveted Sed Rate (indicating inflammation)
Elevated C-reactive protein
Leukocytosis
What interval on an EKG will be prolonged in a child with Rheumatic fever?
prolonged PR interval
How long are prophylactic antibiotics given in a child with Rheumatic fever?
Every day until 18 years of age, and with dental care and surgery as adults.
What labs will be elevated in a person with Kawasaki disease?
Elevated sed rate, indicating inflammation.
What are initial s/s of the first stage of Kawasaki disease?
V red hands and feet, lethargy, high fever unresponsive to tx for >5 days, strawberry tongue
What are the s/s of the second stage of Kawasaki disease?
Cracking lips, peeling fingers/toes, joint pain POSSIBLY MI or CVA d/t coronary blood vessel inflammation.
What is the cardiac consequence of Kawasaki disease?
Coronary blood vessel inflammation, can cause Aneurysms, MI, or CVA.
What is the tx for Kawasaki disease?
Salycilate (aspirin) therapy, IV gamma globulins to assist immune system, Coumadin for the clots, steroids for inflammation
