Pediatric Cardiac Flashcards
How is congenital heart disease classified?
- Structural Abnormalities
- Functional Alterations
- Both of these
Caused by failure of the fetal______ ______ to completely close after birth. What classification is this?
- Ductus Arteriosis
* Left to Right shunting lesions
What stimulates Ductus Arteriosis to close? When does this usually occur?
- Increased O2 in blood when infant begins to breathe
* 10-15 hours after birth
Manifestations of PDA?
- May be asymptomatic
- Continuous murmur (Machine like)
- Widened pulse pressure/bounding pulses (diastolic pressure is lower because blood is leaking from aorta)
- Enlarged heart on CXR (heart is working harder)
- Tachypnea
- Poor feeding, Poor Weight gain
When Ibuprofen is given for PDA, What is the intended end result?
Facilitates necrosis of intima of ductus arteriosis, resulting in halting of ductal flow.
An NSAID/______Inhibitor called ____that causes PDA to ____resulting in a ______ vessel.
- Prostaglandin
- INDOMETHACIN (INDOCIN)
- Constrict
- Closed
When a Cardiac cath is done for PDA, a ____ is placed. ______ will be given prophylacticly for _____ to prevent ________.
- Coil
- Antibiotics
- 6 months
- Infective endocarditis
When is indomethacin used for treatment of PDA?
when other medical treatments fail after 48 hours.
an opening between the atria, allows blood flow from the right to the left atrium
Foraman ovale
blood flow between the pulmonary artery and the aorta, shunting blood away from the pulmonary
circulation
Ductus arteriosis
Most ASD cases present as ________. In these cases you want to monitor for what?
- Asymptomatic
* monitor for closure
How are ASD symptomatic children and infants treated?
- Diuretics for fluid back up
- Digoxin for HF
- antiarrythmics
Surgical procedures for ASD?
Cardiac cath - transeptal closure
Amplatzer Septal Occluder device
Manifistations for ASD?
- Pulmonic murmur
- DOE/fatigue
- Atrial dysrythmias
- Recurrent Respiratory infections
Large ventricular septal defects can cause?
Pulmonary hypertension
with VSD where can you hear the murmur? What does it sound like?
- LSB at the 3rd or 4th intercostal space
* Loud and harsh with palpable thrill
Some manifistations/complications of VSD? How are these managed?
- CHF -Digoxin,Diuretics, ACE to decrease afteroad
* Poor feeding/failure to thrive- NG tube/gastrostomy
20-80% of all VSDs do what? If they dont, what can be done?
- Close spontaneously
* Cardiac cath/repair
Endocardial cushion defect is another term used to describe this defect. What is this associated with?
Atrioventricular Septal Defect (AVSD)
Genetic defects like downsyndrome
in AVSD when does CHF develop?
when pulmonary pressures are low and there is a large amount of L to R shunting
If pulmonary HTN is present, the child will have?
- Borderline O2 saturation
* Intermittent cyanosis
In pulmonary stenosis resistance to blood flow at the valve leads to
right ventricular hypertrophy
Manifestations of Non-severe pulmonary stenosis?
- may be asymptomatic
- systolic murmur with thrill
- Exercise intolerance
Manifestations of severe pulmonary stenosis?
- Right ventricular failure
- CHF
- R to L shunting through foramen ovale
What can right to left shunting through foraman ovale cause? why?
Mild to severe cyanosis.
Deoxygenated blood being transported to body.
Interventional Cardiac Catheterization for pulmonary stenosis?
Balloon valvuloplaty - Balloon is used to open valve
Prostaglandin E (PGE1) is a potent _____ on smooth muscle tissue that keeps the ____ and ____ open temporarily, until______
- Vasodilator
- foramen ovale and ductus arteriosis
- surgery can be performed
What is the purpose of PGE1?
Keeps the foraman Ovale and ductus arteriosis open,
to increase pulmonary blood flow.
Onset of PGE1? Is this site specific? How is this administered?
- A few minutes
- No, systemic effects
- Continuous infusion through dedicated IV site
Symptoms for mild, moderate aortic stenosis?
- Asymptomatic
- Murmer with thrill
- Abnormal ECG with exercise
Symptoms of Severe Aortic stenosis?
- Decreased CO and CHF
- Older children- Chest pain, syncope
- Sudden Death
- cardiomegaly on CXR
Medical management of Aortic stenosis
- Can worsen over time (attend follow up)
- Limited physical activity
- Prophylactic antibiotics for endocarditis
Surgical interventions for Aortic Stenosis
- Cardiac cath - baloon valvuloplasty
- Surgical Valvotomy
- Aortic Valve replacement
- Coumadin to prevent clots
Narrowing or stricture of the descending aorta is called?
Where does this commonly appear?
- Coarctation of the Aorta
* Arch of the aorta
What does Coarctation of the Aorta increase? What helps with this in infants?
- Afterload and work of left ventricle
* PDA
What happens with BP in Coarctation of the Aorta?
Difference between Blood pressures in upper and lower extremities. (higher in upper extremities)
*Note - absents of femoral pulses
management of Coarctation of the Aorta?
- Infants may require PGE1 infusions to keep PDA open
- Improve CO
- Balloon dilation is primary intervention but has many risks
What are the four structural defects in tetralogy of fallot?
- RAPS*
- Right ventricular hypertrophy
- Aorta displacement
- Pulmonary stenosis
- Septal defect (Ventricle)
What may a child do to assist with symptoms of TOF? How does this help?
- Squatting or knee to chest position
* Increases SVR which decreases Right to Left shunting
Signs and symptoms of TOF?
*AFFLICT* Activity - Cyanosis, SOB, Fingernail - Clubbing, Chronic hypoxemia Fatigue/Faints easily - activity intolerance Lifts knee to chest/squatting Cardiact sounds - pulmonic murmer Trouble feeding/thriving
What condition may result from TOF? Why?
Polycythemia - (over production of RBC)
-to compensate for lack of oxygen
In tricuspid atresia, where is blood blocked?
The defect blocks blood flow from the right atrium to the
right ventricle
In tricuspid atresia, how does blood get to the lungs?
Unoxygenated blood flows through the atrial septal defect, into the left atrium, where its mixed with oxygenated blood, into the left ventricle, through the left ventricular defect and into the pulmonary artery.
pharmacological intervention for tricuspid atresia?
Continuous PGE1 infusion is initiated
Aorta and pulmonary arteries are combined with full mixing of blood. What is this known as? What happens with pulmonary blood flow?
Truncus Arteriosis
*Increased pulmonary blood flow with mixed blood
Manifistations of Truncus arteriosis?
- Cyanosis
- CHF
- CO decreased
- Systolic ejection murmur
In transposition of the great arteries where do the Aorta and pulmonary arteries arise from? What does this mean?
The aorta arises from the right ventricle, meaning unoxygenated blood is getting pumped to the body and the Pulmonary artery arises from the Left ventricle, meaning oxygenated blood is getting pumped to the lungs.
In transposition of the great arteries, when do symptoms get worse? When is corrective surgery done?
- As the DA closes
* Surgery done in first 4 to 7 days of life
In TAPVR, What happens to the blood?
Pulmonary blood flow returns to the heart through the right atrium instead of the left, resulting in right sides hypertrophy
What other defect is associated with TAPVR that causes mixing with arterial blood? What does this result in?
- ASD
* Cyanosis
When do children perspire excessively in relation to congenital heart defects?
Happens in children with left-to-right shunts
