Pediatric Cardiac Dysfunction Flashcards
What is ventricular septal defect (VSD) ?
abnormal opening between the ventricles
- increased pulmonary blood flow
- blood flows from LV to RV (causing hypertrophy)
- oxygenated blood flows into the Rt side of heart and it goes to the lungs instead of the rest of the body
- causes increased pulmonary vascular resistance
What are the S&S and Tx for VSD ?
- signs of CHF
Tx: palliative is PA banding , repair is surgical closure
What is the coarctation of the aorta ?
narrowing of the vessel near the ductus arteriosus leading to increase pressure proximal to the defect (head and upper extremities) and decreased pressure distal to obstruction (body and legs)
- signs of CHF or HTN
- Tx: balloon angioplasty; stents (palliative) and Repair is surgical resection (tx of choice)
What are the 4 defects in tetralogy of fallot (TOF) ?
- pulmonic stenosis
- VSD
- overriding aorta
- right ventricular hypertrophy
What is TOF hypercyanotic (TET) spells ?
obstruction of pulmonary blood flow and communication between the ventricles
- causes a decrease in pulmonary blood flow and increase in R to L shunting
What is the tx for TET spells ?
- keep calm
- knee chest position (to change pulmonary pressure and shorten distance for perfusion)
- oxygen
- morphine
- IVF replacement and volume expansion, if needed
What are some S&S of hypoxemia ?
- fatigue w/ feeding
- poor weight gain
- tachypnea and dyspnea
- Chronic hypoxemia: polycythemia (blood cancer where bone marrow has too many RBCs) and clubbing
What is right sided heart failure ?
unable to efficiently pump the blood into the pulmonary artery
- Rt side becomes congested and backs up into veins
What is left sided heart failure ?
unable to pump blood into the systemic circulation
- increased pressure in Lt atrium and pulmonary veins
What are some S&S of Lt HF ?
- cough, crackles, wheezes, blood-tinged sputum, tachypnea
- restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue. cyanosis
- paroxysmal nocturnal dyspnea (SOB while sleeping)
What are some S&S of Rt HF ?
- distended JV
- swelling in hands & fingers, dependent edema, enlarged liver and spleen. ascites
- fatigue
- increased peripheral venous pressure
What meds are used to improve cardiac function ?
- Digoxin: increase CO, decrease HR, decrease venous pressure, and relieve edema
- ACE inhibitors (Captopril): decrease pulmonary and systemic resistance, decrease BP, reduce afterload
- Beta Blockers (Metoprolol): decrease HR and BP, vasodilation
What meds remove accumulated fluid and sodium ?
Diuretics, fluid and sodium restriction
- Furosemide: blocks reabsorption of sodium and water
- Spironolactone: blocks retention of sodium and excretion of potassium
- Chlorothiazide: decrease sodium, water, potassium, chloride and bicarbonate absorption
Shunting from right to left causes ?
cyanosis
What are some characteristics of defects with increased pulmonary blood flow ?
- abnormal connection between two sides of heart
- increased blood volume on right side of heart
- increased pulmonary blood flow
- decreased systemic blood flow
What is a defect that has increased pulmonary blood flow ?
ventricular septal defect
What are some characteristics of obstructive defects ?
- blood exits heart through a stenosis
- pressure in great artery increased before obstruction
- pressure in great artery decreased after obstruction
- decreased cardiac output
- infants and children exhibit signs of HF
What are some defects that are obstructive defects ?
- coarctation of aorta
- aortic & pulmonic stenosis
What is a classic sign of coarctation of the aorta ?
baby has BP that is higher and lower in the extremities (aren’t the same or similar)
What are some characteristics of defects with decreased pulmonic blood flow ?
- obstruction of pulmonary blood flow
- anatomic defect between right and left sides of the heart
- hypoxemia
What are some defects that have decreased pulmonary blood flow ?
tetralogy of fallot
What is included in the complete repair of a TOT (TET) repair ?
- closure of VSD
- pulmonary valvotomy
- transannular patch
- resection of obstructive muscle in RV hypertrophy
What is a pallative tx for TOF ?
palliative shunt: modified blalock-taussig (BT shunt)
- to allow the infant time to grow so outcome of surgery is better
What are some characteristics of mixed defects ?
- complex cardiac anomaly
- mixing of saturated and unsaturated blood to systemic circulation
- pulmonary congestion
- decreased in CO
- lots of times will need heart transplants
What is dilated cardiomyopathy ?
- HF symptoms
- ventricular dilation and decreased contractility
What is hypertrophic cardiomyopathy ?
autosomal dominant genetic abnormality
- increased in muscle mass without an increase in cavity size
What is restrictive cardiomyopathy ?
- rare in kids
- restriction to ventricular filling
- diastolic dysfunction with absence of ventricular dilation or hypertrophy
- HF symptoms
What is stenosis ?
when valves don’t completely open causing a narrowed path for blood to flow through the heart
What are the 2 major groups of cardiovascular disorders in kids ?
- congenital heart disease
- acquired heart disorders
What are the 2 consequences of congenital heart defects ?
heart failure and hypoxemia
What causes the start of hemodynamics from inside mom to outside world ?
the clamping of the umbilical cord and expansion of lungs at birth
What causes the foramen ovale to close ?
pressure in the left atrium exceeds the pressure in the right atrium
What causes the ductus venous to close ?
clamping of the umbilical cord
What is PA banding with VSD ?
placement of a band around the main pulmonary artery to decrease pulmonary blood flow
