Pediatrics: cardiopulmonary

Question 1

Pulmonary and systemic pressures in
1. utero
2. before birth
3. after birth

Answer 1

1. In utero: increased pulmonary pressure
2. due to lungs being a fluid filled system, the lungs are a higher pressure system than the sysematic circulation
3. increased systemic pressure now that the lungs are filled with air; the lungs are a lower pressure system than the systemic circulation. The blood will flow the path of least resistance

Question 2

congestive heart failure in children

Answer 2

• heart is unable to provide adequate cardiac output to meet the cirulcatory metabolic requirements of the body
• initially failure may right or left sided
• if left untreated the entire heart will fail

Question 3

Causes of CHF in peds

Answer 3

• heart muscle dysfunction
• strucutral abnormalities
• pulmonary abnormalities
• systematic disease examples: juvenile idiopathic arthritis, sjorgren syndrome
• infectons example: myocarditis or kawasaki disease

Question 4

What are other examples of causes of cardiovascular disease in pediatrics

Answer 4

• obstructive lesions in heart
• dysrhythmias
• chemotherapy drugs
• sepsis
• respiratory failure

Question 5

what are symptoms seen with CHD in pediatrics

Answer 5

• failure to gain weight in infancy
• right sided venous congestion
• hepatomegaly
• left sided pulmonary venous congestion
• tachypnea
• central cyanosis
• fatigue
• sweating
• dyspnea or breathing abnormalities/sounds
• altered level of concciousness

Question 6

Congestive heart failure management in children

Answer 6

• control fluid status diuretics such as lasix or spironolactone
• limit PO intake (intially)
• fluid sodium restrictions daily
• (BID) weight and maintain nutritional status
• nutrition avoids fluid retention
• address underlying disorder

Question 7

Pediatrics: cardio pulmonary rehab

components/factors to think about

Answer 7

• aerobic
• resistance
• flexibility
• divide as equally as possible
• correct determination of the dosage and intensity of exercise for optimal benefits

Question 8

describe pediatric cardiac rehab

what types of interventions

Answer 8

• aerobic exercise are endless (fun for kid)
• resistance and flexibility training 2-3 times per week and incorporate all major muscle groups
• resistance training machines are safer than free weights
• fixed pattern of movement and easer to learn
• all stretches should be performed to the point of mild discomfort and sustained for 30-60 seconds

Question 8

what is the most common cardiomyopathy

Answer 8

• dilated cardiomyopathy
• left ventricle is enlagred and weakened

Question 9

rehab guideline for cardiopulmonary in peds: initial treatment

Answer 9

• 24 visits spanning 12 weeks of training; three visits per week would be optimal, however two is acceptable
• the execise session: last approximately one to 1.5 hours
• should consist of aerobic exercise and resistance training with warm up and cool down periods
• blood pressure and heart rate should be monitored

Question 10

Pediatric cardiac rehab phases

Answer 10

• baseline assessment
• intensive phase: 2x per week with aerobic, resistance and flexibility
• completion assessment
• maintainance phase: home based with follow up appointments as often as deemed necessary

Question 11

cardiac problems affect on development in peds

Answer 11

• evidence shows that children have more developmental problems

Question 12

long term outcomes in children with congential heart disease

Answer 12

• compared to children without CHD, children with CHD were 3 times more likely to report worse health in the last year
• 3 times more likely to have missed more than 10 days of school or day care
• more likely to need help with or to have had difficulty with crawling, walking, or running, or to have needed special equipment for these activities
• as children with CHD got older they were more likely to report a learning disabiility
• ADHD or ADD or an intellectual disability

Question 13

Congential heart defects: etiology

Answer 13

• genetic factors
• abnormalities
• teratogens: drugs
• maternal infections
• environmental exposures
• prematurity
• advanced maternal age
• pregnancy complications

Question 14

types of congential heart defectts

Answer 14

• patent ductus arteriosus
• arterial septal defects
• ventricular septal defect
• atrioventricular canal defect

Question 15

Ventricular septal defects

Answer 15

• most common
• most small/close spontaneously (usually by age 2 years; uncommon after age 4)
• symptoms of congestive heart failure may occur especially if significant size
• child has failure to thrive/fatigue, respiratory, pulmonary hypertension
• murmur (turbulent flow through abnormal or obstructive opening)

murmurs are hard to hear in peds

Question 16

VSD contributing factors are

Answer 16

• a congential cardiovascular defect in a parent or sibling
• maternal diabetes
• maternal alcohol consumption for muscular VSD

Question 17

4 types of VSD

Answer 17

• perimembranous
• muscular VSD
• conal VSD
• inlet VSD

Question 18

inlet VSD

Answer 18

• occurs in the lower right ventricle and adjacent to the tricuspid valve
• typically occurs in patients with down syndrome

Question 19

patent ductus arteriosus

Answer 19

• from week 6 of fetal life until birth the ductus is responsbile for most of the right ventricular outflow
• normally functional closure of the ductus arteriosus occurs by about 15 hours of life in healthy full term infants
• in full-term infants PDA accounts for 5-10%
• in preterm infants incidence of PDA up to 60%

Question 20

atrial septal defects

symptoms

Answer 20

• most children with isolated ASDs are asymptomatic
• if patients are untreated however symptoms can occur in adulthood
• patients who have large arterial shunts can experience symptoms related to excess pulmonary blood flow and right sided heart failure
• in infants, children and young adults up to approximately age 20 symptoms may include: heart murmur, frequent respiratory infections , slow weight gain

Question 21

atrial septal defects: is associated with

What types of characteristics

Answer 21

• fetal alcohol syndrome
• cigarette smoking particularly in the first trimester
• advanced maternal age >35
• certain antidepressant use
• diabetes

maternal characteristics and behaviors:

Question 22

Tetralogy of fallot

causes? when is it dx? what happens?

Answer 22

• caused by genetics and environmental impacts of mother during pregnancy
• usually diagnosed after birth
• episode of turning blue during crying or feeding (tet spell)
• baby may have bluish-looking skin or heart murmur
• however it is not uncommon for a heart murmur to be absent righ at birth (several people listen)

Question 23

4 defects with tetralogy of fallot

Answer 23

• right ventricular hypertrophy
• overriding aorta
• ventricular septal defects
• pulmonic stenosis

Question 24

Tetralogy of fallot symptoms

Answer 24

• cyanosis,
• systolic murmur
• metabolic acidosis
• poor growth
• clubbing
• severe hypoxia
• surgical treatment: palliative shunts

Question 25

tet spells hypercyanotic

Answer 25

• occurs in first year of life
• may be preceded by feeding, crying or defecation, dehydration, fever, increased stressed
• characterized by hypoexmia, blue extremities circumoral cyanosis
• darker colored skin
• increased hemoglobin and hematocrit counts
• requires immediate attention and treatment to prevent brain damage and death

Question 26

hypoplastic left heart syndrome

Answer 26

• strucutres of the left side of the heart are underdeveloped
• mitral and aortic valves closed or small
• left ventricle non funcitonal
• 4th most common congential heart defect

Question 27

Hypoplastic left heart syndrome: signs

Answer 27

• low levels of oxygen in the blood (detected by pulse oximetry new born screening)
• problems breathing
• pounding heart
• weak pulse
• ashen or bluish skin color

Question 27

treatments for hypoplastic left heart syndrome

Answer 27

• medication
• nutrition
• surgery