Peds - Cardiac

Question 1

umbilical vein

Answer 1

carries oxygenated, nutrient rich blood from the placenta to the fetus

Question 2

umbilical arteries

Answer 2

carry deoxygenated, nutrient depleted blood from fetus to placenta

Question 3

Foramen Ovale

Answer 3

opening between right and left atrium in fetal circulation

Question 4

ductus arteriosus

Answer 4

opening between pulmonary artery and aorta in fetal circulation

Question 5

foramen ovale and ductus arteriosus purpose

Answer 5

little holes that allow blood to skip over fetus lungs in utero

Question 6

risk factors for heart defect

Answer 6

maternal viral infections, diabetes, drug and alcohol use, advanced maternal age

Question 7

heart defects commonly occur with syndromes such as

Answer 7

Trisomy 21, Trisomy 18, Turners syndrome, DiGeorge syndrome

Question 8

right to left shunt

Answer 8

causes cyanosis; blood goes R to L (should go L to R to be oxygenated in lungs) so blood does not become oxygenated and then goes to rest of body

Question 9

ductal depenent

Answer 9

dependent on hole in heart to get blood out to the body

Question 10

shunting

Answer 10

movement of blood from one area to another

Question 11

left to right shunt

Answer 11

acyanotic; blood moves L to R (properly) so blood is becoming oxygenated in lungs so no cyanosis occurs; but there is an excessive amount of blood going to the lungs which can lead to problems

Question 12

Abnormalities that cause L to R shunting

Answer 12

patent ductus arteriosis, atrial septal defect, ventricular septal defect, atrioventricular canal

Question 13

Abnormalities that cause R to L shunting

Answer 13

tetralogy of fallot, tricuspid atresia

Question 14

ductal dependent: mixed heart defects

Answer 14

transposition of the great arteries, hypoplastic left heart syndrome

Question 15

obstructive heart defects

Answer 15

coarctation of the aorta, aortic stenosis, pulmonic stenosis

Question 16

patent ductus arteriosus

Answer 16

L to R shunt; failure of ductus arteriosus to close which should close 12-72 hrs after birth; causes a machine like murmur; small ones often close on their own, surgically closed if bigger, indomethacin can be given or ibuprofen; usually show no other signs or symptoms

Question 17

atrial septal defect

Answer 17

L to R shunting; opening between the atria, often asymptomatic until later in childhood, child may fatifue easily, dyspnea on exertion, poor weight gain and eating as it gets bigger; larger may need patch or surgical closure; assessment findings include hearing murmur

Question 18

ventricular septal defect

Answer 18

L to R shunting; will hear murmur, bigger defect = louder murmur; 2-8 weeks begin showing S&S of HF; tx diuretics, ACE inhibitors, Beta blockers, nutrition, surgical closure

Question 19

atrioventricular canal defect

Answer 19

L to R shunt; one big valve as mitral and tricuspid do not form separately, end up with single AV valve leaving one big chamber in the heart (should be 2); will hear murmur; S&S CHF and failure to thrive tx: CHF, nutrition and surgical repair at 3-6months

Question 20

Tetralogy of Fallot

Answer 20

R to L shunt defect; large VSD, pulmonary stenosis, right ventricle hypertrophy, overriding aorta - will have Tet spells; have to have surgery at some point (some early some little later in life)

Question 21

Tet Spells

Answer 21

hypoxic spells, begins with irritability, prolonged period of intense cyanosis leading to syncope, more R to L shunting causing more deoxygenated blood out to the body

Question 22

Tet Spell Priorities

Answer 22

comfort and keep calm, knee-to-chest position, supplemental oxygen, sedation (morphine), volume

Question 23

Tricuspid Atresia

Answer 23

tricuspid valve does not grow, no communication between the R atrium and R ventricle, will also have VSD and ASD; cyanosis, will be ductal dependent; needs to be put on prostaglandin to keep open, needs to have surgery in neonatal period

Question 24

transposition of the great arteries

Answer 24

ductal dependent/mixed; aorta and pulmonary artery are switched; oxygenated blood continuously circulating through pulmonary circuit; deoxygenated blood continuously circulating through systemic circuit

Question 25

TGA S&S and tx

Answer 25

cyanosis within 1 hr of birth; SpO2 75-85%, will require prostaglandins to keep PDA; if this opening is not big enough will require surgery

Question 26

hypoplastic left heart syndrome (HLHS) what is it and S&S

Answer 26

under developed left heart syndrome, when DA closes very little blood will be able to get to the rest of the body; cyanosis when DA closes, increased RR, fatigue, can lead to very quick progression of cardiogenic shock

Question 27

HLHS

Answer 27

prostaglandins, correct acidemia, inotropes, plan for surgery

norwood surgery at birth, glenn at 2 months old, fontan at 2-4 years old

Question 28

Aortic stenosis

Answer 28

narrowing of aorta making it harder for the left ventricle to eject blood

Question 29

aortic stenosis S&S

Answer 29

exercise intolerance and syncopal episodes, narrow pulse pressure, pronounced apical impulse, thrill

Question 30

aortic stenosis tx

Answer 30

balloon valvuloplasty asap to prevent shock, ross procedure, surgical valve placement (if given mechanical valve will need to be anticoagulated), needs to avoid contact sports

Question 31

pulmonary stenosis

Answer 31

narrowing of pulmonary artery makes it harder for RV to pump, causes hypertrophy

Question 32

pulmonary stenosis S&S

Answer 32

often asympotmatic; as it progresses may see dyspnea on exertion and fatigue, hear murmur

Question 33

pulmonary stenosis tx

Answer 33

pulmonary valvotomy, moderate to severe stenosis child should avoid high intensity activities

Question 34

coarctation of the aorta

Answer 34

narrowing of the aorta, impedes blood flow to the lower half of the body, & appear quickly once DA closes can rapidly lead to hypotension, acidosis, shock and death

Question 35

coarctation of the aorta S&S

Answer 35

Upper extremities: bounding pulses, htn, warm, pink

Lower extremities: weak or absent pulses, hypotensive, pale, cool

Question 35

coarctation of the aorta management

Answer 35

prostaglandins, surgical repair, long time follow up and high risk for recoractation or aortic aneurysm