Peds - Cardiac Flashcards
umbilical vein
carries oxygenated, nutrient rich blood from the placenta to the fetus
umbilical arteries
carry deoxygenated, nutrient depleted blood from fetus to placenta
Foramen Ovale
opening between right and left atrium in fetal circulation
ductus arteriosus
opening between pulmonary artery and aorta in fetal circulation
foramen ovale and ductus arteriosus purpose
little holes that allow blood to skip over fetus lungs in utero
risk factors for heart defect
maternal viral infections, diabetes, drug and alcohol use, advanced maternal age
heart defects commonly occur with syndromes such as
Trisomy 21, Trisomy 18, Turners syndrome, DiGeorge syndrome
right to left shunt
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
ductal depenent
dependent on hole in heart to get blood out to the body
shunting
movement of blood from one area to another
left to right shunt
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
Abnormalities that cause L to R shunting
patent ductus arteriosis, atrial septal defect, ventricular septal defect, atrioventricular canal
Abnormalities that cause R to L shunting
tetralogy of fallot, tricuspid atresia
ductal dependent: mixed heart defects
transposition of the great arteries, hypoplastic left heart syndrome
obstructive heart defects
coarctation of the aorta, aortic stenosis, pulmonic stenosis
patent ductus arteriosus
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
atrial septal defect
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
ventricular septal defect
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
atrioventricular canal defect
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
Tetralogy of Fallot
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)
Tet Spells
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
Tet Spell Priorities
comfort and keep calm, knee-to-chest position, supplemental oxygen, sedation (morphine), volume
Tricuspid Atresia
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
transposition of the great arteries
ductal dependent/mixed; aorta and pulmonary artery are switched; oxygenated blood continuously circulating through pulmonary circuit; deoxygenated blood continuously circulating through systemic circuit
TGA S&S and tx
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
hypoplastic left heart syndrome (HLHS) what is it and S&S
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
HLHS
prostaglandins, correct acidemia, inotropes, plan for surgery
norwood surgery at birth, glenn at 2 months old, fontan at 2-4 years old
Aortic stenosis
narrowing of aorta making it harder for the left ventricle to eject blood
aortic stenosis S&S
exercise intolerance and syncopal episodes, narrow pulse pressure, pronounced apical impulse, thrill
aortic stenosis tx
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
pulmonary stenosis
narrowing of pulmonary artery makes it harder for RV to pump, causes hypertrophy
pulmonary stenosis S&S
often asympotmatic; as it progresses may see dyspnea on exertion and fatigue, hear murmur
pulmonary stenosis tx
pulmonary valvotomy, moderate to severe stenosis child should avoid high intensity activities
coarctation of the aorta
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
coarctation of the aorta S&S
Upper extremities: bounding pulses, htn, warm, pink
Lower extremities: weak or absent pulses, hypotensive, pale, cool
coarctation of the aorta management
prostaglandins, surgical repair, long time follow up and high risk for recoractation or aortic aneurysm
