Test 2 Flashcards
What is the normal flow of blood through the heart?
Right atrium->tricuspid valve>right ventricle->pulmonary artery->lungs->pulmonary veins->left atrium->mitral valve->left ventricle->Aorta
How are heart murmurs classified?
-Location
-Area of the heart where murmur is heard best
-Time of the mumur within S1/S2 cycle
-Intensity of murmur
-Loudness of murmur
What is an innocent murmur?
No anatomic or physiologic abnormality exists
Fever, anemia, rapid growth
What is a functional murmur?
No anatomical cardiac defect exists but a physiological abnormality exists
What is an organic murmur?
A cardiac defect with or without a physiological abnormality exists
What are some of the risk factors for heart defects?
Trisomy 21 (30-50% of cases)
Trisomy 13
Trisomy 18
Diabetes
Phenylketonuria (poorly controlled)
Alcohol consumption
Environmental toxins
The risk of CHD is much higher if?
A first degree relative is affected
What are the 4 classes of CHB?
Increased pulmonary blood flow
Decreased pulmonary blood flow
Ductal Dependent/Mixed Defects
Obstructive Defects
What are the 4 types of increased pulmonary blood flow CHB?
Atrial Septal Defect
Ventricular Septal Defect
Patent ductus arteriosus
Atria-ventricular canal
What is increased pulmonary blood flow CHB?
Defects between the left and right sides of the heart with a left to right shunt that cause pulmonary overcirculation, increased vascular resistance and eventual pulmonary hypertension.
What is an atrial septal defect?
An opening in the septum between left and right atria
What is a ventricular septal defect?
An opening in the septum between left and right ventricle
What is a patent ductus arteriosus?
Failure of the ductus arteriosus closure and due to this the aorta and pulmonary artery remain connected
What is an atrial-ventricular canal?
ASD & VSD allow blood to flow between all 4 chambers
What is CHB decreased pulmonary blood flow?
Defects with obstructed blood flow to lungs or developmental failure leave no connection for right sided blood to flow into the lungs
What are the 2 categories of CHB decreased pulmonary blood flow?
Tricuspid Atresia
Tetralogy of Fallot
What is Tricuspid Atresia?
Decreased pulmonary blood flow due to abcense of tricuspid valve which results in a complete mixing of deoxygenated blood in the heart
What are the signs and symptoms of Tricuspid Atresia?
Cyanosis
Systolic murmur
Poor feeding/weight gain
Fatigue
Clubbing (in older children)
What is the tetralogy of fallot?
4 total defects including VSD, Pulmonary stenosis, overriding aorta and RV hypertrophy
What are the signs and symptoms of tetralogy of fallot?
Cyanosis
Systolic murmur
Clubbing
TET spells (desaturation, worsening cyanosis, squatting)
Increased WOB
Edema
Pulmonary Infections
What is the treatment for tetralogy of fallot?
-Surgery within the 1st year -Attempt to reshunt by repositioning intrathoracic pressure and putting knees to Chest
What are CHB ductal dependent/mixed defects?
Hypo-plastic Left Heart
Transposition of Great vessels
What does survival depend on with CHB ductal dependent/mixed defects?
The ability to mix deoxygenated and oxygenated blood
What is Hypo-plastic left heart?
An underdeveloped left heart with a hypoplastic aorta or atresia
What are the symptoms of a hypo-plastic left heart?
Symptoms such as cyanosis, actvity intolerance, and murmur that increase in the 1st and 2nd week of life
What are the treatment options for a hypo-plastic left heart?
ASD or PDA
Inotropic medications
Prostaglandin E
Surgery
What is Transposition of the great vessels?
Pulmonary artery leave the LV
Aorta leaves the right ventricle
What are the symptoms of transposition of the great vessels?
Cyanosis
Cardiomegaly
Murmur
What are the treatment options of transposition of the great vessels?
ASD, VSD or PDA
Oxygenate blood
Prostaglandin E to keep DA open
Surgery
What are the obstructive CHB defects?
Defects that cause narrowing of vessels for blood to leave the heart
Aortic Stenosis
Coartation of the Aorta
What is aortic stenosis?
Narrowing of aorta between LV and aorta
What is coartication of the aorta?
Narrowing at the aortic arch
What are the signs/symptoms of obstructive CHB defects?
Activity intolerance
Increased RR/HR
Slow growth
Poor feeding
COA
Pale/cyanotic at rest that worsens with activity
“Death spells”
What are “death spells”?
A symptoms of obstructive heart defects that involves rapid color change, dizziness, fainting
What are the interventions of obstructive heart defects?
O2
Reshunt
Diuretics
Surgery
What is Kawasaki Disease?
Acute vasculitis with an unknown cause that can progress to coronary artery aneurysms in 20% of children
What are the signs/symptoms of Kawasaki Disease?
Must have 5 for diagnosis*
Fever for 5+ days
Bilateral conjunctival inflammation w/no exhudate
Oral mucosa changes (dry, cracked lips, strawberry tongue, reddening of oral cavity)
Extremity changes (like edema)
Polymorphous rash
Cervical lymphadenopathy
What are the treatment/care needs for Kawasaki Disease?
Monitor cardiac status (assess for symptoms of heart failure)
ECHO to monitor coronary artery dilation or aneurysm formation
Daily weights
I &Os
Administration of fluids
Medication
Supportive care
What are the administration guidelines for IVIG?
-Give over 10-12 hours
-monitor BP for signs and symptoms of allergic rxn
-Administer within first 7 days of illness
-Educate to avoid any live immunizations for 11 months after therapy
-Watch for signs of fever
What are the adminisitration guidelines for Aspirin for Kawasaki Disease?
High dose: 80-100mg/kg/day
Once afebrile then 3-5mg/kg/day
Continue for 6-8 weeks
What is Endocarditis?
Infection of the endocardial layer of the heart that most often results from a bacterial/fungal infection
What are the risk factors for endocarditis?
Children with a history of CHD (congenital, acquired, prosthetic valves, CV shunts, rheumatic fever w/valve involvement)
What are the signs and symptoms of Endocarditis?
Unexplained low grade fever
Anorexia/weight loss
General Malaise
New murmurs
Dysrythmias
HF
What are the labs/diagnostics to test for Endocarditis?
Labs:
CBC, ESR, Blood Cultures
Diagnostics:
Echo, EKG, CXR
What is the treatment for endocarditis?
Bed Rest
Administration of organsim specific antibiotic/antifungal meds for 2-8 weeks
PICC line for long term therapy
Will have to take prophylactic antibiotics for the rest of life*
Which antibiotics and antifungal are given for endocarditis?
Antibiotics:
Gentamycin
Streptomycin
Antifungal:
Amphotericin
What is rheumatic fever?
Inflammatory disease that occurs within 2-6 weeks after rxn to group A beta hemolytic strep that may result in vascular damage
What are the signs/symptoms of rheumatic fever?
Joint pain
Edema
Fever
Non-itchy rash to trunk and proximal extremties
Mitral valve murmur
Chorea (odd little movements)