THE CHILD WITH CONGENITAL HEART PROBLEM

Question 1

Weaker pulses or lower blood pressure in the lower extremities may indicate

Answer 1

coarctation of the aorta (COA)

Question 2

Bounding pulses can indicate

Answer 2

patent ductus arteriosus (PDA) or aortic insufficiency.

Question 3

to define silhouette of the heart.

Heart size, shape, pulmonary markings, and cardiomegaly.

Answer 3

Chest x-ray

Question 4

n invasive test to diagnose or treat cardiac defects.
Visualizes heart and vessels.
Measures oxygen saturation of chambers.
Measures intra-cardiac pressures.

Answer 4

Cardiac Catheterization

Question 5

Watch for signs of toxicity to the dye used during the procedure

Answer 5

Increased temperature
Urticaria
Wheezing
Edema
Dyspnea
Headache

Question 6

Pre-cardiac Catheterization

Answer 6

Assess vital signs with blood pressure
Hemoglobin and hematocrit
Pedal pulses
Observe NPO
Hold digoxin
IV if child is polycythemic

Question 7

ressures on the left side of the heart are normally higher than the pressures in the right side of the heart.

Answer 7

Left to Right Shunt

Question 8

Clinical Manifestations of

Left to Right Shunt

Answer 8

infant is not cyanotic.

Tachycardia due to pushing increased blood volume.

Cardiomegaly due to increased workload of the heart.

Question 9

Deoxygenated blood from the right side shunts to the left side

Answer 9

Right to Left Shunts

Question 10

Clinical Manifestations Right to Left Shunts

Answer 10

Hypoxemia = the result of decreased tissue oxygenation.
Polycythemia = increased red blood cell production due to the body’s attempt to compensate for the hypoxemia.
Increase viscosity of the blood = heart has to pump harder.

Question 11

Treatment of Heart Failure

Answer 11

Digoxin Therapy

Digoxin increases the force of the myocardial contraction.

Question 12

Bradycardia
Arrhythmia
Nausea, vomiting, anorexia
Dizziness, headache
Weakness and fatigue
signs for?

Answer 12

Signs of Digoxin Toxicity

Question 13

Interventions for Heart Failure

Answer 13

Fluid restriction
Diuretics – Lasix (potassium wasting) or Aldactone (potassium sparing)
Bed rest
Oxygen

Question 14

One of the most common benign defects
Ductus normally closes within hours of birth
Connection between the pulmonary artery (low pressure) and aorta (high pressure)

Answer 14

Patent Ductus Arteriosus

Question 15

Diagnosis of Patent Ductus Arteriosus

Answer 15

Chest x-ray – enlarged heart and dilated pulmonary artery

Echo-cardiogram

Question 16

Treatment of Patent Ductus Arteriosus

Answer 16

1. Indomethocin given po – constricts the muscle in the wall of the PDA and promotes closure
2. Cardiac Catheterization – coil is placed in the open duct and acts like a plug
3. Closed heart surgery – small incision made between ribs on left hand side and PDA is ligated o

Question 17

Blood in left atrium flows into right atrium
Pulmonary hypertension
Reduced blood volume in systemic circulation

Answer 17

Atrial Septal Defect

Question 18

Treatment For Atrial Septal Defect

Answer 18

Surgical closure of the atrial septal defect

Question 19

Opening in the ventricular septum
Left-to-right shunt
Right ventricular hypertrophy
Deficient systemic blood flow

Answer 19

Ventricular Septal Defect

Question 20

Diagnosis of Ventricular Septal Defect

Answer 20

heart murmur
Electrocardiogram – to see if there is a strain on the heart
Chest x-ray – size of heart
Echocardiogram – shows size of the hole and size of heart chambers

Question 21

Treatment of VSD

Answer 21

CHF:
Digoxin if additional force needed to squeeze the heart
FTT (Failure to thrive) o

Question 22

Congenital narrowing of the descending aorta
80% have aortic-valve anomalies
Difference in BP in arms and legs (severe obstruction)

Answer 22

Coarctation of Aorta

Question 23

Treatment of Coarctation of Aorta

Answer 23

Prostaglandin

Question 24

when a baby’s heart does not form correctly as the baby grows and develops in the mother’s womb during pregnancy.

Answer 24

Tetralogy of Fallot (TOF)

Question 25

Tetralogy of Fallot (TOF)

first described by

Answer 25

Étienne-Louis Fallot in 1888

Question 26

Tetralogy of Fallot (TOF)

Four Components

Answer 26

VSD
Pulmonary stenosis
Overriding of the aorta
Hypertrophy of right ventricle

Question 27

has two rather than three leaflets. Leaflets are thickened or fused.
Obstruction of blood flow from left ventricle
Mild symptoms: dizziness, syncope, angina, fatigue

Answer 27

Aortic Stenosis

Question 28

Diagnosis of Aortic Stenosis

Answer 28

Heart murmur
Electrocardiogram
Echocardiogram
Exercise stress test

Question 29

Treatment of Aortic Stenosis

Answer 29

Cardiac catheterization

Surgical valvotomy

Question 30

Life threatening shock develops when the ductus arteriosis closes
Low oxygen saturations – will not increase with oxygen administration
Pulses will be weak in all extremities

Answer 30

HYPOSTATIC LEFT HEART SYNDROME(HLH)

Question 31

TREATMENT FOR HYPOSTATIC LEFT HEART SYNDROME(HLH)

Answer 31

Norwood – right ventricle becomes the systemic ventricle pumping blood to the body
Glenn – done at 3-6 months
Fontan – done at 2 -3 years of age

Question 32

Infection of endocardial surface of the heart

History of CHD, Kawasaki Disease, Rheumatic Fever, or prosthetic valves are more susceptible to infection

Answer 32

Bacterial Endocarditis

Question 33

Acute-self limiting disease
Generalized vasculitis
Peak incidence 6 months to 2 years
More common in males and Japanese

Answer 33

Kawasaki Disease