UNIT 4 CARDIAC Flashcards
What is the normal flow of blood through the heart?
Blood comes from the superior/inferior vena cave—> right atrium—> tricuspid valve—> Right ventricle—> pulmonary valve—> pulmonary artery—> lungs—> pulmonary veins—-> left atrium—> mitral valve—> left ventricle—> aortic valve—> body
What is the only artery in the body w/deoxygenated blood
Pulmonary Artery
What is the only vein in the body that carries oxygen?
Pulmonary Vein
In a normal heart the pressure on the _____ is higher
Left
In a normal heart the pressure on the ____ side is lower
Right
Blood flow is going to depend on the….
Pressure… will go from higher pressure to lower pressure… and no flow = no grow
Aquired heart disease can result from
- Infection
- Autoimmune
- Environmental
- Famililar tendency
What are the causes of CHD?
Maternal
1. fetal alcohol syndrome, medication (dilantin/fenatoyin), illegal drugs, advanced maternal age, diabeties, infection, rubella
Chromosomal abnormalilties
1. Downs syndrome common to have ASD or VSD or both… AV canal also common
What will our physical assessent show in a cardiac potential?
- General appearance: No flow No grow
- Inspection:
- Nutritional state, color, chest deformities, Unusual pulsations, respiratory excursion, clubbing of fingers
- Palpations
- Abdomen, peripheral pulses
- Ausculation
- Heart rate and rhythm, characteristics of heart sounds
What diagnostic procedures might be used for cardiac problems?
- Electrocardiogram (ECG)
- Xray
- Echocardiogram
- Cardiac Cath
- Cardiac MRI
What can an EKG tell us?
12 lead EKG can tell us rate, any abnormal electrical conduction that they are having going on shows ischemia and ventricular hypertrophy.
What can a chest xray tell us? (cardiac)
Can detect cardiomegaly and pulmonary congestion.
What is the number one diagnostic exam for cardiac disorders?
Echocardiogram(ECHO)
1. Non-invasive and provides a good picture of blood flow pattern
2. Complication: Babies have to be still so may need sedation
Why would we use cardiac cath?
- Diagnostic purpose, measure pressures, inject dyes and see blood flow patterns
- Provides a really good picture as to whats going on prior to surgery
- Ballon procedure, stent… are procedures that can be done.
Why might we use electrophysiology?
Irregular rhythms— can go to the EP lab where they can stilulate different parts of the heart so that they can find the problem area
What are CHD that cause increased pulmonary blood flow?
- ASD
- VSD
- PDA
What causes increased pulmonary blood flow in the heart?
Defects along septum or abnormal connection between great arteries
- Left-to-right shunting of blood
- increased blood volume on the right side of heart
- increased pulmonary blood flow
What is ASD?
- Abnormal opening between the atria that allows blood flow from left atrium to right atrium
Symptoms of a small ASD?
May be asymptomatic
Symptoms of a large ASD?
- CHF unusal but possible: not really seen in children unless untreated
- Fatigue
- SOB
- Respiratory infections
ASD treatment includes?
- Spontaneous closure– depends on the defect and age of the child
- Transcatheter closure
- Septal occluders- smaller defects: best for smaller defects in the middle of the septum
- Low-dose aspirin for 6 months after to help prevent clot formation on foreign device
- Eventually tissue will grow over device.
- Surgical closure
- Smaller defects- sutures
- Mod to large defects use patch (pericardial or dacron)
When is surgical or trancather closure done for ASD?
Usually before they are school-aged.
What is VSD?
Abnormal opening between left and right bentricles that allows blood flow from left ventricle to right ventricle may vary in size from pinhole to the absence of the septum- common ventricle
Symptoms of small VSD defects include…
usually asymptomatic, no physical restrictions, reassurance and periodic follow up
Symptoms of a moderate to large of a VSD includes?
CHF common
Treatment for a VSD includes
- Spontaneous closure (20-60%)
- Dependant on size and age of child- usually close within the 1st year of life
- Transcatheter Closure (occluder)
- Surgical closer
- Smaller defects- sutures
- Moderate to large defects- patch (pericardial or dacron)
- Palliative procedure possibly– if they have a significant amount of resp issues they may have to wait on surgical correction and will have a band placed around pulmonary artery to decrease the amount of blood to the lung which lelieves some of the lung issues
What is a PDA?
Patent Ductus Arteriousus
1. Failure of the fetal ductus arterious to close within the 1st few weeks of life. This allows blood flow from higher pressure aorta to lower pressure pulmonary arter (left to right shunt)
Small PDA’s present
asymptomatically
Symptoms of a large PDA…
- CHF
- FTT
- Machinery-like murmmur
- Frequent resp infection (increased blood flow to the lungs)
Treatment of the PDA includes?
- Indomethacin (Indocin) which is the prostaglandin inhibitor.
- Given for premature infants
- Some newborns
- Transcatheter
- Coils: Occlude the blood flow. Tissue grow and close off
- Surgical
- Ligation: Thoracotomy incision rather than sternal because it allows for better visulization
- Will clip or tie off PDA
When is the natural prostaglandin production cut off?
When the umbilical cord is cut
What CHD cause decreased pulmonary blood flow
TOF
What should we know about CHD that decrease pulmonary blood flow?
- Obstruction of pulmonary blood PLUS an anatomic defect between sides of the heart (ASD or VSD)
- Pressure on right side of heart increases and exceeds left-sided pressure.
- Desaturated blood shunted right to left
- Desaturated blood to systemic circulation
- leading to Hypoxemia and cyanosis
What is TOF?
Consists of 4 cardiac defects
1. VSD
2. pulmonary stenosis
3. overriding aorta
4. right ventricular hypertrophy
S/S of TOF?
- Cyonosis (chronic) r/t pressure changes causing more deoxygenated blood in the system
- Tachypnea r/t compensation of hypoxemia
- Acute episodes of cyanosis and hypixa: HYPERCYANOTIC SPELLS
- Clubbing
- Impaired growth
Blood flow r/t TOF depends on ?
What is going on in the body… with TOF you can have left to right shunts or right to left shunts
What are hypercyanotic spells (blue spells or tet spells) in TOF?
usually preceded by activities where o2 requirments exceed the blood flow supply… feeding, crying, defacation or stressfull procedures
- Infundicular spasm decreased pulmonary blood flow
- Increases right to left shunt so desaturated blood flows to systemic ciruclation which results in acute cyanosis- hypoxia
When are hypercyanotic spells most common?
Most frequent in the 1st year of life rare before 2 months of age. Occur most often in the morning
Are hypercyantoic spells nothing to worry about?
No, requires immediate recognition and interventions
Hypercyanotic spells increase the risk for
- emboli
- seizures
- LOC
- Sudden death
Nursing interventions for Hypercyanotic spells include?
- Knee-chest position
- squatting
- Establish a calm enviroment
- Blow by 100% oxygen
- Morphine- helps calm and helps with spasm decrease tachypnea and dexreases pulmonary resistance
- IVF replacement if needed
- Repeat morphine
What is the treatment for TOF?
- Educate family in recognition and intervention of hypercyanotic spells
- Keep well hydrated
- Prevent infections and report fevers to physian promptly
- Monitor for/treat anemia: Need enough RBC to carry oxygen
- Surgical correction
- Palliative shunt-Artifical deviation
- Complete repair
What are some obstructive CHD?
- Coarctation of the Aorta
- Aortic stenosis
- Pulmonic stenosis
What do we need to know about obstructive defects?
Blood exiting heart meets area of anatomic narrowing (stenosis) causing obstruction to blood flow
- Increased pressure in ventricle and vessel behind obstruction
- Decreased pressure after the obstruction
What is coarctation of the aorta (COA)
- Narrowing of the aorta near the insertion of the ductus arteriosus which increases pressure proximal to the defect (HEAD and upper extremities)
- Decreased pressure distal to the obsruction (body and lower extremities)
What are the s/s of COA
- Elevated BP in arms
- Bounding pulses in arms
- Decreased BP in legs
- Weak or absent femoral pulses
- weak or absent pulses in lower extremities
- cool lower extremities
- CHF
How do we treat COA?
Transcatheter
1. Older infants and children: balloon angioplasty
2. Adolescents: stent placement
Surgical repair
1. Treatment of choice for infants <6 months of age & those with long-segment stenosis or complex anatoy