Week 1 Cardiac Flashcards
Characteristics of Murmurs
Sounds like a clunk, woosh, gallop
Intensity - refers to the loudness
Location- where are you hearing it the loudest
Quality - is it musical, blowing, wooshing
Radiation - radiating throughout the cardiac cycle
Timing- before or after s1 or s2
Pitch
Grades of a Murmur
Grade I – VI
I & II usually innocent
III- VI pathology
Signs of possible cardiac dysfunction in early infancy history
Too good a baby Falling asleep during feedings Growth failure Continued skin or mucous membrane abnormal coloring after first few days Dusky babies (blue, mottled) Sweating especially on the head Increased BMR Lower respiratory tract infections Any genetic, chromosomal or renal abnormality
Route of peripheral edema in infants
begins first in the face with infants - then presacral region and then extremities
Edema of lower extremities is characteristic of ventricular HF in older children
What is thought to cause clubbing
Vasodilation
Increased growth factor d/t increased metabolic demand
At what point is clubbing normally seen
After one year
Causes of CHD
Maternal or environmental = 1% to 2%
Maternal drug use: FAS—50% have CHD
Maternal illness- Rubella in first 7 weeks of pregnancy → 50% risk of defects including PDA and pulmonary branch stenosis
CMV, toxoplasmosis, other viral illnesses → cardiac defects
IDMs(infant of diabetic mother) = 10% risk of CHD (VSD, cardiomyopathy, TGA most common)
Chromosomal/genetic = 10% to 12%
Multifactorial = 85%
What is the most common congenital cardiac anomaly
VSD
Increase pulmonary blood flow leads to
CHF
Decrease pulmonary blood flow leads to
cyanosis
obstructed left hearts leads to CHF or cyanosis?
CHF
obstructed right heart lead to CHF or cyanosis?
cyanosis
Treatment for endocarditis
Treat 2-8 weeks. If antbx unsuccessful»CHF develops, valvular damage
Clinical manifestation of Rheumatic heart disease which is used for diagnosis
Carditis
Polyarthritis usually inflammation of large joints → knees, hips, shoulders - can migrate
Erythema marginatum - rash usually appearing on trunk, red macula with a clear center
Subcutaneous nodules - little nodules of boney prominences will persist indefinitely
Aschoff bodies- inflamed hemorrhagic boluses in heart, blood vessels,
Kawasaki disease Treatment
IVIG within 1st 10 days of illness
ASA 80-100/day for fever may continue for 5-6 weeks
coumdin if child is at risk for aneurism
3-5mg/kg/day of antiplatelet
S/S of kawaskis
peeling skin on hand and feet, lips become dry cracked and swollen, swollen”strawberry” tongue, irritable, fever w/o etiology
Most common side effect is inflammation and damage of the coronary arteries and swelling of the walls.
5 types of cardiomyopathy
Contractility of myocardium is impaired Secondary cardiomyopathy Dilated cardiomyopathy ventricles that stretch to accommodate increased volume Hypertrophic cardiomyopathy Restrictive cardiomyopathy
Therapeutic management of cardiomyopthay
Correct underlying cause if possible Often treatment is aimed at managing CHF and dysrhythmias Fluids Anticoagulants Managing symptoms
Pharamalogica intervention of cardiomyopathy
Digoxin (works well in peds pop, improves contractibility)
Diuretics
Lasix/Furosemide, Thiazides
K wasting or sparing Lasix/Furosemide, Thiazides, spironolactone
Lasix/Furosemide wasting K
Thiazides wasting K
spironolactone sparing K
Dig toxicity S/S
nomiting, neuro signs, visual disturbances
Most common tachy dysrhythmia
SVT
RX for tachy dysrhythmia
Vagal maneuvers are the least invasive → ice bag to the face IV adenosine (rapid bolus) is drug of choice
Is secondary or primary HTN seen more in ped pop
secondary
