week 4 module 12 special considerations Flashcards
fetal circulation
R. atrium -> foramen ovale -> L. atrium
R. ventricle -> patent ductus arteriosus not lungs
fetal/infant ventricle size
equal in weight and size because both pump blood systemically.
infants and dyspnea
look for enlargement of heart and position
Closure of PDA
closes by 48 hours
closure of foramen ovale
closes as pressure in L. atrium increases
bulging precordium in child
long-standing heart enlargement
sinus arrhythmia in child
a physiologic event
most acquired murmurs in children are a result of
kawasaki disease
still murmur
causes by vigorous expulsion of blood from L. ventricle into the aorta - inc. with activity - dec. with rest Most common in ages 3-7 vibratory, groaning, or musical
SAFER
Children at high risk of underlying structural heart defect
- Syndromic features: syndromes or chromosomal anomalies
- Age: murmur in infant more likely pathologic
- Family Hx: congenital heart defects have multifactorial inheritance (3-5% chance in offspring)
- Evaluation of feeding and growth: feeding diff. sweating
- Rheumatic fever/ PMH: kawasaki, rheumatic fever
systemic vascular resistance during preg
decreases
BP during preg
dec. in 2nd trimester, returns to nml in 3rd
heart sounds during preg
change with increased blood volume
- audible splitting of S1 and S2
- S3 may be heard after 20wks
- systolic ejection murmurs may happen in 90%
blood volume during preg
inc. 40-50%
- > inc. workload of the heart
- returns to nml 3-4 wks after delivery
CO during preg
inc. 30-40%
peaks at 25-32wks
- returns to nml ~ 2wks after delivery
apical pulse and older adults
harder to find
- inc. anteroposterior chest diameter
- obesity
S4 and older adults
sound is more common
- may indicate dec. L. ventricular compliance
heart size and older adults
may dec. unless pt has HTN or CV disease
older adults and CO
during exercise decreases 30-40%
structural changes to heart in older adults
endocardium thickens
myocardium more rigid -> dec. contractility
fibrosis and sclerosis
infants signs of CV issues
tiring during feeding breathing changes cyanosis Wt gain knee-chest position favored mothers health during preg
children signs of CV issues
tiring during play naps headaches nosebleeds joint pain fever ht and wt gain physical and cognitive development
S3 and children
normal
defining murmurs
timing and duration pitch intensity pattern quality location and radiation respiratory phase variations
Bounding pulses in infant
PDA
aortic regurgitation
Thready pulses in infant
aortic stenosis
congenital heart defects usually occur
within the first 8 weeks of gestation
chromosomal abnormalities account for
nearly 10% of all cardiac malformations
environmental or maternal conditions account for
2-4% of all CHD
- lupus
- diabetes
- PKU
- SLE
- viruses
- ETOH
- anticonvulsant use
pulmonary systolic ejection murmur
common in peds
slightly harsh systolic ejection murmur heard best at 2nd or 3rd ICS
supraclavicular arterial bruit
common in peds
early systolic murmur heard above the clavicles
physiologic peripheral pulmonary stenosis
common in peds
low-intensity systolic ejection murmur
upper-left sternal boarder, axillae, and back bilaterally
- in neonates up until 3-6months
venous hum
humming continuous with murmur
usually at RUSB
will decrease or disappear when supine
kawasaki disease
inflammation in walls of small and medium sized arteries throughout the body
coarctation of the aorta
usually presents with other defects
Males:females 3:1
usually in thoracic portion of descending aorta
- must check femoral pulses
hypertrophic cardiomyopathy
most common cause of death in competitive athletes
- syncope
- heart racing
