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Track 4 > Peds - Exam 2 - Cardiac - What To Know > Flashcards

Peds - Exam 2 - Cardiac - What To Know Flashcards

1
Q

Chest X-ray

A
  • Most frequently ordered

- Shows information about shape and size of heart, pattern of blood flow especially through pulmonary vessels

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2
Q

Cardiac catheterization

A
  • Invasive - thread cath through peripheral vessel (usually femoral)
  • Complications: bleeding, hematomas, infection, blood clots
  • Mark pedal pulses before site so they are palpated again in same position

Post procedure:

  • It is NORMAL for pulse site to be weaker for a few hours after procedure
  • Vital signs - count HR for full minute
  • Check for drainage of blood - if dressing saturated, apply pressure just above the site (1 in above), call physician or have someone call for you.
  • Pt should lay with extremity straight for 4-6 hours
  • Dressing needs to stay clean dry intact for 24 hours after (no bathing etc)
  • No tub baths 3 days (older children can shower day after cath)
  • Avoid strenuous activity for several days but may attend school
  • Can resume regular diet without restrictions
  • Acetaminophen or ibuprofen for pain
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3
Q

Echocardiography

A
  • Non-invasive, nonpainful

- Can be stressful b/c child has to lay still - may need mild sedative

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4
Q

CHF

A
  • Inability of heart to pump adequate amount of blood to meet body’s demands
  • Earliest signs in infant - tachycardia (sleeping HR of > 160)

o Impaired myocardial function

  • Tachycardia; fatigue; weakness; restlessness; S3/S4; diaphoresis; irritability
  • Decreased perfusion – pale, cool extremities; decreased BP, decreased urine output; slow cap refill

o Pulmonary congestion
- Tachypnea, dyspnea, respiratory distress, cyanosis, exercise intolerance

o Systemic venous congestion
- Peripheral and periorbital edema, weight gain, ascites, hepatomegaly (may be able to palpate liver), neck vein distention

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5
Q

Congenital vs acquired heart defect

A

Congenital:

  • Anatomic –> abnormal function
  • Seen most commonly
  • Causes: maternal or environmental (fetal alcohol syndrome, maternal illness - rubella, infants of diabetic mothers, cytomaglovirus, toxoplasmosis, etc); genetic; mostly multifactorial

Acquired
- Disease process - infection, autoimmune response, environmental factors, familial tendencies

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6
Q

Increased pulmonary blood flow - caused by which defects?

A
  • Atrial septal defect
  • Ventricular septal defect
  • Patent ductus arteriosus
  • Atrioventricular canal
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7
Q

Obstruction to blood flow from ventricles - caused by which defects?

A
  • Coarctation of aorta
  • Aortic stenosis
  • Pulmonic stenosis
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8
Q

Decreased pulmonary blood flow - caused by which defects?

A
  • Tetralogy of Fallot

- Tricuspid astresia

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9
Q

Mixed blood flow - caused by which defects?

A
  • Transposition of great arteries
  • Total anomalous pulmonary venous return
  • Truncus arteriosus
  • Hypoplastic left heart syndrome
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10
Q

ASD (Atrial Septal Defect)

A
  • It is an opening between the atria
  • Blood is going to flow from L to R – then causes increased blood flow to lungs
  • Child often presents well, not always caught early on because they are asymptomatic
  • Tx: know in general, usually do cardiac cath procedure (if small enough) or surgical repair procedure with patch
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11
Q

VSD (Ventricular Septal Defect)

A
  • Most common congenital heart defect we see
  • Defect in the ventricular septum
  • Manifestations, severity, prognosis – all depends on size –> Will affect treatment, how badly they present
  • Will hear murmur
  • Tx is surgical
  • Prognosis depends on size
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12
Q

PDA (Patent Ductus Arteriosus)

A
  • Ductus SHOULD close by ~15 hours after birth
  • Can treat that by administering indomethacin in preemies and newborns to close that – otherwise will do surgical intervention or cath lab to close it
  • Prognosis overall good – in preemies, can be worse prognosis because there can be other medical issues
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13
Q

COA (Coarctation of Aorta)

A
  • Coarctation – narrowing of aorta – typically near insertion of ductus arteriosus
  • Causes increased pressure proximal to defect
  • Causes bounding pulses in arms
  • Decreased perfusion to lower extremities (cool cyanotic)
  • Infants – signs of CHF in infants
  • Condition can deteriorate rapidly – how large of an area is narrowed?
  • Older children – dizziness, headache, fainting
  • Going to treat typically with balloon angioplasty (older than 6 mos old) if not too large
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14
Q

AS (Aortic Stenosis)

A
  • Kids should NOT be in strenuous exercise
  • Serious defect because it tends to be progressive
  • Sudden periods of ischemia and decreased CO – can lead to death (which is why it can be so dangerous)
  • Narrowing of aortic valve
  • Clinical – infants with severe defects – decreased CO – faint pulses, low BP, poor feeding
  • Older kids – exercise intolerance, dizziness, chest pain
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15
Q

PS (Pulmonic Stenosis)

A
  • Pulmonic stenosis – pulmonic valve narrowed – in extreme form, can be completely closed off (resulting in no blood to lungs) which would be very serious
  • Decreased blood flow to lungs and R ventricular hypertrophy
  • Foramen ovale can reopen which allows some shunting – some pts have PDA to help compensate
  • Chest xray shows cardiomegaly
  • Balloon angioplasty – very successful, what is typically done
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16
Q

Tetralogy of Fallot

A

4 defects involved in complete defect

  • VSD (ventricular septal defect)
  • Pulmonic stenosis
  • Overriding aorta
  • Right ventricular hypretrophy

S/S characteristic “tet spells” (blue spells) – acute episodes of cyanosis and hypoxia typically occurring after feeding or crying (baby turns blue when cries, or blue around lips after feeding, etc)

Surgery – multi-stage procedure
Risk of emboli, LOC, sudden death, seizures
One way we can prevent seizures is to keep child hydrated (prevent dehydration)

17
Q

Tricuspid Atresia

A
  • Failure of tricuspid valve to develop
  • Tx is going to be giving the prostaglandin E to keep open the foramen ovale so blood can continue to shunt – otherwise no blood flow to lungs
  • High surgical mortality rate
  • Surgery is multistep procedure
18
Q

Transposition of Great Vessels

A
  • No communication between systemic and pulmonary circulation
  • Symptoms depend on type and size of associated defects – the bigger the septal defects, the less cyanotic the newborn will appear (but will still see signs of CHF)
19
Q

Total Anomalous Pulmonary Venous Connection

A
  • Very very rare defect
  • Instead of pulm veins going to L atrium, Pulm veins go to systemic circulation via right atrium, shunted via ASD (atrial septal defect)
  • Clinical manifestations - usually cyanotic early
20
Q

Hypoplastic left heart

A
  • Primary defect - hypoplastic L ventricle – L vent so small, not functioning
  • R side compensates with PDA and foramen ovale
  • Most of the blood can flow across foramen ovale, so that some of that oxygenated blood can go back into the r atrium then into r ventricle – pumped out to lungs
  • Because of PDA patent ductus arteriosus – some goes into systemic circulation
  • Tx for this – need to keep shunts open using prostaglandin E infusion
  • Tx is ultimately going to be surgery – multiple surgeries into correcting this, and the mortality is pretty HIGH
21
Q

Postop cardiac surgery

A

It is normal to have temp up to 100 F post-op, but any higher need to notify MD. Worry about post op infection

If on bypass during sx, will come back intubated on vent

VERY CAREFUL suctioning! No more than 5 secs, GIVE O2 before and after sxn. 2 person job

22
Q

Chest Tubes After Cardiac Surgery

A

Monitor chest tube drainage q hour for COLOR
- Immediate postop may be bright red, but changing to serous
Monitor chest tube drainage for quantity
*** Notify surgeon if chest tube drainage >3 ml/kg/hr ×3 consecutive hours OR 5-10 ml/kg in any 1 hour (possible hemorrhage)
Be alert for cardiac tamponade (rapid onset; life-threatening)

23
Q

Bacterial Endocarditis

A

Bacterial endocarditis or BE, or IE (infective endocarditis), or SBE (subacute bacterial endocarditis)
Infection in valves and endocardium
Usually sequelae of sepsis in child w/ cardiac disease or congenital anomaly
Staph, Strep, Candida, gram-negative bacteria
High-dose ANTBX: Penicillin, amipicillin, methicillin, cloxacillin, streptomycin, or gentamicin
Amphotericin or flucytosine for fungal infections
Treat 2-8 weeks. If antbx unsuccessful»CHF develops, valvular damage
Prophylax before dental procedures, bronchoscopy, T&A, SURGERIES

24
Q

Prevention of IE (infective endocarditis)

A

Prophylactic antibiotics ONLY for highest-risk CHD patients
Recent changes in prophylaxis guidelines
Prophylaxis before dental work, invasive respiratory treatment, or procedures on soft tissue infections
No prophylaxis for GI/GU procedures
Administer prophylaxis 1 hour before procedure
Meticulous dental hygiene

NEED GOOD TEACHING FOR PARENTS OF HIGH-RISK PTS. These parent should not wait to bring their kids in…even if suspect just a cold, need to be evaluated

25
Q

Rheumatic Fever clinical manifestations

A

Carditis involves endocardium, pericardium, and myocardium; most commonly the mitral valve

Arthritis is reversible and migrates, especially in large joints (knees, elbows, hips, shoulders, wrists)

Erythema marginatum—rash; usually on trunk and proximal portion of extremities. Red macule w/ clear center and wavy, well-demarcated border

Subcutaneous nodules: small, nontender nodules appear over bony prominences (hands, feet, elbows, scalp, scapulae, vertebrae) persist indefinitely after onset of the disease and resolve w/ no resulting damage.

Aschoff bodies: Inflamed hemorrhagic bullous lesions that cause swelling, fragmentation, and alterations in connective tissue. Found in the heart, blood vessels, brain, and on serous surfaces of joints and pleura.

26
Q

Prevention of RHD

A

**THIS IS WHY WE CHECK ALL KIDS WITH SORE THROAT FOR STREP AND SEND BACK UP CULTURE PRN

27
Q

Kawasaki Disease

A

 Acute systemic vasculitis, unknown cause
 Duration 6-8 weeks, self-limiting
 Without treatment of KD, 20%-25% have cardiac complications
 Dilation of coronary arteries (ectasia)
 Coronary artery aneurysms (giant aneurysms > 8 mm)
 Acute, subacute, convalescent phases
Etiology
 Uncomfirmed but likely infectious cause. Have seen geographic and seasonal outbreaks
 Peak incidence in toddler ages
 Seasonal variations (late winter/early spring)
 Widespread inflammation of small and medium-size arteries
Clinical Manifestations
 High fever—unresponsive to antipyretics/ antibiotics
 “Strawberry” tongue
 Edema hands and feet
 Extreme irritability (inconsolability)
 It can be really tough to take care of these kids bc of the extreme irritability
 Periungual desquamation
 Arthritis
 Coronary complications
Tx
 high dose IVIG and salicylate (ASPIRIN) therapy

Track 4 (20 decks)

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