Cardiac 10/16 Flashcards
(182 cards)
1
Q
Where can a heartbeat be heard the loudest?
A
Apex
2
Q
When do you use the bell to auscultate?
A
Lower pitch sounds
3
Q
What is an innocent murmur?
A
Benign, no clinical symptoms or signficance, normal cardiac anatomy and function
4
Q
When would congenital murmurs most likely be detected?
A
Weeks after delivery (ASD, VSD, aortic or pulmonic stenosis)
5
Q
What might syncope be a symptom of?
A
- Arrhythmia
- Mitral valve prolapse
- Aortic stenosis
- Long QT syndrome
6
Q
What is a concern post-strep infection?
A
Post-strep murmur
7
Q
What should be done if a murmur is detected at a well-child visit?
A
Assess for other s/s of compensation or complication (benign murmurs are common in pediatric population)
8
Q
How is a murmur characterized?
A
- Intensity
- Location
- Quality
- Radiation
- Timing
- Pitch
- Grade
- Associated factors
9
Q
What does a murmur’s intensity describe?
A
Loudness
10
Q
What does a murmur’s location describe?
A
Where it is best heard (where it is the loudest)
11
Q
What does a murmur’s quality describe?
A
Description of the sound- musical, blowing, swishing
12
Q
What does a murmur’s radiating quality describe?
A
Can the murmur be heard elsewhere throughout the body
13
Q
What does a murmur’s timing describe?
A
During what part of the heartbeat does the murmur occur
14
Q
What are possible associated factors of a murmur?
A
- Occurs only when in a certain position (sitting, lying down)
- Child is dehydrated
- Child has infection
15
Q
How do you grade a murmur?
A
- Grade 1-6 (I-VI)
- 1 = difficult to hear with stethoscope
- 4 = accompanied by thrill (vibration over the heart)
6 = can hear without stethoscope
16
Q
What might trigger an innocent murmur?
A
Bodily/cardiac stress:
- Anemia
- Fever
- Rapid growth
17
Q
What is a thrill?
A
Vibration heard related to murmur at the heart (heard in grade 4-6 of murmurs)
18
Q
What are the parts of the heart present in a fetus (that should close with birth)?
A
- Foramen ovale
- Ductus arteriosus
19
Q
Where is the foramen ovale?
A
Between RA and LA
20
Q
Where is the ductus arteriosus?
A
Connects pulmonary artery and aorta
21
Q
Describe the blood flow of a fetus.
A
Placenta –> umbilical vein –> liver –> ductus venosus –> inferior vena cava –> RA –> RV or foramen ovale
22
Q
What happens to the foramen ovale, ductus arteriosus, and ductus venosus after delivery?
A
Close and atrophy; become legamentum
23
Q
What causes the foramen ovale and ductus arteriosus to close?
A
Pressure changes once baby starts breathing
24
Q
What are S/S of pediatric cardiac dysfunction?
A
- Poor feeding/falling asleep
- Tachypnea
- Tachycardia
- Sweating on head (d/t increased metabolic rate)
- Freq low respiratory infections
- Poor weight gain
- Activity intolerance
- Developmental delas
- Prenatal hx
- Family hx
25
How does Maslow's hierarchy related to pediatric cardiac dysnfunction?
Cardiac dysfunction leads to hypoxia; hypoxia leads to poor feeding, poor growth, and then poor development
26
What prenatal conditions may predispose a child to cardiac dysfunction?
- Lack of prenatal care
- Preterm birth
- Diabetes
- IUGR
- Infection during pregnancy
- Teratogen exposure
27
What are the S/S of CHF?
- Respiratory s/s (fluid = wheezing, congestion, crackles; tachypnea)
- Sweating of upper brow (d/t increased metabolism)
- Tachycardia
- Edema
- Cool extremities
- Lethargy
28
What are the respiratory s/s of CHF?
- Fluid (wheezing, congestion, crackles)
| - Tachypnea
29
What is the cardiac cycle?
Sequential contraction and relaxation of the atria and ventricles
30
What is afterload?
The resistance (pressure) that the ventricles must pump against
31
What is stroke volume?
The volume of blood ejected by the heart with each contraction
32
What is cardiac output?
The volume of blood ejected by the heart per minute (CO = HR x SV)
33
What are the 2 categories of cardiac defects?
- Congenital
| - Acquired
34
What are possible causes of acquired cardiac defects?
- Autoimmune response
- Infection
- Environmental exposure
35
What is the most common cause of congenital cardiac defect?
Multifactorial (85%)
36
What is more common: genetic cause of a congenital heart defect or environmental/maternal illness during pregnancy?
Genetics (10-12%) vs. maternal/environment (1-2%)
37
What are maternal illnesses or exposures that increase fetal risk of congenital heart defect?
- Rubella during first 7 weeks of pregnancy
- Viral illness
- Diabetes
- Alcolohol use (FAS)
38
What is the most common congenital heart defect?
VSD
39
What are the 4 classes of congenital heart disorders?
- Increased pulm blood flow
- Decreased pulm blood flow
- Obstruction of blood flow out
- Mixed blood flow
40
What is a s/s of an increased pulm flow CHD?
CHF
41
What is a s/s of a decreased pulm flow CHD?
Cyanosis
42
What is a s/s of obstructive defects of the ventricles?
- Obstructed L heart = CHF
| - Obstructed R heart = cyanosis
43
What is ASD?
- Atrial septal defect
44
What category of CHD does ASD fit in?
Increased pulmonary flow (blood flows from high P to low P, therefore goes form L heart to R increasing pulm blood flow)
45
What is the change in cardiac blood flow from ASD?
Blood flows from LA to RA via hole in atrial septum
46
What part of the heart becomes distended in ASD?
RA and RV (d/t increased filling secondary to septal defect and pulmonary resistance)
47
What s/s are seen with ASD?
- Typically asymptomatic (although septal defect, since in atria, less s/s seen)
- Even pulm s/s are less since only atrial involvement
48
How is ASD tx?
- surgical = cardiac cath repair w/ patch
49
How is ASD detected?
Since nonsymptomatic, detect via murmur auscultation or s/s of slowed growth and development
50
What category of CHD is patent ductus arteriosus?
Increased pulm flow
51
When should the ductus arteriosus close normally?
- Starts w/ first breath
| - Should be close (by P changes) 15hrs after birth
52
What is PDA?
Patent ductus arteriosus
53
What are s/s of PDA?
- CHF (tachypnea, tachycardia, dyspnea, hoarse cry)
- Bounding peripheral pulse
- Widened pulse pressure
- Murmur @ upper L (pulmonic aorta)
54
How is PDA definitively diagnosed?
Echo
55
How is PDA managed?
- Medically = indomethacin
| - Surgery = surgical ligation via cath
56
What is Indomethacin and what is it used for?
NSAID that closes ductus arteriosis
57
What needs to be dosed prior to a surgical ligation of PDA?
Prophylactic antibiotics to prevent bacterial endocarditis
58
What category is VSD?
Increased pulm flow
59
What 3 heart conditions increase pulmonary flow?
- ASD
- VSD
- PDA
60
Which of the following is typically asymptomatic: ASD, VSD, PDA?
ASD
61
Which of the following frequently cause pulm HTN and CHF s/s: ASD, VSD, PDA?
VSD and PDA
62
Which CHD is the most common?
VSD
63
Which way does blood flow in VSD?
LV to RV via septal defect
64
What part of the heart first hypertrophies in VSD?
LV
65
What are s/s of VSD?
- Murmur
- CHF
- Pulm vascular obstructive disease/HTN
66
What is an increased risk d/t VSD?
Bacterial endocarditis
67
What is a serious side effect of advanced VSD?
Eisenmenger syndrome
68
What is Eisenmenger syndrome?
Severe pulmonary vascular obstruction is >> than systemic circulation; causes reversal of blood flow through ventricles (RV pressure > LV pressure, therefore deoxygenated blood travels systemically)
69
How is VSD treated?
Surgical repair via pulm artery banding (to close hole) or patch
70
What is tetraology of Fallot?
A dx that involves 4 different CHD
71
What 4 CHDs are included in tetralogy of Fallot?
- VSD
- Pulmonic stenosis
- Overriding aorta
- RV hypertrophy
72
What is overriding aorta?
Aorta pulls blood from both RV and LV
73
What category of CHD is tetralogy of Fallot?
Decreases pulmonary flow
74
What are s/s of tetralogy of fallot?
Cyanosis, chronic need for O2:
| - Tet spells (blue spells) = acute episodes of cyanosis and hypoxia
75
Which way does blood flow in tetralogy of fallot?
Depends on severity of each CHD (if PVR > systemic resistance, blood flows from RV to LV)
76
What are risks associated with the s/s of tetralogy of fallot?
- Emboli
- Altered LOC
- Sudden death
- Seizures
77
How is tetralogy of fallot treated?
Surgically:
- Shunt placed from subclavian artery to pulm artery (bypasses stenosis to increase pulm blood flow)
- Complete repair = VSD repair, resect stenosed pulm artery
78
What is a tet spell?
AKA blue spell = acute episode of cyanosis or hypoxia
79
When is complete surgical repair of tetralogy of fallot indicated?
With increased occurrences of tet spells
80
What often triggers a tet spell?
Increased output of energy (stress or energy output):
- Lab draws
- Feeding
- Crying
- Defecating
81
What is done at home to manage a tet spell?
- Knee to chest position to optimize blood flow
| - Calm approach, calm child
82
What is done in patient to manage a tet spell?
- Knee to chest position
- Calming presence
- Morphine to stop spasm
- 100% O2
- IVF
83
What category of CHD is pulmonary stenosis?
Obstructed flow
84
What structural heart changes occur d/t pulmonary stenosis?
- RV hypertrophy
| - Narrowing of pulmonary artery
85
What is an extreme form of pulmonary stenosis?
Pulmonary atresia
86
What is pulmonary atresia
Complete fusion/closure of the pulmonary artery
87
What happens to the ductus arteriosus and foramen ovale secondary to significant pulmonary stenosis?
Foramen ovale and ductus arteriosus reopen (allows for some blood flow to lungs: RV > RA > foramen ovale > LA > LV > aorta > ductus arteriosus > PA > lungs)
88
What are s/s of pulm stenosis?
Systemic cyanosis
89
How is pulmonary stenosis dx?
Chest x-ray = cardiomegaly and pulm stenosis
90
How is pulm stenosis tx?
- Balloon angioplasty to dilate pulmonary artery
| - Replace valve (bypass to do valvotomy)
91
What is coarctation of the aorta?
Narrowing of the artery near ductus arteriosus
92
What category of CHD is coarctation of the aorta?
Obstructive flow
93
What are the s/s of coarctation of the aorta?
- Bounding pulse and high BP @ arms
- Weak pulse and low BP @ lower extremities
- CHF s/s
- Dizziness,
- HA
- Fainting
- Epistaxis (from upper body high BP)
94
What are the risks of coarctation of the aorta?
- Aortic aneurysm
| - Stroke
95
How do you tx coarctation of the aorta?
- Nonsurgical = balloon angioplasty
| - Surgical = resection of coarctation
96
Does surgical tx of coarctation of the aorta require bypass?
No- site of defect is outside of the pericardium
97
What are possible post-op complications r/t tx of coarcation of the aorta?
- Systemic HTN
| - Recurrence
98
What is aortic stenosis?
Narrowing of the aortic valve
99
Which is more common, aortic or pulmonary artery stenosis?
Aortic stenosis (more common in bi- vs. tri-cuspid valves)
100
What category of CHD is aortic stenosis?
Obstructed flow
101
What effects does aortic stenosis have on the heart?
- Increased LV resistance
- Decreased CO
- LV hypertrophy
- Backup of blood into pulmonary circuit (eventually leads to pulm HTN)
- Decreased systemic perfusion
- Decreased coronary artery perfusion (increased risk of MI)
102
What are the s/s of aortic stenosis?
- Murmur
- Faint pulses
- Hypotension
- Poor feeding
- Tachycardia
- Exercise intolerance
- Chest pain
- Dizziness with standing
103
How is aortic stenosis tx?
- Nonsurgical = balloon angioplasty
| - Surgical = valve replacement
104
If aortic stenosis is detected early in birth, what med may be given to support hemodynamic stability?
Prostaglandin (to keep ductus arteriosis patent)
105
What category of cardiac disease does hypoplastic left heart syndrome fall into?
Mixed blood flow
106
What is the prognosis for untreated hypoplastic L heart?
Untreated condition is not compatible with life
107
What is hypoplastic L heart?
- L side of heart is underdeveloped
- L ventricle is small
- Aortic atresia on L side (valve from LV to aorta = small, not fully functional)
- Patent foramen ovale and ductus arteriosus (allows some blood flow to aorta from pulmonary artery)
108
What is tx plan for hypoplastic L heart?
- Keep ducti (DA and FO) open w/ Prostaglandin E infusion
- Surgery (3)
- Option for transplant if surgeries unsuccessful
109
Why is heart transplant the last effort?
- Hard to get a heart to donate
| - High mortality rate with procedure (30-50%)
110
What are the 3 surgeries involved with hypoplastic L heart?
```
1 = Norwood procedure = create new aorta using main pulm artery and creation of large ASD
2 = Bidirectional Glenn Shunt @ 6-9mo to reduce volume load on R ventricle
3 = modified Fontan procedure = tricuspid valve atresia repair @ L ventricle
```
111
In which category of cardiac condition does transposition of the great vessels belong?
Mixed flow
112
What is "transposition of the great vessels"?
Pulm artery leaves L ventricle and aorta leaves R ventricle (patent ductus arteriosus and foramen ovale for life to be sustained)
113
How do you surgically tx "transposition of the great vessels"?
Arterial switch = resect and re-anastomose the great vessels (requires coronory arteries to be reimplanted in order to supply blood to heart with new vessel arrangement)
114
What are the s/s of "transposition of the great vessels"?
- Desaturation of O2
- Cyanosis
- CHF
115
In which category of cardiac condition does truncus arteriosus belong?
Mixed blood flow
116
What is truncus arteriosus?
A single large vessel supplies blood to both the pulm artery and aorta (ASD present)
117
Is Digoxin a positive or negative inotrope?
Positive- increases the F of contraction
118
At what apical infant HR would you give the dose of Digoxin?
90+bpm
119
At what apical chidlren/toddler HR would you give the dose of Digoxin?
70+bpm
120
What are two assessments conducted regularly for a ped on Digoxin (hint: physical assessment and lab)?
- Daily weight
| - Labs drawn for K+
121
Is Digoxin a positive or negative chronotrope?
Negative (slows HR while increasing contractility)
122
What is the mechanism of digoxin?
Angiotensin enzyme inhibitor (reduces afterload of the heart)
123
What are s/s of digoxin toxicity?
- Vomiting
- Neuro changes (irritability, responsiveness)
- Visual disturbances (frequent blinking)
124
How is digoxin tox tx?
- Lasix to remove excess drug
| - K+ supplements (dosing meds and PO (leafy greens, bananas. etc.)
125
Does Digoxin have a slow or rapid onset?
Rapid
126
Does Digoxin have a long or short 1/2 life?
Short
127
How do you administer PO liquid Dig to a pediatric patient?
Squirt to side/back of mouth
128
When should Digoxin be given releative to food?
- W/o food
| - 1hr before feeding or 2 hrs after
129
What should you do if a dose of Digoxin is vomited?
Do not automatically repeat dose
130
What are possible causes of acquired cardio disorders?
- Infection
- Autoimmune response
- Environment
- Family tendencies
131
What is endocarditis?
- Infection in valves and endocardium of heart
132
What are the 3 acronyms for types of endocarditis?
- BE = bacterial endocarditis
- IE = infective endocarditis
- SBE = subacute bacterial endocarditis
133
What is often present in the PMH of a ped dx w/ endocarditis?
- Usually sequelae of sepsis in child w/ congenital heart anomaly
- Ex: staph, strep, Candida, gram - bacteria
134
What are prophylactic measure taken to prevent endocarditis?
1hr before procedures, IV or PO antibiotics are given (before dental procedures, bronchoscopy, T&A, surgeries)
135
What are the risks of unmanaged endocarditis?
Long term damage to the heart (possible CHF or valvular damage)
136
How is endocarditis tx?
- 2-8 wks of antibiotics
- Antibiotics dosed often: -cillin, streptomycin or gentamicin
- Amphotericin or flucytosine for fungal infections/causes
137
Why are rheumatic fever and rheumatic heart disease seen less often in the peds population?
Strep is better treated today
138
What is rheumatic fever?
An inflammatory disease that occurs after group A strep infection
139
What are s/s of rheumatic fever?
- Fever affects joints, skin, brain, serous surfaces, and heart
- Carditis (involves all muscle layers of the heart and the mitral valve)
- Arthritis (reversible; migrates from large joints to others)
- Erythema marginatum (rash)
- Sub-q nodules over bony prominences (hands, feet, vertebrae, etc.); may persist after disease resolves and will eventually clear
- Aschoff bodies (inflammed hemorrhagic bullous lesions that cause swelling and alterations in connective tissue); found in heart, blood vessels, brain, joints, and serous surfaces
140
Where is rheumatic fever seen more often today?
3rd world countries (with less strep control)
141
What is rheumatic heart disease?
- The most common complication of rheumatic fever
| - Damage to heart valves secondary to fever
142
What is carditis?
Carditis involves endocardium, pericardium, and myocardium; most commonly the mitral valve
143
What is polyarthritis in RF?
Arthritis is reversible and migrates, especially in large joints (knees, elbows, hips, shoulders, wrists)
144
What is erythema marginatum in RF?
Erythema marginatum = rash; usually on trunk and proximal portion of extremities. Red macule w/ clear center and wavy, well-demarcated border
145
What are subcutaneous nodules related to RF?
Subcutaneous nodules are inflammation typically on the wrists; resolve after RF resolves
146
What are Aschoff bodies r/t RF?
Aschoff bodies: inflammed 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
147
How is rheumatic fever dx?
Presence of 2 major or 1 major and 2 minor s/s
148
Is rheumatic fever an autoimmune rxn?
Yes
149
What is Kawasaki disease?
Inflammation of the coronary arteries
150
How is Kawasaki disease dx?
S/s:
- Severe irritability
- Fever
- Rash/peeling of palms of hands and feet
- Edema of hands and feet
- Swollen and cracked lips
- Strawberry tongue (red with white dots)
151
How is Kawasaki disease tx?
- IV immunoglobulin G (IgG)
- Aspirin
- Possible use of coumadin (warfarin)
152
How is IgG dosed with Kawasaki disease?
- High doses (to reduce fever and coronary artery abnormalities)
- Given within the 1st 10 days of illness
153
Why is Aspirin dosed in Kawasaki disease in spite of Reye's syndrome?
The risks of Reye's syndrome are weighed against Kawasaki disease and it was determined that it is more appropriate to control the Kawasaki's effectively and assess for Reye's than the alternative
154
What dose of aspirin is given?
- 80-100 mg/kg/day in divided doses Q6h until fever is gone
- After fever is gone, dose 3-5mg/kg/day for antiplatelet effects
- Continue until platelet count returns to normal
155
Should aspirin be continued indefinitely?
Only if there are longterm coronary abnormalities
156
When is Coumadin/warfarin indicated for children with Kawasaki's disease?
Children with giant aneurysm (>8mm)
157
What is cardiomyopathy?
- When contractability of the myocardium is impaired
| - Muscle is rigid and reduced
158
What are s/s of cardiomyopathy?
CHF symptoms
159
What are types of cardiomyopathys?
- Secondary cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
160
How is a cardiomyopathy tx?
- Correct underlying cause if possible
| - Manage CHF and dysrhythmia
161
How are CHF and dysrhytmia s/s of cardiomyopathy managed?
- Possible surgery
- Anticoagulants
- Defibrillator
- Vasodilator
162
What meds are used to manage a cardiomyopathy?
- Digoxin (increase cardiac contractions)
| - Diuretics (Lasix/Furosemide, or Thiazides)
163
What needs to be considered when dosing diuretics to manage a cardiomyopathy?
- Consider K+, Na+, hypotension
| - Low Na+, increased K+ diet
164
What is the difference between Lasix/Furosemide and thiazides?
Thiazides are K+ sparing
165
What are common pharmacologic meds used with CV disorders?
- IV IgG
- Digoxin (improves contractility, need to observe for toxicity)
- Aspirin (antiplatlet and decrease coronary artery inflammation)
- NSAIDs
- Lasix (need to supplement K+)
- Spironolactone (Thiazide)
166
How is a cardiac dysrhythmia dx?
- ECG
- Holter monitor
- Cardiac cath (pressures, diagnostic structural assessment, intervention)
- Transesophageal recording
- Chest x-ray (size of heart)
- Echo (structure and blood flow)
167
What are tachydysrhtymias?
- HR too fast
| - Doesn't allow for quality refill and ejection, inefficient contractions and perfusion
168
What is the most common tachydysrhythmia?
SVT (HR >200 bpm)
169
What are the s/s of a tachydysrhtymia?
- Neuro changes
| - Cyanosis
170
How is a tachydysrthymia tx?
- Vagal maneuver
| - Adenosine (med)- slows HR, very short 1/2 life
171
What is important to know about Adenosine?
Very short 1/2 life
172
How do you perform a vagal maneuver in peds?
Bag of cold ice to the face
173
What is a bradydysrthythmia?
Too slow HR, possible AV block
174
How is a bradydysrhythmia tx?
Pacemaker
175
What is the difference between primary and secondary HTN?
Primary HTN has no known cause; secondary has an identifiable cause
176
What is the common cause of secondary HTN in the pediatric population?
- Structural abnormality of cardio
| - Underlying pathology abnormality (renal disease, CV disease, endocrine or neuro disorder)
177
How is systemic HTN dx?
- Need 3 separate appointments/occasions to document systemic elevated HTN
178
When should BP be screened for children?
ALL OF THE TIME
- Routine check ups
- With any illness
- Failure to thrive
179
What is assessed pre cardiac cath?
- VS (Q1min apical pulse)
- Cap refill and perfusion
- H+H
- Pulses
- Height and weight
- Skin assessment
180
What is assessed post cardiac cath?
- Gauze site and diaper for bleeding (under butt too)
- Temp
- Cap refill
- Pulses
- IO
- Keep quiet for 4-6hrs
181
For which conditions can cardiac catheterization be a tx measure rather than solely dx in ped population?
- Transposition of great vessels
- Single-ventricle defects
- ASD
- Pulmonary artery stenosis
182
How often should VS be taken post cardiac cath?
VS Q15min
