Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

349 Peds Exam 2 > Cardiac Textbook Information > Flashcards

Cardiac Textbook Information Flashcards

1
Q

Cardiovascular disorders in children are divided into two major groups
Which are?

A

Congenital and acquired heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is congenital heart defects?

A

Anatomic abnormalities present at birth that result in abnormal cardiac function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 2 congenital heart defects ?

A

Heart failure
Hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acquired cardiac disorders is what?

A

Disease process or abnormalities that occur after birth and can be seen in the normal heart or in the presence of congenital heart defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the heart function?

A

To pump blood throughout the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the heart develop in the pregnancy phase?
And completely formed?

A

4-5th week of gestation

8th week of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the process of fetal circulation?

A

In which the infant is dependent on the mother for nutrients and circulation throughout the body.

Placenta -> fetal system through umbilicus -> liver ( divided into two ) and IVC

From inferior vena cava by the ductus venosus -> RA -> foramen ovalue to the LA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

After the aorta, where does the blood go!?

A

Placenta from the descending aorta through two umbilical arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Are the lungs functioning in a fetus?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Postnatal circulation
After the baby is born, how do they breathe? Like what is the initiation?

A

Clamping of the umbilical cord and expansion of the lungs

This causes Hemodynamic changes that will let the baby respiratate and circulate on their own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The patent ductus arteriosclerosis starts to close within what day and how?

A

First day of birth via the construction of smooth muscles in the vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does the PDA work for preterm babies?

Usually at what week does it close for them?

A

It usually is less responsive to oxygen and higher levels of prostaglandins, which both can delay the ductwork closer

2-3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are functions of arteries?
What are function of veins?

And how do they work on fetal too?

A

Thick wall filled with oxygen and push blood away from heart

Thin wall with deoxygenated blood and comes towards the heart

In the fetus
This is opposite !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The arteries and veins work together to help maintain our what?

A

Blood pressure !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The heart is the first organ to receive blood what comes after that? Like what next organ gets blood?

A

The brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does tachycardia mean?

A

Fast heart rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does bradycardia mean?

A

Slow heart heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does Tachypnea mean and typically a warning sign for what?

A

Fast breathing
Heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does murmurs mean?

A

Heart sounds that reflect the flow of the blood within the heart
Audible whooshing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cardiac catherterization!

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is cardiac catheterization?

A

An invasive diagnostic procedure in which a radiopaque catheter is inserted through a peripheral blood vessel into the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is the catheter usually introduced ?

A

Through a Percutaneous puncture into the femoral vein
And then guided through the vessel into the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

It’s important to note that cardiac Catherization may be performed for diagnostic, interventional or electrophysiologic purposes.

What are the two types of diagnostic cardiac catheter?

A

Right sided ( venous )
Left sided ( arterial )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does right side and left sided catheter differ?

A

Right side - goes through vein into RA

Left side - goes through artery into aorta and LV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What’s the most common Cath. Site
Left or right?

A

Right sided as it’s easier to get into because septal ductus permit entry into the left side of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Notes
Common interventions surgeries are
Ballon atrial septostomy
Balloon dilation
Stent placements
Coil occlusions
Transcatheter device closure
Transcatheeter pulmonary valve replacement
Radiofrequency ablation

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is interventional cardiac Catherization?

Example?

A

Use of catheter delivered device to treat heart disease

Balloon catheter to dilate narrowed valves and vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is electrophysiologic studies used for?

A

To evaluate and treat Dysrthymias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Notes
Pre procedural care
- accurate height and weight to properly decide which size cath
- history of allergies
( iodine based )
- signs and symptoms of infection
- diaper rash is contraindicated as it’s a site for femoral entry
- pulses present
- oxygen baseline
- preparation of surgery understanding

Post procedural care
- pulses
- temperature for coolness and blanching may indicate arterial obstruction
- vital signs
- BP hypotension -> hemorrhage
- dressing site
- fluid intake

Infants are at high risk for hypoglycemia
Do they should receive dextrose and blood glucose should be checked out

Stroke assessments!

If bleeding occurs direct continous pressure is applied 1inch above the site of injection

Usually they should remain in bed for 4-6 hours

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Congenital heart disease !

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Notes
The incidence of congenital heart disease in children is 1 in 110 birth in the United States

25% of these babies will need treatment first year of life

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is congenital heart defect? Like how do we know it’s this?

A

Usually from a single defect in the septum, heart valve, arteries or veins

But often a combination of all or one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the cause of congenital heart defects?

A

The main cause is unknown
However many say
Maternal risk of uncontrolled diabetes, alcohol, tetagenic exposure

Genetics of family members

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the syndrome many kids with this have usually end up getting congenital heart defects?

Others are like
Digeorge syndrome
Williams syndrome
Noonan syndrome

A

Down syndrome sadly :(

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The physiology of heart defects is defined as what?

A

Pressure gradients, blood flow and resistance within circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does septal defect work?

A

Blood flow from higher pressure from left side to one of lower pressure, which is right side

This is a left to right shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How does a normal blood flow work?

A

Low pressure on the right side
To a high pressure on left side

So low pressure to bring up the deoxygen
High pressure to push oxygen to body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

It’s important to note with altered hemodyanmics that any blood flow from an area of high pressure to a low pressure because it will always take the path of least resistances

However with heart defect it’s?

A

It doesn’t do that, it usually results in an alter dynamic and changes it

Like the left right shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Now
Tell me how much oxygen and saturation should be in each section
SVC/IVC?

RA,RV,PA

A

Low oxygen saturation

Equal both & most oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Depending on the type of defect
Typically the saturated and desaturated blood may?

A

Mix
And this results in the defect where improper heart beats and such occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are some clinical consequences of congenital heart disease?

But what are the 2 main ones?

A

It’s truly all depends on the severity of the defect and the alerted Hemodynamic?

Congenital heart failure & hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Typically defects that result in left to right shunting of blood causes symptoms of?

A

Congenital heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Typically defects that result in decreased pulmonary blood flow causes?

A

Cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Notes
It’s also important that congenital heart disease can have one or multiple things going on.
So even with surgical repair more complications can occur
- usually uncommon
But it a very sad thing to see

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Onto the slides information regarding congenital heart disease

What’s the most common anomaly?

A

VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

According to dr.rickerby.
Maternal and environmental play a huge role in what causes CHD.

So what is the main maternal issue with CHD?

What are some environmental factors? (3)

A

Alcohol syndrome

Rubella, CMV, Toxoplasmopis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Rubella in the first 7 weeks of pregnancy will increase the risk by 50% of defects to occur
Main ones being?

A

PDA
pulmonary branch stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What changes occurred during development, what are the 4 main things we can help diagnose a child with CHD. Like what do we look at?

Think of the shape of the heart
Hole or no hole
Explain

A

Did not form - atresia ( no hole )
Did not space - great vessels together
Did not fuse - holes like ASD
( think of how like ovalume is still open )

Did not differentiate - TAPVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

So we know there are congenital CHD
Which is from birth

What is acquired example of CHD?

A

Infections
Autoimmune response
Environmental factors
Familial tendencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the 2 types of congenital heart defects?

A

Cyanotic heart disease
Acyanotic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the 2 cyanotic heart disease?

A

Decreased pulmonary flow
Increase pulmonary flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is decreased pulmonary flow for cyanotic heart disease examples that we are going to review? (3)

A

Tetralogy of fallot
Tricuspid atresia
Other univentricular heart with pulmonary stenosis

Anything reducing and or increasing blood flow to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the 2 examples of increased pulmonary flow for cyanotic heart disease?

A

Transposition of great artieries
Total anomalous pulmonary venous return
( so the heart is providing too much blood flow and goes into the lungs for a second round)

Over circulation!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the 2 examples of acyanotic heart disease?

A

Left & right shunt lesions
Obstructive lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is left right shunt lesion examples for acyanotic heart disease? (4)

A

Ventricular septal defect
Atrial septal defect
Atrioventricular septal defect
Patent ductus arteriosis

If it stays open, by overflowing of blood on the body side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the obstructive lesions of acyanotic heart diseases ? (3)

A

Aortic stenosis
Pulmonary valve stenosis
Coarctation of aorta

Anything obstructing the actual blood flow to the heart and body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Acyanotic heart disease is a what?
And example what this means too?

A

Left side to right shunt

So too much pressure on the left side of the heart.
We understand that the left side of the heart should have received full oxygen from the heart, however
With acyanotic it is going to come back to the left side

( overall circulate on the lungs )

So this can result in a lot of lungs problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Acyanotic heart defect is also known as those that cause increased what?

And has an increased risk for?

A

Pulmonary blood flow

Pulmonary congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

With the severe risk of pulmonary congestion, it can lead to kids getting?

A

Congestive heart failure
From that left to right shunting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

For acyanotic heart defect, the ones that obstruct the blood flow from the ventricular

What is the biggest worry and how does it present?

A

Patient has severe obstruction of pulmonary blood flow
And can lead to cyanosis

Meaning no circulation of blood due to that obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Now onto cyanotic
This is often known as what type of shunt?

Explain this

A

Right to left shunting

So we understand that our body pumps deoxygenated blood from the right side and moves to oxygens to the left

In this case
It comes up as deoxygenated blood and still is deoxygenated blood when reaching the left side of the body
So the baby isn’t getting oxygen

And presents with that cyanosis look
Blue toes and fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

PowerPoint question
Which way does blood shunt in acyanotic heart defects?

What condition does this cause long term?
Example this?

A

Left to right

Pulmonary hypertension
( excessive blood flow on the left, because those pulmonary arteries will have narrowing because of how much blood is being forced into there )

Think of how the oxygen keeps coming back and causing trauma to the area
This area becomes narrowed and that blood pressure will increase
Pulmonary hypertension because it’s all happening in the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

For the physical examination for CHD
No matter if it’s cyanotic or acyanotic
We will look at what?
Think basic

But what are the 2 big things to look at 100% to differnaate the two

A

Heart rate
Blood pressure
Pulses

Upper and lower extremities if we see oxygen reaching them or not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are diagnostic testing for CHD
What’s the structural check for it ??

A

Chest x-ray
ECH
Echocardiography !! This one
Cardiac catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Before a baby gets discharged home
We look at the?

Test question !

A

pre and post ducal saturation in all babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is pre ductal saturation?
How do we do it?
What does it tell us?

A

So before the ductus ( PDA )
Looking for a patent ductus

Oxygen saturation on the Right hand

Much lower on the right hand and lower extremities

It’s suggestive it’s a CHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are the 3 clinical presentation of CHD?

A

Shock
Cyanosis
Congestive heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are symptoms of shock in CHD baby? And signs?

What are the potential problem?

A

Poor feeding
Fussiness
Progression to lethargy

Extreme tachycardia
Pallor
Weak peripherally pulses
Delayed capillary refill
Hypotension

Obstruction!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is cyanosis for symptoms and signs of CHD!?

What usually is the CHD problem with this?

A

Fussiness
Cyanosis

Hypoxia

Decreased pulmonary flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is congestive heart failure sign and symptoms for CHD patients?

Usually this is with?

A

Feeding difficulty
Sweating with feeds
Failure to thrive
Fussiness

Tachypnea
Takes
Hepatmegaloy

Left to right shunt
Acynatoic issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Question!
If there is a problem with congenital heart defects, what limb would you see a normal oxygen saturation?

A

Right upper extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Now think of birth
What happens when the pressure changes ? Doors slam shut!?
Describe what she means

A

So when the umbilical cord is clamped
The lungs at birth should trigger to breathe and allow blood to finally circulate into the lungs

In a normal baby
PDA and formaen ovale should shut!!

This pressure of the left atrium exceeds pressure in the right atrium to close

PDA
Closes in the presence of increase oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Question
What two structure close with pressure changes in the heart?

A

Formen ovale
Ductus arteriosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

How many arteries and veins are in the umbilical cord?

A

2 arteries
1 vein

:) smile remember !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the biggest clinical manifestation of heart problem!?

A

Sweating!!!!!!!!!!

Tachypnea and tachycardia

Failure to thrive & weight loss

Developmental daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Why do we seriously look at weight with heart failure or congenital heart disease patients?

A

Because the amount of oxygen their trying to get, which is why their Tachypnea is taking up all their calories

So many children lose a lot of weight and fail to gain it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

O2 administration and shunting
Oxygen is a really dangerous and can worsen pulmonary over circulation

Aka flooding of the lungs of blood

So who and why do you think these type of babies ( name the l to r or r to l shunt ) shouldn’t it receive large amount of 02?

A

Right to left shunts

If their body is pumping deoxygenated blood already into their lungs
And if we shove more oxygen in them
It increase the amount of blood flow going
So deoxygenate and oxygen blood
And we potentially drowned them in blood in their lungs essentially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What would be the better alternative for those kids with right to left shunts who can’t receive a lot of oxygen?

A

Better to do like 1-2L of oxygen nasal cannula really

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

I’m going to come right back to congenital heart disease with the specific defects but let’s talk about

CONGESTIVEHEART FAILURE

A
80
Q

What is congestive heart failure?

A

The heart inability to pump adequate amount of blood to the systemic circulation at normal filling pressure to meet the body’s metabolic demands

81
Q

Usually we see congestive heart failure with which type of shunts?

A

Left to right shunt

Because typically oxygen is either being obstructive from the lungs and rest of the body

Or the oxygen doesn’t get distributed right and comes back for the second round causing an increase pulmonary blood flow and increased pulmonary congestion

Making the child breathe too much and the body starts to shunt down and that breathing is altered truly

82
Q

We can divide heart failure into two groups
Right and left
What’s the difference?

A

Left heart failure is can’t pump enough blood for the body

Right can’t pump enough blood into the lungs to get oxygen

83
Q

How does the body first compensate for the heart failure?

A

Cardiac reverse

Hypertrophy
Dilation
Increase BP
Increase RR

84
Q

What are the 3 big clinical manifestation of heart failure?

A
  1. Impaired myocardial function
    ( fancy, sweating , fatigue )
  2. Pulmonary congestion
    ( Tachypnea, falling nares, retractions )
  3. Systemic venous congestion
    ( weight gain, hepatomeglay, peripheral edema )
85
Q

Notes
Heart failure ( HR )
Volume overload
Pressure overload
Decreased contractility
High cardiac output demands

Right side
- reduce function
( hard to push blood into lungs )
Left side
- increased pressure & lung congestion
( hard to push blood into body )

A
86
Q

What are some things we will use to diagnose heart failure?

A

Echocardiogram
Chest x ray

87
Q

What are the 4 goals we have for heart failure patients?

A

Improve cardiac function
Remove accumulated fluid & edema
Decrease cardiac demands
Improve tissue oxygenation & decrease oxygen consumption

88
Q

How are we going to remove accumulated fluid
So that water and sodium?

A

Diuretics!!

89
Q

What are the two important diuretics for remember for heart failure?

A

Furosemide ( lasix )
Spironolactone ( aldactone )
- potassium spraing^

90
Q

What is the biggest ting to remember with diuretics? What are we looking out for?

A

Our potassium!! ( any other is hypokalemia !! )

If spironolactone( hyperkalemia )

91
Q

What medication we will use to help reduce the after losd of the heart for heart failure?

A

Ace inhibitors
- vasodilator !!
( this is potassium sparing!! Hyperkalmiea !! Watch out !! )

92
Q

How can we improve tissue oxygenation for heart failure?

A

Usually with a humidifiers or oxygen tanks

93
Q

Something to note
With diuretics, you want to be careful with their intake and output as dehydration can occur frequently

So we need to monitor what?

Notes
- if it’s losing a lot of potassium, usually eat bananas oranges and whole grains to help!

  • potassium sparing dorueircs, avoid them
A

There daily weight too!

94
Q

What are signs of hypokalemia?

Hyperkalemia?

A

Muscle weakness
Hypotension
Dysthymias
Tachy or braid

Twitching
Bradycardia
V-fib
Oliguria

95
Q

What is the drug that can improve cardiac function?

A

Digoxin

96
Q

Digoxin is famous of its narrow therapeutic window
So toxic levels need to be assessed.

Also check pulse and heart rate before the dosage.

How do we know digoxin is toxic for a kid!?

A

Bradycardia
Visual disturbances ( like halo in light )

97
Q

What is the average digoxin dosing for infants?

A

1Ml ( 50mcg, 0.05 mg )

98
Q

What’s the antidote for digoxin?

A

Digoxin immune fab fragment ( digiband )

99
Q

Digoxin and furosemide cause?

A

Hypokalemia!!!

Bradycardia !!

100
Q

Now onto hypoxemia!!

A
101
Q

What is hypoxemia?

A

Reduction in tissue oxygenation
Cyanosis

Lower than normal arterial oxygen tension

102
Q

What’s the biggest example of hypoxemia for CHD?

A

Tetralogy of fallot

103
Q

What are the 3 biggest signs of hypoxemia?

A

Clubbing
Polycythemia
Hypercyanotic spells ( tet spells )

104
Q

In theory, persistent hypoxemia stimulates erythropoiesis, which results in that polycyhemia or increase red blood cell

But why does this not help in hypoxemia?

A

Because the body isn’t going to have enough iron to behind the oxygen, resulting in literally anemia

And since we don’t oxygen being binded, really clubbing is gonna occur

105
Q

Why is hypoxia?

A

Reduction in tissue oxygenation

106
Q

What is the difference between hypoxemia and hypoxia?

A

Hypoxemia - Low oxygen in the body

Hypoxia - that low oxygen in body starts to show outside the body with cyanosis cause tissues turn blue

107
Q

How do we treat these hypercyanotic spells, tet spells?

A

Knee to chest

Changes the pressure from the chest, to now into the abdomen
So it opens the chest up to get more fluid going

108
Q

What is the diagnostic evaluation behind hypoxemia?

A

Oxygen saturation
Cyanosis looking
CBC

109
Q

What’s the treatment for these kids who are hypoxemic? (3)
It’s super important to know

A

100% oxygen via face mask
Knee chest positioning
Morphine for pain

110
Q

Notes
There are shunt procedures for children with cardiac defects

Modified blakock tassuig shunt
Sano modification
Central shunt

Usually these procedures are performed to help increase that oxyegn due to the cyanotic congenital heart defects

A
111
Q

Now we are coming back to the acyanotic congenital heart defects

Lets talk about defects with increase pulmonary blood flow

A
112
Q

What are the 4 acyanotic defects with left to right shunt

A

Atrial septal defect
Ventricular septal defect
Atrioventricular canal defect
Patent ductus arteriosus

113
Q

What is atrial septal defect? Provide a description?

A

abnormal opening between the atria
Allowing blood from the higher pressure left atrium flow into low pressure right atrium

114
Q

What is the patho behind atrial septal defect?

A

Blood flows from left to right cause increasing oxygenated blood into the right side of the heart.

It kinda circulates backwards and causes the patient to take another “breathe” think of it like that

There is a hole that doesn’t differentiate left and right side
It literally is reoxgenated blood that’s already been oxygenated causing extra pressure on the lungs

115
Q

What is the main clinical manifestation of atrial septal defect?

A

Murmurs !

116
Q

What is the treatment of atrial septal defect?

A

Surgical closure
Or TCC ( transcatheter closure )

117
Q

What is ventricular spatial defect description?
Most common!

A

Abnormal opening between the ventricles

118
Q

What is the patho of ventricular septal defect?

A

The hole between ventricles
( really just ventricles difference )
Left to right shunt
Left = lungs

So once again oxygenated blood is kinda just sitting there and has to re pump it again

119
Q

What is the clinical manifestation of ventricle septal defect? (2)

A

Heart failure and murmur

120
Q

What is the treatment for ventricular septal defect?

A

Surgical and TCC

121
Q

What is atrioventicular canal defect description & patho?

A

incomplete fusion of the endocardial cushions
Most common in Down syndrome

Two holes !!
So hole in atrium & ventriculars

Really is the levels of how much blood is being pumped out from right to left
But this is left to right
So it kinda is just the AV node being really big and allowing this to happen

122
Q

What is the 2 clinical manifestation of atrioventriculae canal defect?

A

Heart failure / murmur
Pulmonary vascular obstruct disease

123
Q

How do we treat atrioventriculae canal defect?

A

Surgery

124
Q

What is description of patent ductus ateriosus & patho?

A

Failure of the ductus arteriosus to close within the first weeks of life

This opening allows for the oxygenated blood to re enter again into the lungsand fill the lungs up
- meaning double the amount of work

125
Q

What are the clinical manifestation of patent ductus arteriosus? (3)

A

Murmur
Heart failure
Hypertension may occur

126
Q

What is the medication administration we can give for patent ductus ateruosis?

If not this
Surgery and TCC

A

Indomenthacin ( prostaglandin inhibitor )

Helps promote that closure

127
Q

Notes
Patent formen ovale is normally closed

So the blood flows back again !!

Same thing like everything else truly

A
128
Q

Name the defect that connects the pulmonary artery to the aorta?

A

Ductus ateriosia

129
Q

Now onto the acyanotic obstructive defects!

A
130
Q

What are the 4 obstructive acyanotic defects?

A

Coarcatation of the aorta
Aortic stenosis
Valvular aortic stenosis
Pulmonic stenosis

131
Q

What is coarctation of the aorta description & patho!

A

Localized narrowing near the insertion of the ductus arteriosus
Causing the obstruction

Narrowing of the aorta

132
Q

What is the clinical manifestation of coarctation of the aorta?

A

High blood pressure
Bounding pulses
Heart failure
Cyanosis of the lower extremities !!!

Severe
- hypotension

133
Q

How do we treat coarctation of the aorta?

A

Surgery & TCC

134
Q

What is aortic stenosis & valvular aortic stenosis description and patho?

A

Narrowing of the aorta valve causing obstruction

Or valve

And this on exertion causes to eject blood from the left ventricle

135
Q

Clinical manifestation of aortic / vavular stenosis?

A

Hypotension
Weak pulses
Tachycardia

136
Q

What is the treatment for aortic and valvular aortic stenosis?

A

Surgery

Balloon angioplasty which is a cath procedure

137
Q

What is pulmonary stenosis description and patho?

A

Narrowing of the pulmonary artery

Causing resistance of blood flow

Doesn’t allow blood to really circulate in the body or lungs

138
Q

What is the clinical manifestation of pulmonaey stenosis?

A

Usually asymptotic
Bug severe can lead to cyanosis

139
Q

What is the treatment for pulmonary stenosis?

A

Surgery

140
Q

Now onto the cyanotic congestion heart defects !

A
141
Q

What are the decreased pulmonary blood flow for cyanotic ? (2)

A

Tetralogy of fallot
Tricuspid atresia

142
Q

What is the description & patho of tetralogy of fallot!? (4)

Teta = 4
Explain each too !

A

The classic form includes 4 defects
1. Ventricular septal defect
( opening between the heart left and right lower chambers )

  1. Pulmonary stenosis
    ( narrowing of the pathway that carried blood from heart to lungs )
  2. Displaced aorta / overriding
    ( rise father on the right side of the heart )
    Mixing of oxygen and deoxygenated
    - so purple blood going out to the body
  3. Ventricular hypertrophy
    - thickening of the heart muscle in lower right ventricle
143
Q

What is the x ray for fallout tetralogy?

A

Boot shaped heart

144
Q

Why do we see this boot shaped heart in tetra of fallot?

A

Because of that intensive right ventricular hypertrophy
That causes it come way over and misshape the heart

145
Q

What is the clinical manifestation of tetralogy of fallot?

A

Tet spells or blue spells
Hypoxia !!
Murmur

146
Q

What is the recommendation for treatment for teta fallot?

A

Surgery!

147
Q

What a sign of chronic hypoxia?

A

Clubbing
( oxygen is not reaching in fingers )

Boblous
- capillaries try to save itself and ghags the bobs in the fingertips

148
Q

A child will put themselves in a certain position, also known as a tet spell
So they will get extremely agitated, super blue, Tachypnea, limp,
Murmur

What is this position

Teta spell = turning more blue !!!

A

Knee chest position

149
Q

Do we let the children with teta stay in a knee chest position!?

A

YES!!

150
Q

What is the biggest nursing management for teta?

A

Knee chest positioning!

151
Q

What is tricuspid atresia patho and description?

A

So tricuspid valve doesn’t develops and that manes there is no connection to the right atrium to right ventricular

Causing decrease blood flow

152
Q

What is the clinical manifestation of tricuspid atresia?

Usually give them prostaglandin or surgery!

A

Cyanosis

153
Q

Now onto the cyanotic mixed defects!!
That increasing!

A
154
Q

What are the 4 mixed defects for cyanosis?

A

Transposition of great vessels & arteries

Total anomalous pulmonary venous connection/return ( tapvr )

Truncus atreisous

Hypo plastic left heart syndrome

155
Q

What is transposition of the great arteries or transposition of great vessels description and patho!?

A

Pulmonary artery leaves left ventricle
Aorta exits from right ventricle

They literally swapped
Unoxygenated blood goes into the body
Oxygenated blood goes into lungs

Switch!

156
Q

Clinical manifestation for this great vessels and arteries

Treatment is just surgical treatment
Arterial switch operation

A

Cyanosis

157
Q

What is total anomalous pulmonary venous return ( TAPVR ), patho and description?

A

Simply where the veins are not in the right spot

So like pulmonary veins go into the right atrium instead of the left atrium!
Then from right atrium goes back into the lungs
And then repeats
Really really hard to get blood out to the body

So it causes blood mixture

158
Q

What is the surgery to help with this?

A

Simply switch pulmonary veins from the right atrium to the correct spot to the left atrium

159
Q

What is truncus ateriosus?
Notes!!!

A

Failure to normal separation and division of the embryonic bulbar

Blood ejected from lefts to right ventricles mix togethe

Severe heart failure & murmur

Surgery

160
Q

What is hypo plastic left heart syndrome??

A

A single ventricle left ventricle did not form comepletey

Just one ventricle ( just the right )

Usually missing the left one

161
Q

Since the left ventricle isn’t formed
The right ventricle has too do a lot more and isn’t used

  • so what can happen to it?
    (3)

Surgery is instant needed!

A

Myopathy ( enlargement )
Aorta is small and now allowing much blood to the body
Cyanosis

162
Q

What are defects of the boot shaped heart?
Pulmonary stenosis!?
VSD?
Ventricular hypertrophy?
Overriding aorta?

A

Ventricle hypertrophy

163
Q

What defects is most common in children with Down syndrome?

A

AV canal

164
Q

Additional information!
Murmurs !!

Innocent murmurs
- usually is normal cause cardiac anatomy and function
It’s 50% good and bad

So send them off to CARDIO

A
165
Q

What is a thrill mean?

A

Soft vibration over the heart that reflects the transmittes sound of a heart murmur

166
Q

What are some surgical procedures we can for congenital heart disease?

Dont over think it

A

Open heart
Closed heart
Staged procedures

167
Q

Post operative care for the child
!!

A
168
Q

What is properly one of the most important things for postoperative care for a child?

A

Urine output!!

169
Q

Notes
Monitor vital signs and blood pressure
Respiratory needs
Rest, comfort and pain management
Fluid management
Progression of activity

A
170
Q

Chest tubes after cardiac
Monitor tube drainage
- bright blood start off first
- it should graduate change to a serious color

WHAT HAPPENS IF IY GOES BACKWARDS SO BRIGHT RED TO LIKE BROWN SND THEN GO BAXK TI RED?

A

Literally we need to intervene

171
Q

What is the drainage greater than
___ml/kg/hr X3 consecutive hours

Or
__to__’ml/kg in any 1

This means what?

Be alert for cardiac tamponade ( life threatening)

A

3
5-10

Hemorrhage

172
Q

Once again monitor those fluids
I&O!!

What would renal failure indicate?
___ml/kg:hr

A

1

173
Q

Notes
ASPRIN is normally for cardiac kids

But be careful cause reye sundrome !!

A
174
Q

Now onto ineffective endocarditis
Infection of the valve !!

A
175
Q

What is infective endocarditis!?

A

An infection of the inner lining of the heart, endocardium, involving the valves

176
Q

What’s the most common cause of these infective endocarditis?

A

Streptococcus & staphy

177
Q

What are the clinical manifestation for infective endocarditis?!(4)

A

Low grade fever
New murmur!!
Splenomegaly!!
Older nodes- red painful nodes on pads of fingers !!

Janeway spots - painless spots on hands and feet !!

178
Q

How do we avoid infective endocarditis?

A

Usually with prophalaxis 1 hour before procedures

Dental work typically

179
Q

How do we treat infective endocarditis?

What’s the diagnosis?

If we do surgical intervention what do we do?

A

Antibiotics 2-8 weeks

Culture

Replace the valve with prosthetic ( pig valves, watch out with Muslims ! )

180
Q

Now onto rhenumatic fever !!

A
181
Q

What is rheumatic fever ?
And can turn into rheumatic heart disease?

A

Abnormal immune response to group A strep pharyngitis ( not treated strep )

Usually not treated and turns into heart disease

182
Q

Usually this is seen where?

A

In forgein countries and low income families

183
Q

What are the clinical manifestations of rheumatic fever? (7)

A

Carditis - affects muscle layers of the heart & mitral valve !!!

Polyartheitis - reversible affecting large joints of the body

Erythema - redness

Rash in chest and truck

Non itching

Crops over body promiscuous

Subcutaneous nodules

184
Q

Cardititis for rheumatic fever is mainly found where?

A

MITRAL VALVE !!

185
Q

How do we treat RHD?

A

Penicillin & sulfa

If allergies used macrolides like erythromycin

186
Q

How do we prevent RHD?

A

Treatment of strep and tonsillitis

187
Q

What procedures should patient at risk be treated preventatively with antibiotics?

  • invasive dental procedures
  • surgery
  • major injuries
  • concerns for sepsis
  • major illness including fever
  • artificial joints
A
188
Q

Now onto Kawasaki disease !!

A
189
Q

What is Kawasaki disease?

How long is the time for this?

A

Acute systemic vasculitis
Unknown cause

6-8 weeks and self limited really

Systemic inflammation of the small and medium sized blood vessels

190
Q

What are the symptoms of the Kawasaki disease ? (4)

A

Carditis - affects muscle layers of the heart - mitral valve

Polyarthritis - pain in joints

Erythema marginatum
- truck and chest
- not itchy

Subcutaneous nodules
- crops bony places

191
Q

What is the peak incidence of Kawasaki diseases?

A

Toddlers ages

192
Q

What are the clinical manifestation of Kawasaki diseases? (7)

A

High fever
Strawberry tongue
Edema on hands and feet
Extreme irritability
Periungual desquamatiom
Arthritis
Coronary complication

193
Q

Strawberry tongue is the VERY COMMON

PEELING ON THE FINGERS

CONJUCTIVE

LIPS CHAPPED AND BLEEDINF

LARGEE LYMPH NODES!!

A
194
Q

What is the treatment for Kawasaki disease?

A

High dose of IVIG along with salicylate therapy

Iys shown to help lowers fever and coronary artery abnormalities

Usually ASPRIN as well is given as a initial treatment for the inflammatory and fever reducing aspects

195
Q

What is the main death for Kawasaki diseases?

A

The enrage of coronary aneurysm

196
Q

What is the prognosis for Kawasaki disease?

A

Usually positive and doesn’t need any transplant of valve

Just early diagnosis is the best

197
Q

3 stage Kawasaki
Acute stage
- irritable and inconsable
- fever
- strawberry tongue

Subacute
- fever
- enlargment of the heart

Convalescent phase
- everything resolves but labs may be abnormal
- arthritis may continue
- baseline

A

349 Peds Exam 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions