Cardiovascular Flashcards

(68 cards)

1
Q

Increased pulmonary blood flow heart defects

A

Atrial Septal Defect
Ventricular Septal Defect
Patent Ductus Arteriosus

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

Obstruction of systemic blood flow heart defects

A

Coarctation of the aorta
Aortic Stenosis
Hypoplastic Left Heart Syndrome

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

Decreased pulmonary blood flow heart defects

A

Tetralogy of Fallot
Pulmonic Stenosis

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

Mix blood flow heart defects

A

Transposition of the great arteries
Truncus Arteriosus

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

Septal development of the heart

A

Artrial, ventricular septum and heart all are developed between week 4-8 of gestation

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

What is fetal circulation?

A

umbilicus - liver (divides in two 1) hepatic system
2) inferior vena cava - heart - body

pressure of heart is higher on the R side

high pulmonary vascular resistance

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

What shunt spreads blood to the ret of the body in fetal circulation?

A

Ductus arteriosus

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

What does infant circulation look like?

A

Umbilical cord is cut (no more need of the ductus venosus)
Ductus arteriosus closes because of the use of the lungs and the oxygenated blood that enters the heart (10-21 days)

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

What are the hemodynamic changes with infant circulation?

A

Increased pulmonary blood flow
Decreased pulmonary vascular resistance (PVR)

Left atrium increased blood flow

Right atrial pressure falls, Increased pressure in left atrium (Stimulates closure of foramen ovale)

Higher oxygen saturation than fetal circulation (Stimulates closure of ductus arteriosus)

vasodilation

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

Difference between pulmonary blood vessels (fetal and neonatal)

A

F: Constricted with little blood flow; lungs not expanded
N: Vasodilation and increased blood flow; lungs expanded; increased oxygen stimulates vasodilation

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

Differences in systemic blood vessels (Fetal and neonatal)

A

F:Dialated, with low resistance, blood mostly in placenta
N: Arterial pressure rises due to loss of placenta; increased systemic blood volume and resistance

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

Differences in Ductus arteriosus (fetal and neonatal)

A

F: Large, with no tone, blood flow from pulmonary artery to aorta
N: Reversal of blood flow; now from aorta to pulmonary artery because of increased left atrial pressure. Ductus arteriosus is sensitive to increased oxygen and body chemicals and begins to constrict

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

Differences in foramen ovale (fetal and neonatal)

A

F: Patent, with increased blood flow from R atrium to L atrium
N: Increased pressure in left atrium attempts to reverse blood flow, closing flaps on the one-way valve

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

Differences in ductus venosus (fetal and neonatal)

A

F: Patent, blood flow from placenta to liver and inferior vena cava
N: Blood flow stops when umbilical cord is cut; ductus venosus begins to constrict

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

What does the SA node do for the heart?

A

pacemaker of the heart
leads to contraction

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

What does systole mean?

A

contraction of the heart

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

What does diastole means?

A

relaxation of the heart

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

What is cardiac output?

A

= volume of blood ejected by heart in 1 min
= heart rate x stroke volume

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

What is stroke volume?

A

= volume of blood ejected by ventricles per beat (in mLs)

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

What is stroke volume affected by?

A

Preload
Afterload – clinically measured by BP
Contractility – clinically measured by perfusion & urinary output

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

What is heart rate influenced by?

A

ANS

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

Can neonates change their stroke volume?

A

No, they can not increase their stroke volume

They depend of HR to increase CO

If the heart rate is too fast, it does not give the heart enough time to fill

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

What does tissue perfusion depend on?

A

HR, circulating blood volume, pump function, systemic and vascular resistances, capillary permeability and tissue utilization of oxygen

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

What do you want to include in a cardiac history?

A

Mothers health history, pregnancy and birth history
Detailed family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is included in the mothers health history?
Chronic health conditions (e.g. lupus, diabetes) Medications (e.g. phenytoin) Maternal alcohol use or illicit drug use Exposure to infections (e.g. rubella) Infants with LBW due to IUGR (intra uterine growth retardation) High-birth-weight infants (e.g. IDM)
26
Cardiac history of infant/young child
Feeding difficulties with fatigue, frequent vomiting, rapid breathing, sweating with feeds, poor weight gain, developmental level Incidence of respiratory infections & breathing problems Onset & frequency of colour changes – cyanosis that worsens with feeding or activity Parents feel baby’s heart race Irritable; weak cry Most comfortable position – HOB elevated, squatting
27
Cardiac history with Older child
Exercise tolerance & activities Presence of edema & respiratory problems, chest pain, palpitations Neurologic problems – fainting or headaches Recent infections or toxic exposures; e.g. cardiomyopathy or rheumatic fever
28
Cardiac history with all children
review all other health problems presence of other congenital anomalies medications (OTC, herbal supplements)
29
Abnormal findings through physical examination
Weak, irritable, in distress Undernourished, underweight Chest retracts, heaves or lifts, enlargement over heart, asymmetrical chest movement pallor, cyanosis, mucous membranes dry? clammy with activity/feeding, peripheral/periorbital edema, scars from surgery? Cyanotic, clubbed finger nails Pulses bounding Liver through palpation
30
Physical examination = vital signs
HR - increased or decreased RR - increased even at rest (raise HOB) BP - differences in arms and legs (8-10 mmHg is concerning)
31
Tests of cardiac function
Radiography - chest x ray, fluoroscopy Electrocardiography (ECG) Echocardiography (where the blood is flowing) Cardiac catheterization (femoral artery, invasive) Exercise stress test Cardiac MRI
32
What is the most common congenital heart disease with autistic children?
septal defect
33
What are the hemodynamics of the heart?
= pressures generated by blood & pathways blood takes through the heart & pulmonary system Blood flows from high to low pressure  path of least resistance Normally, pressure on right side of heart is lower than left & resistance in pulmonary circulation is less than in systemic
34
What is HF?
Inability of the heart to pump adequate amount of blood to systemic circulation at normal filling pressures to meet body’s metabolic demands
35
What are the causes of HF?
Volume overload (too much in the ventricles) Pressure overload (difficulty with blood leaving heart, narrowing of aorta) Decreased contractility (cardinal myopathy, myocardial ischemia) High cardiac output demands (needs more O2 than heart can deliver)
36
what are the compensatory mechanisms of HF?
Hypertrophy and dilation of cardiac muscle Sympathetic nervous system - Release of catecholamines which increases force and rate of contraction; peripheral vasoconstriction - Sympathetic cholinergic fibers (sweating) Renal system (Renin-angiotensin-aldosterone mechanism)
37
What is the first sign of impaired myocardial function?
tachycardia
38
Other signs of impaired myocardial function
Infant tires easily, especially during feeding (first sign) Diaphoresis, irritability Weight loss or poor weight gain (Developmental delays (gross motor)) Frequent infections Poor perfusion (cardiogenic shock) - Cold extremities, weak pulses, slow cap refil, low BP, mottled skin, extreme pallor, duskiness, cyanosis
39
Signs of pulmonary congestion
Tachypnea, nasal flaring, grunting, retractions, cough, crackles, wheezing, hoarseness Cyanosis Orthopnea – relieved by sitting up Gasping & grunting respirations – late sign
40
Signs of systemic venous congestion (R sided)
Hepatomegaly Cardiomegaly Edema - Weight gain; periorbital, facial, sacrum, scrotal - Ascites, pleural effusions Distended neck & peripheral veins (usually only noted in older children)
41
What does digitalis glycosides do? (digoxin)
Increases force of contraction Decreases heart rate & slows conduction of impulses through AV node Indirectly enhances diuresis by improving renal perfusion Hold if HR is lower than 60BPM (adults), 100BPM (children) -apical pulse First dose is loading dose (BLOOD LEVELS need to be done)
42
What are the signs of digitalis (digoxin) toxicity?
bradycardia, anorexia, N and V
43
What do ACE inhibitors do?
reduce afterload
44
What to do before giving ACE inhibitors?
Monitor BP before & after administration (hypotension) Monitor serum electrolytes – block action of aldosterone & are potassium-sparing Carefully assess renal function
45
How can we decrease cardiac demands?
Allow for uninterrupted rest Minimal handling Reduce stress Maintain stable environment temp Prevent skin breakdown
46
How can we care for respiratory distress?
Count RR for full minute Position with HOB elevated or sitting up Provide for unrestricted chest expansion Remember: babies are diaphragmatic breathers!! Oxygen administration
47
How can we maintain nutritional status?
Greater caloric needs but impaired ability to take in adequate calories Well rested before feeds; feed soon after awakening (minimize energy expenditure on crying) q3h feeding schedule – individualize to infant’s needs Allow no more than ½ hour to complete feed (NG prn) Increase caloric density of formulas - Add corn oil or MCT oil to formula or HMF to breastmilk Metabolic needs are high with HF
48
How do we removed accumulated fluid and sodium?
Administer diuretics (give early in day) Accurate I&O Daily weights (same time, same scale) Observe for signs of dehydration or edema Observe for signs of electrolyte imbalance Fluid restriction rarely needed - If required, plan to give most fluids during waking hours Possible sodium restriction
49
Whats normal PaO2 range?
80-100 mmHg
50
What does low PaO2 indicate?
hypoxemia
51
What causes hypoxemia
Desaturated venous blood enters systemic circulation without passing through lungs
52
Synonyms for hypercyanotic spells?
blue spells, tet spells
53
What are clinical manifestations for hypercyanotic spells?
Increased rate & depth of respiration Increased cyanosis Increased heart rate Pallor & poor tissue perfusion Agitation or irritability - may lead to limpness or seizures
54
Tx of tet spells
Knee-chest position Calm, comforting approach Administer 100% oxygen Give SC or IV morphine Begin IV fluid replacement & volume expansion, prn Repeat morphine administration
55
What is rheumatic fever?
Follows infection by some strains of group A beta-hemolytic streptococci May lead to permanent heart valve damage If croup antibiotics aren’t used up, it can lead to this
56
What is bacterial infective endocarditis?
Inflammation of lining, valves, & arterial vessels Streptococcus or Staphylococcus Prevention important; e.g. prophylactic antibiotics before dental procedures Pneumonia can lead to this
57
What is Kawasaki Disease?
Mucocutaneous Lymph Node Syndrome Young children Acute systemic inflammatory illness Widespread inflammation of small & medium-sized blood vessels (coronary arteries most susceptible). May lead to dilation of coronary arteries & aneurysm formation. Primary cause theorized to be infection with organism or toxin but not spread person-to-person Most often late winter & early spring
58
Kawasaki disease diagnostic critera
Fever for at least 5 days, unresponsive to antipyretics & antibiotics Must have 4 of the following: 1. Changes in extremities - Acute - erythema of palms & soles, edema of hands & feet - Subacute - peeling of hands & feet in 2nd & 3rd week 2. Polymorphous rash (flat) 3. Bilateral conjunctival (pink eye without discharge) inflammation without exudate 4. Changes in lips & oral cavity - Erythema, dryness & cracking of lips, oropharyngeal reddening, or “strawberry tongue” 5. Cervical lymphadenopathy (enlarged lymph nodes), usually unilateral
59
Acute stage of Kawasaki disease
Fever, conjunctival hyperemia, red throat, strawberry tongue, swollen hands & feet, rash, enlargement of cervical lymph nodes, +++ irritable 1-2 weeks
60
Subacute stage of Kawasaki disease
Cracking lips & fissures, desquamation of skin on tips of fingers & toes, joint pain, arthritis, cardiac disease, & thrombocytosis; irritability continues 2-4 weeks
61
Convalescent stage of Kawasaki disease
Appears normal but lingering signs of inflammation Increased ESR 6-8 weeks after onset, all blood values returned to normal
62
Medication for Kawasaki disease
IVIG (intravenous immunoglobulins) Aspirin (salicylates)
63
Why do we not normally give aspirin to children?
They can get Reye’s syndrome. They are given because of the risk of clotting with KD
64
Nursing care for Kawasaki disease
Assessment of signs & symptoms; Tolerance of medication Promote comfort (soft solids for food) Passive ROM Discharge teaching re: aspirin, cardiac follow-up
65
What is the criteria for MIS-C?
< 21 years, presenting with fever, laboratory evidence of inflammation, & evidence of clinical severe illness requiring hospitalization , with multisystem (≥2) organ involvement (cardiac, renal, respiratory, hematologic, GI, dermatologic, or neurological); AND No alternative plausible diagnoses; AND Positive for current or recent SARS-CoV-2 infection, serology, or antigen test; or COVID-19 exposure within 3 weeks prior to onset of symptoms
66
What are the manifestations of MIS-C?
Myalgia, tachycardia, hypotension, hypo- or hyperperfusion, lymphadenopathy/lymphadenitis Rash, lip swelling/cracking, strawberry tongue, extremity swelling/peeling, conjunctivitis, blisters or erosions Nausea/vomiting, diarrhea, abdominal pain Respiratory distress, chest pain Headache, altered mental status, meningismus, focal deficits, seizure
67
What is the discharge criteria for MIS-C?
No fever for 48 hours without antipyretics Improvement in presenting symptoms Improvement in lab markers Influenza vaccine
68
When do you want to return to the ED with MIS-C?
Fever > 38 Recurrence of presenting symptoms or unwell with other symptoms Respiratory distress or SOB