Cardiovascular

Question 1

In fetal circulation where is the foramen ovale located?

Answer 1

Between right and left atrium

Question 2

How does fetal circulation work?

Answer 2

IVC ➡️ RA ➡️ foramen ovale ➡️ Aorta

SVC ➡️ PDA ➡️ aorta

Question 3

What causes fetal shunts to close?

Answer 3

1. Increased arterial oxygen tension
2. Decreased prostaglandins
3. Decreased adenosine levels

Question 4

When does the fetal shunts start to close?

Answer 4

When baby takes its first breath due to increased PVR

Question 5

When does the PDA start to close?

Answer 5

Closure is within 10 to 24 hours

Question 6

When does foramen ovale start to close?

Answer 6

When the pressure in the RA is less than the pressure in the LA

Question 7

What is cardiac output?

Answer 7

1. Volume of blood pumped by the heart and one minute
2. Measures hearts efficiency
3. Stroke Volume x Heart Rate

Question 8

What is the cardiac output in a normal newborn?

Answer 8

200 mL/kg/min

Children has higher CO then adult due to increased heart rate

Question 9

What is preload?

Answer 9

1. End of diastole
2. Elasticity when the ventricles are filled to the maximum
3. Volume

Question 10

What can cause decrease in preload?

Answer 10

Dehydration

Vasodilation

Question 11

What is afterload?

Answer 11

1. Pump
2. Resistance against which the ventricles must pump
3. The work that the heart has to do to push blood into the aorta and around the body or into the lungs

Question 12

What is contractility?

Answer 12

1. Squeeze

2. Amount of force exerted with each contraction

Question 13

What causes contractility?

Answer 13

Hypoxemia

Question 13

What is the conduction of the heart?

Answer 13

SA node
AV node
Bundle of His
Purkinje fibers

Question 14

What does the Purkinje fibers do?

Answer 14

It causes LV to contract

Question 15

What is congestive heart failure?

Answer 15

A syndrome in which the heart cannot pump an adequate amount of oxygenated blood to meet the metabolic needs of the body

Question 16

What are the two types of heart failure?

Answer 16

Right sided heart failure

Left sided heart failure

Question 17

What is right-sided heart failure?

Answer 17

The right ventricle is not able to efficiently pump blood into the pulmonary artery therefore the right side of the heart becomes congested and backs up into the veins and the body

Question 18

What is left-sided failure?

Answer 18

Left ventricle is not able to pump blood into the aorta and systemic circulation resulting in increased pressure in the left atrium and pulmonary veins and goes back into the lungs

Question 19

Causes of CHF in children

Answer 19

1. Structural abnormalities
2. Myocardial failure
3. Excessive demands on the normal heart muscle

Question 20

Hypoxemia

Answer 20

An arterial oxygen tension (of pressure, PaO2) that is less than normal and can be identified by a decreased arterial oxygen saturation or a decreased PaO2

Question 21

Hypoxia

Answer 21

Reduction in tissue oxygenation that results from low oxygen sats and paO2 and results in impaired cellular processes

Question 22

Define shock

Answer 22

Circulatory failure - inadequate perfusion to meet metabolic needs of the body

Question 23

What would happen to the BP on initial shock?

Answer 23

Increased BP d/t initial vasoconstriction

Question 24

3 signs of shock

Answer 24

Hypotension Hypoxemia Metabolic acidosis

Question 25

Compensated shock

Answer 25

Vasoconstriction caused by sympathetic nervous system Normal BP, might be a little high Provides blood to vital organs Cold, clammy skin Decreased bowel sounds Decreased urinary output Lactic acid increases - inc metabolic acidosis

Question 26

Uncompensated shock

Answer 26

Compensation fails and the cv system can no longer maintain perfusion to the microvasculature

Question 27

Manifestations of uncompensated shock

Answer 27

``` Hypotension Rapid respiration Tachycardia Mental status changes Increased BUN and creatinine Liver enzymes increase DIC ```

Question 28

Types of shock

Answer 28

Cardiogenic shock Hypovolemic shock Obstructive shock Distributive shock

Question 29

Cardiogenic shock

Answer 29

Ineffective pumping mechanism of the heart | Decreased CO and increased SVR caused by inc afterload, dec contractility

Question 30

Hypovolemic shock

Answer 30

``` Most common type in children Dec in intra vascular body by 15-25% ⬇️ preload ⬆️ afterload No change in contractility ```

Question 31

Obstructive shock

Answer 31

Severe obstruction to ventricular filling or outflow | Ex. Tension pneumothorax or PE

Question 32

Distributive shock

Answer 32

Abnormal distribution of blood volume ⬇️ SVR d/t massive vasodilation Blood shunts pass capillary beds

Question 33

Three types of distributive shock

Answer 33

Septic Anaphylactic Neurogenic

Question 34

What is anaphylactic shock

Answer 34

``` Vasodilation from release of mediators: IgE Histamine Serotonin Bradykinin PGR ```

Question 35

Neurogenic shock

Answer 35

Loss of sympathetic vasomotor tone leads to extreme visit dilation Can be a complication of brain or spinal cord injury

Question 36

In a child diagnosed with cardiac hypertrophy, the heart muscle enlarges due to:

Answer 36

⬆️ in the size of myocytes

Question 37

Cardiomyopathy

Answer 37

Disease of the heart muscle

Question 38

Myocyte degeneration occurs because of

Answer 38

Changes in the myocardium

Question 39

Decreased contractility occurs because of

Answer 39

Scarring

Question 40

The most common cause of sudden cardiac death and young healthy athlete is

Answer 40

Hypertrophic cardiomyopathy

Question 41

Three types of cardiomyopathy

Answer 41

Hypertrophic Dilated Restrictive

Question 42

What is commotio Cordis

Answer 42

Sudden hit in chest that causes lethal arrhythmia

Question 43

``` 40% Most often seen in infants and teens Autosomal dominant Hypertrophied nondilated left ventricle Left ventricular outflow tract obstruction ⬆️ size and thickness of left ventricle ⬇️ LV filling Syncope is most common sign d/t arrhythmia ```

Answer 43

Hypertrophic cardiomyopathy

Question 44

Name a few causes of dilated cardiomyopathy

Answer 44

Idiopathic Myocarditis Genetic

Question 45

``` CHF from dilated left ventricle and systolic dysfunction ⬆️ ventricular chamber size ⬆️ myocardial stretch ⬇️ contractile force ⬆️ ventricular end diastolic pressure ⬆️ diastolic volume ⬇️ stroke volume ```

Answer 45

Dilated cardiomyopathy

Question 46

Least common type of cardiomyopathy Minimal contractile movement Ventricular walls become stiff and prevent the heart from filling with blood ⬇️ ventricular compliance

Answer 46

Restrictive cardiomyopathy

Question 47

Manifestations of cardiomyopathy

Answer 47

``` Enlarged heart Contractility changes Signs of CHF Poor perfusion Changes in heart sounds especially Gallop Arrhythmias risk of emboli Chest pain Syncope ```

Question 48

Medicines for hypertrophic cardiomyopathy

Answer 48

Beta adrenergic agonist ⬇️ ventricular workload Inotropes: used cautiously Ca Channel blocker ⬇️ afterload and Contractility

Question 49

Medicines for dilated cardiomyopathy

Answer 49

Digoxin: ➕ inotropes: ⬆️ contractility Beta blockers: counter sympathetic stimulation

Question 50

Surgery for cardiomyopathy includes

Answer 50

Ventricular septal myotomy Pacing Fluid and Na restrictions Transplantation