Cardiovascular Assessment Flashcards
Cardiac Dysfunction in two categories
Congenital: anatomic abnormalities present at birth resulting in abnormal cardiac function
Acquired: occur after birth, can be seen in a normal heart or a heart with congenital anomalies
Cardiovascular Transition to Extra-uterine Life
Occurs within a few hours after birth, completes at approximately days 10-21 with permanent closure of ductus arteriosus
Hemodynamic change
- increased pulmonary blood flow
- decreased pulmonary vascular resistance (PVR)
- left atrium increased blood flow (from lungs through pulmonary veins)
- 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)
Hemodynamics
Pressures generated by blood & pathways blood takes through the heart & pulmonary system
hemodynamics: blood flow pathway
blood flows from high to low pressure -> path of least resistance
What side of the heart normally has higher pressure
normally pressure on right side of the heart is lower than left & resistance in pulmonary circulation is less than in systemic
Lower pressure pulmonary artery and higher in the aorta
Saturations
Blood returning to heart should have lowest O2 saturation
Blood returning from lungs to heart should be fully saturated (first to the brain)
Normally, saturated blood circulates separately from desaturated blood
(depending on defect, mixing may occur -> results in varying degrees of hypoxemia & cyanosis)
Assessing a Child with Cardiac Dysfunction
History
Assessment
History (5)
Mother’s health history, pregnancy & birth history
- chronic health conditions (lupus, diabetes)
- medications during pregnancy (lithium, phenytoin)
- maternal alcohol use or illicit drug use during pregnancy
- exposure to infections in utero
- infants with low-birth weight d/t IUGR or high-birth weight (IDM)
Detailed family history
History: Infant/Toddler (4)
Feeding and weight gain
Incidence of respiratory illnesses
Developmental milestones and activity
Cardiac concerns (cyanosis)
History: School age/teenager (4)
Exercise tolerance & activities
Cardiac and/or respiratory concerns (edema, chest pain, palpitations)
Neurologic concerns (fainting or headaches)
Recent infections or toxic exposures (rheumatic fever)
History: All children
review any other health conditions or concerns
- presence of other congenital anomalies or syndromes
- medications, including OTC & herbal supplements
Physical Exam: H2T - General Appearance
Weak, irritable, in distress
Developmental delay
Physical Exam: H2T - Vital signs
irregular HR (tachy/bradycardia, arrhythmias)
tachypnea
irregular BP (differences in limbs, cuff should cover 2/3 of upper arm and bladder needs to cover 80-90% of arm. retake if abnormal and take manual. see if difference in limbs.
Hypoxemia (know normal range of O2 sat)
Fever (if d/t infectious cause)
Physical Exam: H2T - Respiratory
Respiratory distress (mild -> severe) - increased comfort with HOB raised
Adventitious breath sounds
Diminished air entry
Asymmetrical chest movement (based on size of heart)
Physical Exam: H2T - Cardiovascular
Pale, mottled, or cyanotic colour (central or peripheral)
Irregular apical pulse
- murmur (if possible, note timing - systolic or diastolic or continuous), location, intensity, quality
- other sounds: split sounds, gallop, rubs
- Dysrhythmias: pacemaker (permanent or temporary)
Bounding, thready, or asymmetrical pulses
Cool to extremities
Delayed capillary refill
Size, shape & symmetry of chest:
- chest retracts, heaves or lifts
- enlargement over heart
- hyperactive precordium
- PMI
