Cardiovascular Issues and Disorders Flashcards by W W

Blood flow through the heart:

a) Superior vena cava —>
b) _____ ______ —>
c) tricuspid valve —>
d) Right ventricle —>
e) Pulmonic valve —>
f) lungs —>
g) Pulmonary veins —>
h) ____ ____ —>
i) mitral valve —>
j) Left ventricle —>
k) aortic valve —>
l) ______ —>
m) body —>

b) Right Atrium
h) Left atrium
l) aorta

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Mitral/tricuspid (AV) valves closure, aortic/pulmonic (semilunar) valve open

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Aortic/ pulmonic (semilunar) valves closure, mitral/ tricuspid (AV) valves open

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Period between S1 and S2

Systole

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Period between S2 and S1

Diastole

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” Ken-tuck’ -y”; increased fluid states

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“Ten-ne-ssee”; stiff ventricluar wall

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Right upper sternal border (RUSB)

Aortic

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Left upper sternal border (LUSB)

Pulmonic

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Apex (Erb’s point)

Aortic or mitral

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Left lower sternal border (LLSB)

Ventricular septal defect or tricuspid

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Blood flows from ____ to lower pressure

higher

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Resistance and flow
_____:
[ Increased pulmonary vascular resistance (PVR)
decreased systemic vascular resistance (SVR)] > no lung flow

Fetal

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Resistance and flow
______:
(Decreased PVR, increased SVR) > lung flow

Neonatal

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_____ loudness scale: 1 to 4 systolic

Murmur

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Ventricular septal defect (VSD): _____

Thrill

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Obstructive defect:

a) ______ click due to turbulence
b) Referred or radiated sound noted

Ejection

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There is a variety of cardiovascular malformations resulting from abnormal structure development in the ____ trimester

first

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The etiology of congenital heart disease multifactorial Includes ________ abnormalities, Adverse environment conditions, and unknown factors

chromosomal

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Overall congenital heart disease occurs in ______ births

8: 1,000

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Ventricular Septal defect (VSD) comprises up to ___ of all cogenital Heart defects

30%

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Heart defects Noted Cogenitally:

a) ______ Lesions (Left to right shunting)
b) _______ Lesions (Right to left shunting)
c) _________ Lesions

a) Acyanotic
b) Cyanotic
c) Obstructive

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________________________ (______ __ ___ ___)

1) Murmur
a) Grade 2 or 3/4 systolic ejection murmur
b) Heard best at the left upper sternal border (LUSB)
2) ECG: Right ventricular hypertrophy (RVH)
3) X-ray; Cardiomegaly, increase pulmonary vascular makings

Acyanotic defects (left to right shunting)

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_____ ____ ____ (___)
1) Murmur
a) Grade 2 to 5/ 6 systolic ejection murmur
b) holosystolic thrill may be felt at the LLSB
2) ECG: Left ventricular hypertrophy (LVH) progressing to
biventricular hypertrophy if large VSD
3) X-ray; Cardiomegaly, increased pulmonary vascular markings

Ventricular Septal Defect (VSD)

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5% to 10% of a congenital heart defect in term infants; very common in premature infants 1) Murmur: LUSB a) 2 to 4/ 6 holosystolic b) "machinery" sound 2) ECG findings: Left ventricular hypertrophy (LVH) to biventricular hypertrophy 3) X-ray findings: Cardiomegaly and increased pulmonary vascular markings

Patent ductus arterioles (PDA)

``` ______ ____ (Right to left shunting) Transposition of the Great Arteries ``` 1) Murmur a) Same as VSD 2) ECG findings: RVH 3) X-ray: "Egg on a string" with cardiomegaly, and increased pulmonary vascular markings

Cyanotic heart defect

____ _____ (Right to left shunting) 1) Four defects a) Large VSD b) Pulmonary Stenosis c) Overriding aorta d) RVH 2) Murmur: Loud systolic ejection click at the middle and upper left sternal border (M-LUSB) 3) ECG findings: Right axis deviation and right ventricular hypertrophy 4) X-ray findings: Boot-shaped heart, no cardiomegaly or pulmonary vascular markings *Tet Spell: Hypercaynaotic episodes*

Tetralogy of Fallot

Obstructive Lesions ____ _____ 1) Murmur a) Systolic thrill at the right upper sternal border (RUSB) b) Systolic ejection click present which does not vary with respirations c) Grade 2 and 4/ 5 2) ECG findings: LVH 3) X-ray findings: Usually normal, CHF if severe

Aortic Stenosis

``` Obstructive Lesions _____ _____ 1) Murmur: a) Systolic, loudest at the LUSB b) Grade 2 to 4/ 5 ejection click c) The intensity of click decreases with inspiration and increases with expiration d) Thrill at the LUSB radiating to the back and sides 2) ECG findings: RVH 3) X-ray findings: Usually normal ```

Pulmonary Stenosis

1. Murmur a) 2 or 3/ 4 systolic ejection murmur with radiation to the left interscapular area b) may have an ejection click at the apex and RUSB if the bicuspid valve is involved 2) ECG findings: RVH progressing to LVH 3) X-ray findings: a) Cardiomegaly b) pulmonary venous congestion c) Rib notching dut o collateral circulation *BP in lower extremities will be lower than in upper extremities*

Coarctation of the Aorta

_______ syndrome: Aortic arch anomalies

DiGeorge syndrome

Digeorge syndrome is associated with what trisomies?

a) Trisomy 18/ Edward's | b) Trisome XXI/ Down syndrome

_____ _______: Atrioventricluar septal defects,VSD

Trisomy XXI/ Down syndrome

______ syndrome: Aortic regurgitation, mitral valve prolapse

Marfan syndrome

____ syndrome: Coarctation of the aorta, bicuspid aortic valve

Turner syndrome

Prenatal, birth, and family history of heart defects, and evaluate for the following: a) ____ _____ ______ b) Exercise intolerance c) Color changes; cyanosis d) Tachypnea during sleep e) ___ _____ f) diaphoresis g) abnormal heart sounds h) ______ i) Clubbing j) Congestive heart failure

a) Frequent respiratory infections e) Feeding problems h) Edema

Management of pediatric Cardiac defects: a) Referral to pediatric _________ b) ensure optimal primary care and anticipatory guidance

a) cardiologist

AKA functional, benign or physiologic murmur

Innocent Murmurs

______ murmurs 1) No associated symptoms, failure to thrive, or cyanosis 2) Occurs in > 50% of children a) Thin chest wall b) More angulated great vessels c) More dynamic circulation 3) Low- intensity systolic murmurs (Grade 1 - 3/ 6) 4) May vary with position (sit > standing) 5) No radiation to neck/ back 6) Sinus arrhythmias: Heart rate varies upon inspiration and expiration

Innocent Murmurs

_______ Murmur 1) Most common innocent murmur 2) Musical systolic murmur 3) Heard best between LLSB and apex 4) Due to turbulence in the left ventricular outflow tract 5) Systolic ejection murmur

Still's Murmur

______ Hum 1) Continuous humming murmur 2) RUSB 3) heard best in the sitting position; disappears in the supine position 4) Also obliterated by turning head and/or compressing neck ipsilaterally

Venous Hum

A persistent elevation of average systolic/diastolic blood pressure > 95% with measurements obtained on at least three separate occasions per published tables for age and sex

Hypertension

______ as a symptom of other organ dysfunction is most common in children ( secondary to this)

Hypertension

Signs and symptoms of _________ a) Headache b) Visual problems c) Dizziness d) Respiratory distress e) Irritability f) Nosebleed

Hypertension

Laboratory for hypertension: a) ____ ___ (PA and lateral) b) Plasma aldosterone level to rule out aldosteronism c) Morning and evening cortisol level to rule out Cushing's syndrome d) UA, basic metabolic panel (BMP), CBC, cholesterol, and triglycerides e) ECG for dysrhythmias, bundle branch block or LVH

Chest x-ray

Management of Hypertension: | a) Referral to a _________

Cardiologist

A post-infectious inflammatory disease that can affect the heart, joints and central nervous system

Rheumatic fever/ Heart Disease

_____ fever follows a group "A" strep infection of the upper respiratory tract and is most common in ages 6 to 15 years

Rheumatic Fever

The _____ valve is the most commonly affected with Rheumatic fever.

mitral valve

Diagnosis of Rheumatic Fever is fever plus two major or one major and ____ minor Jones criteria

two

Major manifestations for Rheumatic fever are: a) ______ b) polyarthritis c) Chorea d) _____ ________ e) Subcutaneous nodules

a) Carditis | d) Erythema marginatum

Minor Criteria: a) Arthralgia without objective inflammation b) Fever > ______ c) Elevated level of acute phase reactants [erthrocyte sedimentation rate (ESR) and C- reactive protein] d) Prolonged PR interval on ECG with evidence of a group "A" B-hemolytic Streptococcus infection

> 102.2 degrees F

Laboratory/ Diagnostic fo Rheumatic fever: 1) Acute phase reactants a) _____ throat culture b) positive rapid strep assay c) Increased or rising strep antibody titer 2) ECG 3) Echocardiogram

a) positive

Management of this requires: a) refer to a pediatric cardiologists b) aggressive management of the strep infection c) bed rest if acute carditis is present d) prophylactic antibiotics for invasive procedures as indicated

Rheumatic Fever

Acute febrile syndrome causing vasculitis cause this disease?

Kawasaki disease

Kawasaki Disease a) The leading cause of _____ ___ disease in children of an infectious etiology b) Most commonly noted in children under the age of two c) Occurs most commonly in children of Asian ethnicity

coronary artery disease

The patient must have a ___, as well as at least four of the criteria listed below if the patient has more than four of the criteria, coronary vessel involvement is most likely.

Kawasaki Disease

Signs and symptoms of this are: 1) Fever for greater than five days 2) Bilateral conjunctival injection without exudate 3) polymorphous rash (urticarial or pruritic) 4) Inflammatory changes of the lips and oral cavity 5) Changes in extremities (erythema, edema) 6) Cervical lymphadenopathy

Kawasaki Disease

Laboratory/ diagnostics for Kawasaki: a) _____ b) Elevated erythrocyte sedimentation rate (ESR) c) Positive C- reactive protein d) ECG changes: Prolonged PR and QT interval

CBC

Management of Kawasaki disease is: 1) Immediate referral to a cardiovascular specialist 2) High dose ____ therapy a) 80 to 100 mg/kg/day until afebrile for 48 hours b) Then, lower ASA dose ( 3 to 5 mg/kg/day) for antiplatelet response c) Discontinue ASA therapy in collaboration with cardiologist

ASA