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CVS Disorders Flashcards

(45 cards)

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1
Q

Normal flow of blood through an adult heart?

A

superior/inferior vena cava- right atrium- tricuspid valve- right ventricle- pulmonary semilunar valve- pulmonary artery- lungs- pulmonary vein- left atrium- bicuspid valve- left ventricle- aortic valve- aorta

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2
Q

Systole vs diastole?

A

S- heart contracts with ejection of blood from ventricle
D- heart relaxes and fills with blood (resting phase)

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3
Q

What is CO and normal CO for infants?

A

CO- volume of blood ejected from left ventricle each minute, CO=HR x stroke volume

Normal CO for infants is 77mL/kg/min

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4
Q

HR parameters for kids?

A

Very high is >180 and very low is <80. Low HR can compromise CO and high HR myocardial O2 consumption is increased/cardiac ischemia and ventricular dysfunction may occur

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5
Q

Preload vs afterload?

A

P- amount of blood filling ventricles during diastole (volume at end of diastole), increase in preload=increase in SV
A- load that heart must eject against to circulate blood

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6
Q

What is contractility?

A

Force of contraction. Increase in contractility produces increase in SV

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7
Q

Different ways blood flows through fetus circulation?

A
  1. oxygen takes place at placenta-umbilical vein-ductus venosus (around liver through premortal shunt)-inferior vena cava- right atrium-foramen ovale (hole in septum- also known as shunt)- left atrium-left ventricle-aorta
    or
  2. umbilical vein-ductus venosus- RA-RV-pulmonary artery- ductus arteriosis (premortial shunt)-aorta
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8
Q

What happens if fetal circulation persists?

A

Leads to mixing of saturate/destaturated blood that goes out to tissues with decreased O2 so tissues become hypoxia

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9
Q

Changes at birth to fetus circulation?

A

Stretching of umbilical arteries=artery constriction and reduced venous return through umbilical vein, and ductus venous gradually close over a few days (usually by 15 hrs of age)

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10
Q

What are the factors that close the ductus?

A
  1. Increased O2 concentration
  2. Acetylcholine
  3. Bradykinin in blood triggers contraction of ductus arteriosus
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11
Q

What is the drug that keeps the ductus open

A

Prostaglandin E vasodilator

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12
Q

Some causes of heart defects?

A

Chance, family link, deletion of chromosome 22, teratogenic (environmental factors- nutrition, pre-natal care access, drug abuse, certain meds)

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13
Q

What is down syndrome?

A

Genetic condition caused by extra chromosome. There are 3 chromosomes at position 21. Can cause CHD and other abnormalities

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14
Q

What is turner sydnrome?

A

Chromosome abnormalities in which all/part of X chromosome is absent. Affected individuals have 45 chromosomes along with aortic/valve problems

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15
Q

S+S of CHD (congenital heart disease)?

A

Cyanosis (peripheral or central), respiratory distress , CHF, decreased CO, abnormal cardiac rhythms, edema, change in mental status, prolonged cap refill, diminished pulses cardiac murmurs, failure to thrive, and enlarged liver/heart

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16
Q

What is cyanosis? peripheral and central

A

C- abnormal blue colour of skin/mucous membranes. It’s common in hypoxemia with low O2 concentration in arterial blood.
P- blue discolour of distal extremities (hands, feet, nails), mucous membranes generally not involved
C- generalized blue colour of body/visible mucous membranes (see around mouth) d/t inadequate O2

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17
Q

What is CHF? what does right vs left CHD cause

A

Inability of heart to pump out blood that enters the heart and leads to the back pressure to all organs. Lefts HF causes pulmonary congestion and RHF causes peripheral congestion

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18
Q

What is failure to thrive?

A

Decelerated/arrested physical growth by falling below third/fifth percentile or downward change in growth across 2 major growth percentiles. Reasons for FTT is inadequate nutrition

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19
Q

Cap refill test and clubbing?

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A

CRT- test used for assessing blood flow through peripheral tissues and pulses
C- tips of finger enlargement and nails become extremely curved, associated with cyanosis

20
Q

Dx test for CHD?

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A
  1. Echocardiogram- ultrasound to generate image of heart to assess location of structures/size/blood flow direction
  2. Cardiac catheterization- insert catheter through peripheral vein/artery into heart (look at pressure, O2 sat, blood flow patterns, structural info)
21
Q

What do lesions with increased pulmonary blood flow cause in CHD?

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A

Blood is shunted from left (higher pressure) to right side (lower pressure) of heart and this can cause CHF.

22
Q

How to manage patent ductus arteriosus?

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A

O2, fluid restriction, diuretics if needed, nephrotoxic, indomethacin PGE inhibitor (vasoconstriction to close PDA), trans catheter closure is kids >6 months, and surgical ligation

23
Q

What is atrial septal defect?

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A

Incomplete closure between 2 upper chamber of heart (right and left atrium). It’s twice as often in females. Normally after birth a fall in PVR causes decrease in right heart pressures and SVR increases/left pressures increase and closes the forman ovale, but if no closure than ASD develops

24
Q

ASD types

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A

Low, middle, and high septum (depends on location of defect). Causes left to right shunt.

25
Surgery for ASD?
Sutures or patch. Can use a closure device in the cath lab as well
26
How to manage ASD?
Closure depends on type, some close spontaneously, some can be monitored asymptomatic without meds, and symptoms are treated with diuretics/digoxin
27
What is ventricular septal defect?
Opening in ventricular septum and is the most common defect. Most close spontaneously but it creates a left to right shunt of blood.
28
Managment of lesions with increased pulmonary blood flow? 5 steps
1. Assessment- decreased perfusion, CHF, S+S 2. Meds- indomethacin, diuretics (drive fluid off), O2 3. Elevate HOB 4. Proper nutrition 5. Correction via cardiac cath or surgery
29
What is CHD with decreased pulmonary blood flow?
Decrease of pulmonary blood flow with delivery of deoxygenated blood to body (because of blood mixing)=hypoxia or decreased volume of flow. It causes a right to left shunt through structural defects. Types are tetralogy of fallot (TOF) and TA
30
What is tetralogy of fallot? TOF
Causes 4 different lesions (ventricular septal defect, pulmonary stenosis- narrow of pulmonary valve=obstruction of blood flow from right ventricle to pulmonary artery, overriding aorta- aorta arises from right/left ventricles instead of just left, and right ventricular hypertrophy- wall increase in size/muscular b/c it works harder to push blood out).
31
What are tet spells in TOF?
Become very blue/breath rapid/possibly pass out d/t low O2 in their blood stream (main cause of inadequate O2 in blood is obstruction of blood flow to pulmonary b/c of elevated PVR). Also irritable, prolonged cry, and increasing cyanosis.
32
Treatment for tet spells?
Increase SVR to decrease right to left shunt, slow HR/raise BP to push de-O2 venous blood into pulmonary valve/vessels. Squatting position/bending knees can help increase amount of blood returning to right heart from veins/reduce cyanosis spells
33
Management of TOF?
Knee chest position (increases preload/SVR by compressing abdominal aorta), calm the child, O2 therapy, morphine (calms, decreased tachypnea and PVR), alpha agonist to increase SVR, propranolol to slow HR/decrease right to left shunt, and prostaglandin to vasodilator
34
Surgical treatment of TOF?
BT shunt- shunt with graft from the subclavian to pulmonary artery (not full correction but helps decrease symptoms). Taussigs shunt- graft between subclavian and pulmonary arteries. Central shunt- between ascending aorta/main pulmonary artery made of prosthetic. Total repair- closure of VSD and relief of right ventricular outflow tract obstruction
35
What is tricuspid atresia? S+S
Absent of imperforate tricuspid valve (has no opening between right atrium and right ventricle). Causes right atrial hypertrophy and right generically hypotrophic. Causes cyanosis, acute resp failure, hypoxemia, and acidosis. Symptoms arise when DA starts to close at 12-24 hrs and are exacerbated during times of feeding.
36
How to fix TA?
Balloon septostomy to maximize blood flow between atria, BT shunt, central shunt, and fontan
37
What is a fontan?
Operation for TA that results in flow of venous blood to lungs without passing through ventricle
38
General managment of decreased pulmonary blood flow defects?
1. Prostaglandin E1 2. Hydration 3. Supplement O2 4. Surgery
39
Assessment of pt with CHD?
Physical assessment head to toe- look at signs of decreased perfusion/decreased ventilation (colour), monitor BP, listen to heart sounds, pulses, fluid status (any edema), activity and growth
40
What is nursing care pre-catheterization?
NPO, sedation needed, orientate fam/child to unit and give them information about the cath lab
41
Complications of catheterization?
Arrhythmias, bleeding, cardiac perforation- fluid around heart, infection, stroke, hypercyanotic spells, contrast agent reactions, and local vascular complications
42
Complications post cath to monitor? 3 of them
1. Extremity arterial perfusion compromise- look for pale, mottled skin, diminished strength, cool temp, delayed cap refill 2. Venous Obstruction- venous congestion interferes with arterial circulation, any edema 3. Infection risk- monitor site of insertion/temp/blood cultures
43
Nursing care post cath?
Monitor for bleeding, resp compromise, pain, hypothermia, fam support, renal function alterations, fam/child anxiety and knowledge deficits
44
CHD categorized based on?
1. Disorders with decreased pulmonary blood flow- TOF, tricuspid atresia 2. Disorders with increased pulmonary blood flow- PDA, atrial septal defect, ventricular septal defect
45
What is a patent ductus arteriosus?
connection between PA and AO causes left to right shunt from aorta to pulmonary artery. This leads to volume overload in lungs/pulmonary HTN. Occurs commonly in premature infants

Pediatrics (11 decks)

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