Exam 3: Cardio Flashcards

Question

What to record with heart murmurs (5 things)

Answer 1

1. Location (where the murmur is heard best) 2. Time (when it is heard in S1 S2 cycle) 3. Intensity (related to child's position; heard when sitting up?) 4. Loudness 5. Grading (I-VI) *Murmurs IV-VI are accompanied by thrill

Answer 2

Very faint, often not heard if child sits up

Answer 3

Usually readily heard, slightly louder than grade I and audible in all positions

Answer 4

Loud, but not accompanied by a thrill

Answer 5

Loud, accompanied by a thrill

Answer 6

Loud enough to be heard with a stethoscope barely touching the chest; accompanied by a thrill

Answer 7

Loud enough to be heard with stethoscope not touching chest,, accompanied by a thrill

Answer 8

The two great veins; blood returning through them has lowest O2 saturation

Answer 9

1. Blood flows from area of higher pressure to lower pressure and takes path of least resistance * Pressure in left side of heart > right side of heart 2. Resistance in pulmonary artery is less than in systemic circulation 3. Pressure in pulmonary artery is less than the pressure in the aorta

Answer 10

1. Atrial spetal defect 2. Ventricular spetal defect 3. Patent ductus arteriosus 4. Atrioventricular canal

Answer 11

1. Coarctication of aorta 2. Aortic Stenosis 3. Pulmonic Stenosis

Answer 12

1. Tetrology of Fallot | 2. Tricuspid atresia

Answer 13

1. Transposition of great arteries 2. Total anomalous pulmonary venous return 3. Truncus arteriosus 4. Hypoplastic left heart syndrome

Answer 14

1. Left to right shunting (because pressure is higher on left and blood goes to side of least resistance) 2. Right atrial and ventricular enlargement (not very significant but it can occur) 3. Unusual to have CHF 4. May be totally asymptomatic except for auscultating a murmur 5. Depending on the size of the hole, it can wait to be fixed (can close on it's own by school age)

Answer 15

ASD= hole between right and left atrium 1. Primum – lower end of septum 2. Secundum – center of septum * *This is the most common 3. Sinus venus defect – junction of SVC & right atrium

Answer 16

1. May be asymptomatic 2. May develop CHF 3. Audible murmur

Answer 17

1. Most common defect causing increased pulmonary blood flow * This defect is causing increased pulmonary blood flow because it is going from the left to the right and then out the lungs 2. It is an opening between right & left ventricle * Can be membranous or muscular * Muscular: multiple holes in the heart 3. It is frequently found with other defects 3. 20 – 60 % close spontaneously during first year of life * Depending on the size, may wait to do surgery during first year of life 4. Overtime it can cause ventricular hypertrophy * ↑ pressure in right ventricle→ hypertrophy 5. Eisenmenger syndrome may develop

Answer 18

1st: There is chronic increased pressure on the right side of the heart, which isn't used to high pressure 2nd: As a result, children develop secondary pulmonary HTN, which adds more pressure to right side of heart 3rd: Pulmonary arterioles hypertrophy and become resistant to blood flow 4th: Pressure from back flow continuously increases and you get reverse shunt of blood, and now blood goes from right to left ventricle, causing a mixture of deoxygenated and oxygenated blood to go through aorta and into systemic circulation

Answer 19

1. CHF common | 2. Audible murmur

Answer 20

1. Incomplete closure of endocardial cushions 2. Low ASD continuous with high VSD * Can see there is a big hole in the middle of the heart * Can affect valves if severe 3. Defects in mitral & tricuspid valve 4. Blood flow between all 4 chambers of the heart 5. Most common defect in children with Down’s syndrome

Answer 21

1. CHF 2. Murmur audible 3. Mild cyanosis that ↑ with crying

Answer 22

1. Heart block 2. CHF 3. MV regurgitation 4. Arrhythmias 5. pulmonary hypertension * All due to location of the AV canal * May need pacemaker due to heart block

Answer 23

1. Failure of PDA to close within first weeks of life 2. ↑ pulmonary blood flow; Increased pulmonary blood flow occurs with PDA because the pressure of the aorta is higher than in the pulm`onary artery, so you will have blood flow regurgitating back into the lungs which increases pulmonary blood flow 3. May develop right ventricular hypertrophy

Answer 24

May show signs of CHF, murmur *Mortality rate is very low

Answer 25

1. Indomethacin: A prostaglandin inhibitor that helps close the PDA 2. NSAIDs can also be used to close it * Don’t want PDA to close during pregnancy, so pregnant women should never take NSAIDs!!

Answer 26

Type of obstructive defect When there is a narrowing of the aorta, about where the patent ductus arteriosis inserts into the aorta *Localized narrowing near insertion of ductus arteriosis * There is extra circulation through collateral circulation, which are microvessels that are off branches of the heart * Collateral circulation can cause poor CO

Answer 27

1. ↑ upper extremities BP 2. ↓ lower extremities BP 3. Bounding upper extremities pulses 4. Weak pulses in lower extremities 5. CHF in infants 6. Older children describe: headache, dizziness, leg pain * Leg pain because not getting adequate blood flow to legs

Answer 28

1. Type of obstructive defect; IT IS THE NARROWING OR STRICTURE OF THE AORTIC VALVE 2. ↓ cardiac output 3. Left ventricular hypertrophy * See this because LV has to work harder to push blood passed the obstruction 4. Pulmonary vascular congestion * Because blood is backing up into the pulmonary veins

Answer 29

1. Valvular stenosis= Most common; when the valve itself is affected 2. Subvalvular stenosis= a tissue in the aorta below the valve 3. Supravalvular stenosis= Tissue in the aorta above the valve

Answer 30

1. Faint pulses 2. Hypotension * Because narrowing is occurring further up in the heart 3. Tachycardia * Compensating for low CO 4. Poor feeding 5. Exercise intolerance 6. Chest pain and/or palpitations 7. Dizziness with standing

Answer 31

1. Obstructive defect; Narrowing of entrance to pulmonary artery 2. Right ventricular hypertrophy with ↓ PBF 3. Could get pulmonary atresia - total fusion; no way for blood to come out of right atrium and then pulmonary artery (no blood going from heart to lungs) 4. If PS severe, patients can develop CHF 5. If very severe, patient can become cyanotic * But cyanosis isn’t usually associated 6. PDA partially compensates for obstruction * PDA helps because it can increase blood flow to the lungs (since pressure is higher in the aorta)

Answer 32

1. May be asymptomatic 2. Mild cyanosis or CHF 3. Newborns – cyanotic 4. Murmur

Answer 33

1. Defect of decreased pulmonary flow 2. VSD 3. Pulmonic stenosis * In area of aorta below the valve that is narrowed 4. Overriding aorta 5. Right ventricular hypertrophy * Due to the pulmonary stenosis 6. Depending on position of aorta, blood from both ventricles may be distributed systemically * Aorta pushed to right = increased cyanosis * Aorta pushed to left = decreased cyanosis

Answer 34

1. Cyanosis (increased if aorta is pushed to right) 2. TET spells 3. Murmor

Answer 35

Need to get blood flow in the lungs, done using Blalock-Taussing shut 1. Palliative: Blalock-Taussing shunt * Connection between subclavian and pulmonary artery * Increases blood flow to the lungs * Do this first, until the heart is ready for full correction 2. Complete repair: close VSD, pericardial patch * Can do this once patient is 1 year old * Close VSD, shift aorta, etc.

Answer 36

1. NO COMMUNICATION BETWEEN RIGHT ATRIUM AND RIGHT VENTRICLE * NO TRICUSPID VALVE!!! * If blood comes into the right atrium, it will just sit there 2. To get the blood to go to lungs, may try to keep PDA open * If PDA stays open, some blood can go into lungs * Keep PDA open by giving Prostaglandin E 3. Complete mixing of oxygenated and deoxygenated blood in systemic circulation * Child will be very cyanotic when born * Will be prepared for this when child is born, otherwise child won’t survive 4. ASD or PFO necessary to create a hole to have somewhere for the blood to go

Answer 37

1. PDA --> allows blood to flow to pulmonary artery for oxygenation * Give Prosteglandin E to keep it open 2. ASD ---> allows blood flow to enter right ventricle and then to go into the lungs * or can be PFO

Answer 38

1. Cyanosis 2. Tachycardia 3. Dyspnea 4. Clubbing

Answer 39

1. Pulmonary artery leaves left ventricle and aorta leaves right ventricle with no connection (not compatible with life because totally deoxygenated blood is going into systemic circulation) 2. Must keep PDA open and create PFO and/or ASD * PDA open to get blood out to extremities

Answer 40

Created to have blood come into left side of heart, go over to the right side of heart (there is a mixing of oxygenated and deoxygenated), and then out into extremities *Better to have some oxygenated blood in systemic circulation than none!

Answer 41

cyanotic and cardiomegaly

Answer 42

1. Prostoglandin E to open PDA, 2. Arterial switch with reimplanting coronary arteries 3. Total correction will be done within first few weeks of life * Put Aorta on left side and Pulmonary artery on right side

Answer 43

1. Underdevelopment of left side of heart 2. Develops aortic atresia 3. In order to survive to surgery, need other defects in place; Requires PDA and PFO or ASD immediately * NEED PROSTAGLANDIN E TO KEEP PDA OPEN!

Answer 44

mild cyanosis with CHF, after PDA closes progressive deterioration

Answer 45

1st Norwood – main pulmonary artery to aorta * Will occur early in infancy * Making the pulmonary artery the aorta and making right side of heart the left side of heart * All circulation to the lungs will be passive circulation 2nd: Bidirectional Glenn * To make all circulation to lungs passive circulation 3rd: Modified Fontan * To make all circulation to lungs passive circulation ~Will always require a transplant by mid-teens ~May only do palliative care and no surgery

Answer 46

1. Volume overload – left to right shunts 2. Pressure overload – obstructive defects 3. ↓ contractibility – cardiomyopathy 4. High cardiac output demands – sepsis, anemia, etc.

Answer 47

1. Edema | 2. Hepatomegaly

Answer 48

1. Respiratory distress | 2. Congestion

Answer 49

1. Tachycardia 2. Diaphoresis * Usually seen on the bridge of the nose or scalp in children 3. Easily fatigued 4. Tachypnea 5. Dyspnea 6. Mild cyanosis 7. Retractions, grunting 8. Wheezing, cough 9. Poor profusion * Prolonged capillary refill * Decreased urinary output 10. Hepatomegaly 11. Edema, weight gain * Weight gain from fluid retention 12. Developemental delays * Clinical manifestations are due to ↓ myocardial contraction, ↑afterload & ↑preload

Answer 50

To treat CHF 1. ↑cardiac output 2. ↓ heart size by decreasing HR 3. ↓venous pressure 4. Relief of edema 5. Before giving Digoxin, must take HR for full minute!! 6. Symptom of toxicity in children: bradycardia, vomiting, arrythmias * For infants and toddlers, question HR lower than 110 * For older children, question HR lower than 60 7. Digoxin is usually given in liquid solutions; order in micrograms to ensure giving the right dose!!

Answer 51

To treat CHF Captopril(Capoten) and Enalapril(Vasotec) 1. Before giving ACE inhibitors, take BP!! 2. Reduces blood pressure

Answer 52

1. Furosemide (Lasix) 2. Spironoldactone (Aldactone) *Possible fluid restriction and Na+ restriction

Answer 53

1. Provide neutral thermal environment * Ensure patient isn’t too hot or too cold, as sweating and shivering can increase cardiac demands 2. Treat existing infections 3. Decrease effort to breath; Elevate HOB 4. Provide rest periods * Organize care! Patient will get tired simply after washing * Do AM care, give rest period, then come back for feeding

Answer 54

1. ↑BMR 2. Well rested before feeding 3. Every 3 hour feeds, ½ hr to finish feeding * May need to gavage after nippling if they only take a small amount by mouth * Don’t wait to put NG tube in until after feeding otherwise they will vomit * Small, frequent feedings; never take over 30 minutes to feed 4. Soft preemie nipple 5. Semi-upright position 6. ↑calories/oz. instead of volume * Never give more volume, but increase calories!

Answer 55

Decreased arterial O2 saturation Over time, 2 physiologic changes occur in response to chronic hypoxemia 1. Polycythemia – due to↑ RBC production * Polycythemia is an increase in RBC * Compensation to increase RBC for more oxygen * Check Hbg/Hct * Increase RBC puts you at risk for clots! 2. Clubbing – thickening and flattening of tips of finger and toes * Children who are cyanotic since birth are smaller, poor weight gain, dyspnea on exertion and fatigue easily

Answer 56

Hypeprcapnic spells (decreased O2, increased CO2) * Occurs with defects with obstructive pulmonary blood flow and communication between ventricles * Patient experiencing tet-spell can become very cyanotic

Answer 57

1. Quickly put child in knee-chest position * This decreases venous return of desaturated blood from the legs and increases systemic pulmonary vascular resistance (diverting more blood flow into the pulmonary artery instead of out of the aorta, which would be desaturated blood) 2. Calm child 3. 100% O2 4. Morphine IV push * Give morphine during tet-spell because there is an area with pulmonary stenosis that can go into a spasm * Morphine helps relax the spasm that occurs during tet spell 5. IV replacement fluid

Exam 3: Cardio Flashcards

(81 cards)