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PNP cardiac

Cardiac anomaly that results from failure of the endocardial cushion to develop properly. Has 3 components-ASD, VSD and formation of AV valves. L>R shunting. AV (atrioventricular) canal
cardiac lesion-failure of primitive arterial trunk to divide into aorta and PA causing mix of systemic and pulm. blood flow Truncus Arteriosis
Is truncus arteriosis (TA) cyanotic or non-cyanotic cyanotic
Management for truncus arteriosis (TA)? Prostaglandin administration, manage shock and CHF. Surgery when stable.
Aorta arises from RV and PA rises from LV Transposition of the Great Vessels
Management of transposition of the great vessels (TGV)? If no ASD or VSD, will require immediate prostaglandin infusion, balloon septostomy ASAP
Cardiac lesion with 4 findings: outlet type VSD, RVOT obstruction, overriding aorta, RVH. R>L shunting. Tetrology of Fallot
What is the treatment for a TET spell? Legs to chest will increase SVR, phenylephrine is drug.
What cardiac lesion can be diagnosed later in life? Coarctation of the Aorta
How does a coarctation present in the older child? Systemic hypertension
Assessment of hypertension involves BP eval (repeated), heart sounds, dysmorphic features, abnormal retinal exam (papilledema) abnormal growth parameters.
Diagnostic test for hypertension CBC, UA, UC, uric acid, BUN, creatinine, lytes, lipid panel, renal US, echocardiography
Management of mild essential hypertension dietary, exercise, wt loss
management of essential hypertension diuretics, vasodialators, beta blockers, ACE inhibitors (never first line)
Management of secondary hypertension find and tx underlying cause, referral to cardiology or nephrology
Definition of hypertension in kids BP consistently >95% for age, gender, height measured on 3 separate occasions
Def secondary hypertension usually renal vascular or systemic vascular with genetic syndrome, endocrine disorder, excess endogenous catecholamine
Def essential hypertension multifactorial, genetic, familiar, enviro, dietary factors
Def kawasaki syndrome Aquired heart disease. Acute systemic vasculitis of unknown origin. Acute and subacute phases.
Diagnosis/ symptoms of kawasaki disease PRI: fever x5d, indurated palms & soles, erythematous rash, conjunctivae injection, desquam lips, strawberry tongue, LAD. SEC: vasculitis as murmur, N/V/D, abd pain, proteinuria, cough, joint swelling, seizures. 5D FEVER +4/5 PRIMARY OR 3+ CARDIAC INVOL
Treatment of kawasaki disease IVIG, high dose aspirin, chronic aspirin if indicated, cardiology & ID consults. LT f/u echo's
Def rheumatic fever Aquired heart disease. Collagen vascular disease of connective tissue resulting in vasculitis. Inflammation of joints & heart. Complication of GAS pharyngitis.
Diagnosis/ symptoms of rheumatic fever Presents as migratory polyarthritis with joint pain, rash & subq nodules. Jones criteria: 2 major (carditis, polyarthritis, chorea, erythea marginatum, subq nodules) OR 1major & 2 minor (arthralgia, fever, elevated CRP, ESR, WBC, prolonged PR interval.
Rx & treatment for Rheumatic fever Acute: penicillin, aspirin therapy. Bed rest until fever and symptoms resolove. cardiology and ID consults. Then PCN prophylaxis for endocarditis.
Symptoms of cardiomyopathies CHF & decreased CO =>SOB
Etiology of cardiomyopathies Acute or chronic sequelae of atypical viral disease. Dilated cardiomyopathy is most often seen.
Diagnosis of cardiomyopathies CXR reveals cardiomegaly. ECHO globally decreased function. Work up for anatomic abnormalities, metabolic causes, infectious causes.
Treatment of cardiomyopathies Acute: support cardiac output with inotropes and vasodilators, diuretics. Treat causes (IVIG, antivirals, surgery for ALCAPA)
Etiology of hypertrophic obstructive cardiomyopathy 50% familial, often found on autopsy
Symptoms of hypertrophic obstructive cardiomyopathy Acute decompensation, may be with sports or activity
Management of hypertrophic obstructive cardiomyopathy Activity restriction, beta blocker, avoidance of catecholamines
Etiology of Long QT syndrome Congenital disorders characterized by a prolongation of the QT interval on ECG and a propensity to ventricular tacharrhythmias, which may lead to syncope, cardiac arrest, or sudden death
Symptoms of Long QT syndrome Typically diagnosed s/p cardiac event(syncope or arrest). Eval relatives: K+, mg+, thyroid. EKG & echo.
Management of Long QT syndrome Treat with beta blockers. Implantable cardioverter/defibrillator. Avoid meds that prolong QT (inc amioderone, EES, zoles & most psyc meds)
Definition/description of ASD Opening in atrial septum. Left -> right shunting.
Symptoms/ characteristics of ASD Usually asymptomatic, with soft, systolic ejection murmur with fixed S2. EKG - may show right axis deviation, RVH, Echocardiogram.
Management of ASD May close spontaneously. Echocardiogram is routine monitoring. Surgery for large lesions.
Definition/description VSD Open in the ventricular septum. Left to right shunting.
Symptoms/ characteristics of VSD Findings dependent on the size of lesion and pulmonary vascular resistance. Signs of CHF, holosystolic murmur, pulmonary hypertension. can occur.
Management of VSD Control symptoms of CHF prior to surgical correction, nutrition. Surgical correction is usually after the age of one.
Diagnostic tests of VSD Echo, CXR, B-type natriuretic peptide serum level, EKG, occasionally cardiac catheterization.
Definition/description of Atrioventricular canal Results for failure of endocardial cushion to develop normally. 3 components: ASD, inlet VSD, abnormal AV valves. LEFT TO RIGHT SHUNTING.
Symptoms/ characteristics of Atrioventricular canal Depend on type and configuration. Tachypnea, poor weight gain, other signs of CHF.
Management of Atrioventricular canal Control CHF and encourage weight gain. Surgical management.
Diagnostic of Atrioventricular canal Echocardiogram, CXR.
Definition/description of PDA Vessel connects the left main pulmonary artery to the descending aorta, in utero is part of normal circulation, after birth, lesion closes, if remains open: LEFT TO RIGHT SHUNTING.
Symptoms/ characteristics of PDA Symptoms depend on extent of shunting. Possible CHF or pulmonary HTN. Symptoms include murmur, widened pulse pressure, low diastolic pressure and bounding pulses.
Management of PDA Allow spontaneous closure. Surgery can be used. NSAIDs and prostaglandin keep PDA open.
Definition/ description of Truncus Arteriosus Rare lesion - failure of the primitive arterial truck to septate and divide into aorta and pulmonary artery causing mixture of systemic and pulmonary blood flow. RIGHT TO LEFT SHUNTING.
Symptoms/ characteristics of Truncus Arteriosus Usually diagnosed prenatally. Symptoms occur soon after birth with normal fall of PVR and include shock. Bounding peripheral pulses, cyanosis, harsh systolic murmur. EKG _ left atrial enlargement and biventricular hypertrophy.
Management of Truncus Arteriosus Prostaglandin administration managing shock and CHF. Surgery indicated once patient stable.
Definition/ description of Transposition of the Great Vessels Aorta rises from the anatomic right ventricle and the pulmonary artery rises from the anatomic left ventricle. RIGHT TO LEFT SHUNTING.
Symptoms/ characteristics of Transposition of the Great Vessels Two separate and parallel circulation present.
Management of Transposition of the Great Vessels Infants with intact ventricular and atrial septums will require immediate prostaglandin infusion, balloon septostomy ASAP.
Definition/ description of Tetralogy of Fallot 4 findings: outlet type VSD, right ventricular outflow tract obstruction, overriding aorta, RVH. RIGHT TO LEFT SHUNTING.
Symptoms/ characteristics of Tetralogy of Fallot Degree of cyanosis is related to the degree of RV outflow tract obstruction. Presentation varies. Typically- TET spells. EKG - persistence of RVH beyond 3 months of age. CXR - "boot shaped" heart.
Management of Tetralogy of Fallot Medical management of symptoms, nutrition until surgical repair which is only definitive treatment.
4 Left to right shunting conditions ASD, VSD, AV, PDA
4 Right to left shunting conditions Truncus Arteriosus, transposition of the great vessels, tetralogy of fallot, total anomalous pulmonary venous return.
What congenital cardiac condition has a boot shaped heart on CXR Tetralogy of Fallot
Definition/ description of Total Anomalous pulmonary venous return (TAPRV) Drainage of the pulmonary veins into a systemic venous structure or right atrium instead of left atrium. RIGHT TO LEFT SHUNTING.
Symptoms/ characteristics of Total Anomalous pulmonary venous return (TAPRV) symptoms differ depending on obstruction type. Pulmonary venous HTN & pulmonary edema can develop. Presentation = CHF or inadequate growth, frequent pulmonary infections, mild cyanosis. "snowman" sign on CXR, Echocardiogram indicated.
Management of Total Anomalous pulmonary venous return (TAPRV) Treatment of symptoms. Surgical repair by age 2 or 3.
Definition/ description of Coarctation of the Aorta Obstructive condition. Variety of conditions occurring along the aortic arch - either discrete or generalized narrowing.
Symptoms/ characteristics of Coarctation of the Aorta NN or older child. Pul edema occurs in NN w/ LV failure. Systemic HTN in older child. HF or cardiogenic shock in infant. Asymptomatic murmur/ HTN in older child. EKG, CXR- not conclusive for diagnosis. Echo or doppler studies, MRI definitive.
Management of Coarctation of the Aorta Surgical repair, stent placement.
Post cardiac surgery emergencies Pulmonary artery hypertension, cardiac tamponade, dysrhythmias, post pericardiotomy syndrome.
Definition/ description of Myocarditis Serious, acute inflammation / infection of the myocardium. Often secondary to viral illness such as coxsackie or adenovirus.
Symptoms/ characteristics of Myocarditis Sudden cardiac failure, murmur, gallop, tachypnea, life threatening arrhythmia.
Management of Myocarditis Support while critically ill. ACE inhibitors, digoxin, diuretics, IVIG.
Diagnosis of myocarditis gold standard = biopsy. Elevated troponin, flat T-waves on ECG
Definition/ description of Pericarditis Sequelae to acute viral illness, such as inflammation of the pericardium of the heart.
Symptoms/ characteristics of Pericarditis Fever, tachypnea, tachycardia, pericardial friction rub. May present in tamponade, ECHO may show fluid in pericardial sac. CXR= cardiomegaly. ECG= ST elevation, depression.
Management of Pericarditis If tamponade, emergent pericardiocentesis; Abx 2-4 weeks for weeks for Staph & H flu.
Definition/ description of Endocarditis Acute sepsis presentation
Symptoms/ characteristics of Endocarditis Fever, murmur, embolic phemomena such as petechiae, vasculitis, osler nodes. Echo= vegetation and small, 2mm lesions
Management of Endocarditis *Strep: PCN, Ceftraixone or Vanc. *Enterococci: ampicillin. *Staph Aureus: Nafcillin. Surgery for persistent +blood cx, absecess of valves &/or embloic events during abx tx.
Assessment and diagnosis of acute hypertension Assessment: History, Symptoms, 4 extremity BP, heart sounds Diagnostics: EKG, echocardiogram, renal function, determine underlying cause.
Post pericardiotomy syndrome: Post operative problem: febrile illness secondary to an inflammatory reaction involving the pleura and pericardium.
Post cardiac surgery complications Pulmonary artery hypertension Cardiac Tamponade Dysrhythmias Post pericardiotomy syndrome
Cardiac Tamponade cardiac compression occurring when blood or fluid builds up in the space between the myocardium and the pericardium.
Pulmonary artery hypertension physiologic consequences of RV pressure overload and ventricular dysfunction.
Created by: jjenlouu