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210 Ped Ch. 48


2 kinds of cardio dysfx congenital heart disease(CHF, hypoxemia) Acquired Cardiac Disorders (Kawasaki Dis, Rheumatic Fever)
Inspection of infant w/ suspected cardiac dysfx 1.nutritional state: wt/failure to thrive 2.color: cyanotic/pallor 3.clubbing(not infant) 4.pulsating neck vv
inspect abd? abd: hepatomegaly/splenomegaly: indicates rt sided failure peripheral pulses: discrepancies chest: feel a thrill
pre=procedural cardiac catheterizations? post? b4, get baseline VS/ht/wt/allergies/dorslis, post tibial pulse watch for hemorrhage post: same
CHD: congentital heart disease cause: most common anomaly in VSD cause: mom drug use, rubella, toxoplasmosis, VSD, cardiomyopathy
circulation changes at birth b4: pressure greatest on right after: pressure greatest on left
fetal circulation structures foramen ovale: bn R/L atrium ductus arteriousus: bn aorta and pulmonary art ductus venosus: comes from umbilicus
Older classifications of CHD? Newer? old: acyanotic/cyanotic new: hemodynamic considerations.... incr/decr pul flow, obstruction of flow out of heart, mixed flow
Defects that decr pulmonary blood flow? abn connection bn 2 sides of heart, incr vol on Rside, incr pul flow, decr systemic flow ASD: atrial septum defect VSD: ventrical septum defect PDA: patent ductus arteriosus AVD: atrioventricular canal defect
ASD? hole bn 2 atriums at septum, asymptomatic, more probs with athletes later, L-R shunt, R atria/vent distended, incr oxy blood into R atria then lungs, risk for emboli tx: nonsurgical patch
VSD? L-R shunt, most common, can vary, R vent enlarged, incr blood flow to lungs, CHF common, risk of endocarditis tx: patch
Severe case of VSD? Eisenmenger syndrome: resis in pulm flow > systemic circulation, so reverse flow in vent. tx: heart/lung transplant as adult
PDA? ductus arteriosus not close, heart works harder to get blood to system tx: indomethosine: closes, antibiotics, (prostaglandin E keeps open) Dx: echo
s/s pda bounding peripheral pulses, widened PP>25(bc losing resis out of heart cause losing vol so losing pressure), machinery murmur
AVD: endocardial cushion defect, both septums open, so blood flows thru all 4 chambers, L-R shunting, hypertrophy on R side Most common in Down syndrome
Obstructive Defects: block flow of blood out of heart, it's oxygenated Coarctation of Aorta Aortic stenosis Pulmonic stenosis
coarctation of aorta? aorta is narrowed near ductus arteriosus, high bp, bounding pulses in arms/weak in femoral, cool lower extremities, back up in L side and lungs tx: balloon, post: HTN, if HTN, recurrence
Aortic Stenosis? Narrow aortic valve, L side hypertrophy, Vfib? incr resis in L vent, decr CO, pul congestion/HTN, decr coronary perfusion, incr risk of MI
s/s os aortic stenosis in infant? child? infant: decr co, faint pulses all over, hypotension, poor feeding, tachy, murmur child: excercise intolerance, chest pain, dizzy stand tx: balloon, sugical
Pulmonic stenosis? Severe? pulmonic valve narrowed, R vent hypertrophy, decr pul flow tx: balloon, surgical severe: pul atresia-need PDA/prost E, shunt unoxy to L atrium-cyanotic
Decr pul flow defects pul flow obstructed, have defect ASD/VSD, back up in R side, deoxy shunt R to L to syst, hypoxic Tetralogy of Fallot Tricuspid atresia
TET? 4 things: VSD, pulmonic stenosis, overriding aorta, R vent hypertrophy, R-L shunting, TET spells, squatting/flex infant knees, risk of emboli tx: repair VSD/stenosis
Tricuspid Atresia need prost E, no tricuspid valve, so no comm bn R atria/vent. ASD adn VSD formed tx: opening from atria to vent
Mixed Defects deoxy in system, co decr, cyanosis Transposition of great vessels Total anamolous pul venous connection R/L Hypoplastic heart syndrome
Transposition of Great Vessels pul a leave L vent/ aorta leave R vent, must have prost E for PDA or septal defect to allow oxy blood to system tx: surgical fix
Total Anomalous Pulmonary Venous Connection rare, pul vv fail to join L atrium, and drain into R atrium, so mixed. Oxy blood not delivered, cyanotic early on tx: surgical: reconnect pul v to LA and close ASD
Truncus Arteriosus blood ejected from L/R vent into common trunk mixing pul and syst blood
Hypoplastic Left Heart L side underdeveloped, L vent small with aorta atresia, need Prost E, then blood go to R atrium/vent and out to pul aa, also aorta gets from PDA to give to sys tx: transplant
Created by: palmerag