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Pediatric Cardio
peds/cardio/anomolies/disease
| Question | Answer |
|---|---|
| What are the 3 shunts in fetal circulation | Ductus Arteriosus Ductus Venosus Foramen Ovale |
| Give the functions of the Ductus Arteriosus | protects lungs from circ. overload Allows (R) vent to strenghten increase pulmo vascular resist decrease pulmon blood flow carries mostly medium leve o2 saturated blood |
| Give the functions of the Ductus Venosus | Connects umbilical vein to inferior vena cava regulates blood flow via sphincter carries mostly HI oxygenated blood |
| Give the functions of the Foramen Ovale | Shunts highly oxygenated blood from (R)atrium to (L)atrium |
| What are the clinical manifestations of Coarctation of aorta | Weaker pulses and B/p in LE's Congenital narrowing of the Aorta 80% have aortic valve anomalies |
| What diagnostic test will show defect | Echocardiogram and CXR (enlarged heart and dialated PA) |
| What happens in Coarctation of aorta if PDA closes | higher resistence develops and hear failure can occure |
| Give treatments for Coarctation of Aorta | Prostaglandins may be given to keep PDA open to reducce pressure changes. most common would be resection of narrowed area and re-anastomosis. antibiotic prophylaxis d/t possible aortic valve abnormalities. |
| What are some complications of Coarctation surgery. | Kidney damage d/t clamping off of blood flow increased b/p post surgery may need antihypertensive. |
| most common benign defect of the heart | PDA patent ductus arteriosis |
| When should a PDA close and what makes the PDA close | within hours after birth. when PO2 level in arterial blood increases the PDA closes |
| Pulmonary artery flows at what pressure | Low |
| Aorta flows at what pressure | High |
| Blood flows from high pressure to low pressure since this is the case in a PDA what direction is blood flowing (aorta vs pulmonary artery) | With a PDA blood would flow from the aorta into the pulmonary artery circulation at the PDA which would increase the vol of blood going to the lungs. |
| With a PDA what type of shunting occurs | Left-to-Right shunt |
| What are the affects of left-to-right shunting | increased workload on the left side of heart increased pulmon vascular congestion potentially right vent pressure and hypertrophy. |
| Increased pulmonary blood flow usu exhibits what clinical manifestations | signs and symptoms of CHF: Fatigue Tachycardia; sweating; heavy breathing;Restlessness;decreased urine output;decreased b/p |
| what medical management is used to close a PDA | Indomethacin (prostaglandid inhibitor) |
| Name 4 goals of treatment for PDA | 1)improve cardiac function 2)remove accumulated fluid 3) decrease cardiac demands 4)improve tissue oxygenation and decrease oxygen consumption |
| What primary medication is used in children to improve cardiac function | Digitalis glycosides |
| What are the benefits of digitalis | increased cardiac output (increased contractility), decreased heart size, decreased venous pressure and relief of edema |
| What is the therapeutic serum digoxin level range | 0.8 to 2.0 |
| What treatment is used to remove accumulated fluid | Diuretics |
| What are the most common diurectics used | Lasix and thiazides (potassium -losing) and aldactone |
| What effect does Lasix have | Blocks reabsorption of sodium and water in proximal tubule and interfers with the reabsorption of sodium |
| common signs of digoxin toxicity in children | N/V,anorexia,bradycardia,dysrhythmias |
| ventricular septal defect causes shunting from | left-to-right |
| ventricular septal defect leads to | (R) ventricular hypertrophy deficient systemic blood flow |
| ventricular septal defect does not usu cause | cyanosis |
| If pulmonary arterial pressure = systemic pressure what will happen | reversal of the (L) to (R) shunting and resulting in cyanosis |
| What happens in (R) to (L) shunting | blood bypasses the lungs for re-oxygenation resulting in cyanosis,breathlessness,poor feeding,FTT |
| VSD can be diagnosed by hearing | a heart murmur (the smaller the hole the louder it is) |
| long term exposure to increased blood vol. in pulmonary artery leads to | thickened vessel walls = pulmonary vascular disease |
| What is the pathophysiology of an atrial septal defect | there is a hole inbetween the right and left atrium and blood flows from left atrium into the left atrium |
| what are the clinical manifestations of ASD | Pulmonary HTN,decreased blood vol. in systemic circulation. |
| How to diagnose ASD | heart murmur @ the pulmonary valve d/t heart forcing lg. amt of blood thru normal sized valve |
| what is the treatment for ASD | surgical closure |
| What is the pathophysiology of Tetralogy of Fallot (4) | stenosis/narrowing of pulmon valve hypertrophy of (R) ventricle displacement of aorta over VSD VSD |
| abnormalities of tetrology of fallot leads to | insuff. oxygenated blood pumped to body |
| tetrology of fallot is responsible for | cyanosis in child over the age of 1 |
| with increasing cyanosis there may be | clubbing of the fingers |
| in tetrology of fallot what does not help the cyanosis | oxygen |
| what treatments are available for tetrology of fallot | Prostaglandins to keep PDA open (if O2 levels are extremely low) complete repair when infant is 6 mo |
| what information can be obtained from a cardiac cath | visualization of heart/vessels measure of O2 of chambers measure intra-cardiac pressures determine muscle function and pumping action |
| What are red flags for cardiac cath procedure | toxicity to dye shellfish allergy |
| what are signs/symptoms of toxicity during cardiac cath proced | increased temp uticaria wheezing edema SOB HA |
| name pre-cardiac cath proced. | all VS Labs for @ risk blood loss (Hgb and Hct) pedal pulses NPO hold digoxin IV if polycythemia(dilute to decrease thrombis) |
| name post-cardiac cath proced | VS q 15 X 1 hr apical count X 1 min assess pulses below cath site assess temp and color of affected extremity monitor for bleeding and formation of hematoma acetaminophen for pain |
| what manifestations indicate a (R)to(L) shunting | VSD obstructive lesion |
| pathophysiology of (R) to (L) shunting | increased pressure on right than on left increased resistance of lungs pulmonary artery restricted |
| if (R) to (L) shunting occurs what happens to deoxygenated blood from right side | it gets shunted to the left side and out to systemic circulation (body)= cyanosis because it bypasses lungs to pick up O2 |
| what are affects of (R) to (L) shunting | hypoxemia=decreased tissue oxygen polycythemia=dodys attempt to compensate for hypoxemia |
| what are complications of (R) to (L) shunting | thrombus formation d/t sluggish circulation brain abcess or stroke |
| signs and symptoms of L side HF (systemic venous congestion) | weight gain hepatomegaly edema JVD |
| signs and symptoms of R side HF (pulmonary venous congestion) | tachypnea dyspnea cough wheezes |
| what are some compensatory responses to heart failure | tachycardia cardiomegaly diaphoretic fatigue FTT |
| When giving digoxin what electrolyte should be closely monitored | potassium levels |
| name apical pulse parameters to hold digoxin | infant/toddler <100 older child <80 adult <60 |
| What is Kawasaki Disease | acute,self limiting generalized vasculitis(inflammation of all vessels) esp. coronary arteries. |
| manifestations of kawasaki disease | enlarged lymph nodes patchy rash peeling skin oral mucosal changes pink eye stawberry tongue high fever edema hands and feet red palms of hands and soles |
| what labortory values do you expect to see in kawasaki disease | increase WBC, ESR and platelets |
| What are some interventions for kawasaki disease | IV gamma glubulin high dose of ASA in hospital, low dose at home baseline echo to assess CA |
| What anomoly happens in aortic stenosis | there is 2 rather than 3 leaflets leaflets are thickened or fused there is obstruction of blood flow from left vent. |
| symptoms of aortic stenosis | dizziness syncope angina fatigue |
| what are signs/symptoms in an infant who has aortic stenosis | FTT poor feeding exertion breathlessness |
| left vent hypertrophy equals | Cardiomegaly |
Created by:
Booschick
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