cardio
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| 2 kinds of cardio dysfx | congenital heart disease(CHF, hypoxemia)
Acquired Cardiac Disorders (Kawasaki Dis, Rheumatic Fever)
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| 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
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| inspect abd? | abd: hepatomegaly/splenomegaly: indicates rt sided failure
peripheral pulses: discrepancies
chest: feel a thrill
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| pre=procedural cardiac catheterizations? post? | b4, get baseline VS/ht/wt/allergies/dorslis, post tibial pulse
watch for hemorrhage
post: same
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| CHD: congentital heart disease cause: | most common anomaly in VSD
cause: mom drug use, rubella, toxoplasmosis, VSD, cardiomyopathy
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| circulation changes at birth | b4: pressure greatest on right
after: pressure greatest on left
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| fetal circulation structures | foramen ovale: bn R/L atrium
ductus arteriousus: bn aorta and pulmonary art
ductus venosus: comes from umbilicus
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| Older classifications of CHD? Newer? | old: acyanotic/cyanotic
new: hemodynamic considerations....
incr/decr pul flow, obstruction of flow out of heart, mixed flow
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| 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
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| 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
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| VSD? | L-R shunt, most common, can vary, R vent enlarged, incr blood flow to lungs, CHF common, risk of endocarditis
tx: patch
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| Severe case of VSD? | Eisenmenger syndrome: resis in pulm flow > systemic circulation, so reverse flow in vent.
tx: heart/lung transplant as adult
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| PDA? | ductus arteriosus not close, heart works harder to get blood to system
tx: indomethosine: closes, antibiotics, (prostaglandin E keeps open)
Dx: echo
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| s/s pda | bounding peripheral pulses, widened PP>25(bc losing resis out of heart cause losing vol so losing pressure), machinery murmur
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| 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
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| Obstructive Defects: | block flow of blood out of heart, it's oxygenated
Coarctation of Aorta
Aortic stenosis
Pulmonic stenosis
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| Mixed Defects | deoxy in system, co decr, cyanosis
Transposition of great vessels
Total anamolous pul venous connection
R/L Hypoplastic heart syndrome
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| 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
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| 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
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| Truncus Arteriosus | blood ejected from L/R vent into common trunk mixing pul and syst blood
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| 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
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