1
Q
What are level are the pressures of systemic and pulmonary resistance in utero?
A
pulmonary pressure is high and systemic pressure is low
2
Q
What is the pulmonary vasodilator?
A
Oxygen
3
Q
What disappears in the body that allows structures to close?
A
prostaglandins
4
Q
What hemodynamic changes occur after birth?
A
-decrease in pulmonary vascular resistance
-increase in systemic vascular resistance
-increase pulmonary blood flow
5
Q
In normal pressure is it higher in the ventricles or in the atria?
A
ventricles
6
Q
What stimulates the closure of the foramen ovale?
A
increased pressure in the left atria
7
Q
What stimulates the closure of the ductus arteriosus?
A
higher oxygen saturation than in fetal circulation
8
Q
How long does it typically take from the change to high pressure systemic and low pressure pulmonary system?
A
6-8 weeks
9
Q
What is cardiac output?
A
the amount of blood pumped through the body within a minute
10
Q
What three things effect cardiac output?
A
preload, afterload, and contractility
11
Q
CO= ____ x _____
A
Heart rate x stroke volume
12
Q
What are the pediatric indications of cardiac dysfunction?
A
tachycardia, tachypnea, poor feeding, FTT, poor wt gain, activity intolerance, family hx of cardiac dx, prenatal hx, and developmental delays
13
Q
What prenatal exposures can lead to heart complications?
A
Rubella, Dilantin, alcohol, Diabetes and Lupus
14
Q
What leads to a higher chance of fetal anomalies?
A
low birth weight
15
Q
What leads to a higher chance of fetal heart disease?
A
high birth weight
16
Q
What is the main characteristic of Murmur classification 1-3?
A
you can hear them
17
Q
What is the main characteristic for murmur classifications 4-6?
A
you can hear and feel them
18
Q
What are the characteristics of an innocent murmur?
A
-S1 and S2
-murmur occurs after the “lub”
-low pitch
-can hear in supine and disappears when lying down
-occur in 50 percent of all children
-grade 3 or less
19
Q
What needs to happen for critical heart defects in the first year of life?
A
surgery
20
Q
Older classifications of CHD?
A
Cyanotic and Acyanotic
21
Q
Newer classifications of CHD?
A
-Increased pulmonary blood flow (CHF)
-decreased pulmonary blood flow (cynosis)
-obstruction of blood flow to the heart
-mixed blood flow
*based on the why
22
Q
What are some examples of defects with increased pulmonary blood flow?
A
Atrial septal defect
Ventricular septal defect
atrioventricular canal
patent ductus arteriosus
23
Q
What is occurring in defects with increased pulmonary blood flow?
A
Left to right shunting from high pressure SVR to low pressure PVR. This results in Heart failure.
24
Q
What are some examples of decreased pulmonary blood flow complications?
A
Tetralogy of Fallot
Tricuspid atresia
25
What is occurring in defects with decreased pulmonary blood flow?
Right to left shunting with resting hypoxia. This leads to cyanosis
26
What are some examples of obstructive defects?
Coarctaction of the aorta
Aortic stenosis
Pulmonary stenosis
27
What are examples of mixed defects?
Transportation of the great arteries
Total anomalous pulmonary venous return
Truncus arteriousus
Hypoplastic left heart syndrome
28
What is congestive heart failure?
inability of the heart to pump adequate amount of blood into systemic circulation to meet the bodies metabolic demands
29
What are some causes of CHF?
-volume overload
-pressure overload
-decreased contractility
-increased cardiac demands
-Cor pulmonale (aka right sided heart failure)
30
What are the first signs you will see in a kid with heart failure?
sweating (primarily on the head), tachypnea, and tachycardia
31
Signs of impaired myocardial function?
tachycardia, diaphoresis, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine, irritability
32
Signs of pulmonary congestion?
Tachypnea, cyanosis, exercise intolerance, respiratory distress, and dyspnea
33
Signs of systemic venous congestion?
peripheral and periorbital edema, ascities, edema, weight gain, hematomegaly, neck vein distention
34
What two medications can help improve cardiac function?
Digoxin and ACE inhibitors
35
Digoxin need to knows !!!
-2 nurses need to sign off
-2 doctors needed to prescribe (one must be from cardiology)
-must come in 1ml syringe or less
-green liquid
-0.8mcg-2mcg is therapeutic level
-toxicity= vomiting and bradycardia
-monitor potassium levels
36
What is the management of hypercyanotic spells?
-knees to chest position
-100 percent oxygen
-morphine
-IV fluids
-remain calm
37
When pulmonary blood flow increases, which side of the heart has more blood flow?
the right side
38
What is Atrial Septal Defect?
abnormal opening between right and left atria
39
What are some signs and symptoms of Atrial Septal Defect?
-systolic heart murmur
-poor feeding tire easily
-tire easily
-risk for pulmonary emboli later in life
40
What is the treatment for Atrial Septal Defect?
surgical closure and device closure in the cath lab
41
What is a Ventricular septal defect?
abnormal opening between the ventricles
42
What are some signs and symptoms of VSD?
-FTT
-loud holosystolic murmur
-fatigue with exertion
-tachypnea
-tachycardia
-grunting
-retractions
-color change or diaphoresis
-HF
43
What is the treatment for VSD?
small defects may close, transcatheter closure, large defects require surgical closure
44
What is Atrioventricular canal?
Low ASD and high VSD with clefts in the mitral and tricuspid valves
45
What are the signs and symptoms of Atrioventricular canal?
-loud systolic murmur
-cyanosis worsens with crying
-HF
46
What is the treatment of Atrioventricular canal?
surgical closure
47
What is a Patent Ductus Arteriosus?
failure for the ductus arteriosus to close
48
What are some signs and symptoms of the PDA?
-small defects have none
-large bounding pulses
-widened pulse pressure
-CONTINUOUS MACHINE LIKE MURMUR
-fatigue
-tachypnea
-HF
49
What is the treatment for PDA?
Indocin, device closure, surgery
50
Why do pregnent women need to stay away from taking medicine such as ibuprofen and Indocin?
it can prematurely close the ductus arteriosus
51
What are the 4 defects on the right side of the heart in Tetralogy of Fallot?
-Pulmonary Atresia
-VSD
-Overriding Aorta
-Right ventricle hypertrophy
52
What are the signs and symptoms of Tetralogy of Fallot?
-sudden cyanotic spells
-poor weight gain
-irritability
-tachypnea
-increased work of breathing
-polycythemia
-clubbing
53
What is Tricuspid atresia?
The failure of the tricuspid valve developing
54
What are the signs and symptoms of Tricuspid Atresia?
cyanosis
tachycardia
dyspnea
In older children- chronic hypoxia and clubbing
55
What is the treatment of Tricuspid Atresia?
PGE needed at birth and surgical repair
56
What increases and what decreases in obstructive defects?
Increased pressure and decreased cardiac output
57
What is Coarctation of the Aorta?
Aorta narrows near the insertion of the ductus arteriosus
58
What are the signs and symptoms of Coarctation of the Aorta?
increased BP and bounding pulses in upper extremities
Weak or absent pulses, cool, diminished in lower extremities
Leg pain
systolic murmur
dizziness
HA
fainting
epistaxis
59
What is the treatment for Coarctation of the aorta?
balloon angioplasty and surgical repair (has a risk of recoarctation bc of scar tissue)
60
What is aortic stenosis?
narrowing of the aortic valve, can be valvular or subvalvular
61
What are the signs and symptoms of Aortic Stenosis?
pulmonary edema
systolic ejection murmur
decreased cardiac output
exercise intolerance
dizziness
chest pain
62
What is the treatment for Aortic Stenosis?
Balloon angioplasty, surgical repair with aortic valve replacement, sub valvular stenosis repaired by surgically cutting fibrous ring
63
What is pulmonary stenosis?
narrowing at the entry to the pulmonary artery
64
What are the signs and symptoms of Pulmonary stenosis?
systolic murmur
dyspnea on exertion
cyanosis
65
What is the treatment of pulmonary stenosis?
Balloon angioplasty
Surgical valve repair
66
What is Transposition of the Great Arteries?
position of the pulmonary artery and the aorta are reversed, which prevents communication between systemic and pulmonary circulation
67
What are the signs and symptoms of Transposition of the Great Arteries?
Cyanosis
Cardiomegaly
Tachypnea
68
What is the treatment of Transposition of the Great Arteries?
PGE and balloon atrial septostomy until surgery
Surgical repair with arterial switch procedure
69
What is a Total Anomalous Pulmonary Venous Connection or Return ?
Rare defect in which the pulmonary veins fail to join the left atrium (can be supracardiac, intracardiac, and infracardiac)
70
Signs and symptoms of Total Anomalous Pulmonary venous connection or return?
Cyanosis
retractions
tachypnea
hepatomegaly
difficulty feeding
heart murmur
71
What is the treatment for TAPVS or TAPVR?
surgical repair to reposition the pulmonary veins to the left atrium
72
What form of TAPVC is considered the most emergent?
Infracardiac
73
What is Truncus Arteriosus?
Pulmonary artery and aorta fail to divide during fetal development
74
What are the signs and symptoms of Truncus Arteriosus?
Activity intolerance
Poor feeding
Decreased growth
Cyanosis
heart murmur
Tachypnea
nasal flaring
grunting
retractions
restlessness
75
What is the treatment of Truncus Arteriosus?
surgical repair by 1 month to separate the pulmonary arteries from the aorta and attach to the right ventricle
76
What is Hypoplastic Left heart syndrome?
underdevelopment of the left side of the heart- left ventricular hypoplasia and aortic stenosis or atresia
77
What are the signs and symptoms of HLHS?
mild cyanosis
signs of HF
decreased CO
Cardiovascular collapse
78
What is the treatment of HLHS?
PGE infusion until surgery (Norwood, Glenn, and Fontan), may need a transplant
79
What is the O2 level and age of when the Norwood Procedure takes place?
75-85%, first week of life
80
What is the O2 level and age for the Glenn procedure to take place?
80-90%, 4-6 months
81
What is the O2 level and age that the Fontan procedure takes place ?
>90%, 2-4 years
82
How long should patients remain on bed rest after a cardiac cath?
4-6 for venous
6-8 for arterial
83
If there is a risk for bleeding after the cardiac cath how should you proceed?
hold pressure 1 inch above the site for 15 minutes
84
What color should blood be immediate post op for a chest tube?
Sanguinous, but changes to serous
85
When should you notify a MD about the amount of drainage from a chest tube?
>3ml/kg/hr for 3 consecutive hours or 5-10 ml/kg for any 1 hour
86
What urine output amount could indicate possible renal failure ?
<1 ml/kg/hr
87
Post pericardiotomy Syndrome
Symptoms: fever, pericardial friction rub, pericardial and pleural effusion
Occurs in immediate post op or 7-21 days after
88
What is endocarditis?
infection of the inner lining of the heart most commonly caused by strep
89
What can be done as a prophylaxis for endocarditis?
Antibiotics for 1 hour before procedures
90
What are some contributing factors to Endocarditis?
-cardiac surgery
-dental work
-long term indwelling catheters
91
What are some clinical manifestation of Infective Endocarditis?
-low grade fever
-new or change in murmur
-splenomegaly
Classic signs: petichiae on oral mucosa, splinter hemorrhages, roth spots, osler nodes, neurologic signs, multiple micro-abscesses, intercereberal hemmorrhage, embolic stroke, janeway lesions
92
What is the Therapeutic management for a patient with Infective Endocarditis?
High dose antibiotics for 2-8 weeks, evaluate the effectiveness with repeat blood cultures, if no or minimal response surgery may be an option
93
What is the prevention of Infective Endocarditis?
Prophylactic antibiotics are only given for the highest risk CHD patients
94
When would a patient take prophylaxis antibiotics for IE and when would they not?
WOULD: before dental work, invasive respiratory treatment, procedures on soft tissue infections (high risk)
WOULD NOT: GI/GU procudures or if not high risk
95
What is Rheumatic Fever?
inflammatory disease occurs after Group A b-hemolytic streptococcol phyaringitis
96
What is a common complication of RF?
Rheumatic heart disease
97
How is Rheumatic Fever diagnosed?
a throat culture, rapid antigen test streptococcol antibody test
98
What are the clinical manifestations for Rheumatic fever?
Major: carditis, polyarthritis, erythema marginatum, chroea, subq nodes
Minor: arthralgia and fever
98
What is the treatment for Rheumatic fever?
antibiotics, anti-inflammatory, corticosteroids, and anticonvulsants
99
What labs would be elevated in an RF patient?
ESR and C-reactive protein
100
How is RHD prevented ?
By treating strep, tonsilitis/pharyngitis with:
Penicillin G- IM x1
Penicillin V- oral x 10 days
Sulfa- oral 10xdays
Eryhtromycin- oralx 10days
101
What is Kawasaki Disease?
acute systemic vasculitis
102
What occurs in the acute stage of Kawasaki disease?
high fever that does not respond to meds, red conjunctivae, red pharynx
103
What occurs in the subacute phase of Kawasaki Disease?
fever has subsided, other symptoms prevail, hopefully in the hospital by this stage
104
What occurs in the convalescent stage of Kawasaki Disease?
Disease is gone but the inflammatory markers remain abnormal
105
What is the hallmark sign of kawasaki disease?
strawberry tongue
106
What is the initial treatment for Kawasaki disease?
IVIG- reduce duration of fever and decrease the incidence of coronary artery abnormalities
ASA- helps with fever, anti-coag properties, anti-inflammatory, decrease incidence of anerysms
107
What are the signs of Reye's syndrome?
vomiting, diarrhea, tachypnea, lethargy, confusion, seizure and coma
108
What are the two medications used for hyperlipidemia if patient does not respond well to change in diet?
Colestipol (Colestid) and Cholestyramine (Questran)
109
What are some causes of Secondary Cardiomyopathy?
antineoplastic drug toxicity, Duchenne muscular dystrophy, Kawasaki disease, thyroid dysfunction, and collagen disorders
110
What is Dilated Cardiomyopathy?
most common form in children and leads to HF symptoms
111
What is hypertrophic cardiomyopathy?
heart muscle fibers grow abnormally preventing normal diastolic filing. Commonly affects the left ventricle
112
What is restrictive cardiomyopathy?
occurs when the heart muscle is stiff and poorly compliant. The ventricles do not fill with blood but are not dilated or hypertrophied
113
What is typically the first symptom of restrictive cardiomyopathy?
fainting
114
