Cardiac

Question 1

Defects that increase pulmonary blood flow

Answer 1

ASD (Atrial Septal Defect)
VSD (Ventricular Septal Defect)
PDA (Patent Ductus Artteriosus)
AV Canal (Atrioventricular Canal)

Question 2

ASD

Answer 2

Atrial Septal Defect

abnormal opening between left and right atria

Question 3

VSD

Answer 3

Ventricular Septal Defect

abnormal opening between the right and left ventricles

Question 4

PDA

Answer 4

Patent Ductus Arteriosus

artery connecting the aorta to the pulmonary artery

Question 5

AV Canal

Answer 5

low ASD and high VSD

allowing blood to flow between all 4 chambers of the heart

Question 6

Defects that decrease pulmonary blood flow

Answer 6

Tetrology of Fallot (TET or TOF)
Tricuspid Atresia (TA)

Question 7

TET

Answer 7

Tetrology of Fallot

VSD, Pulmonary stenosis, overriding aorta, RV hypertrophy

Question 8

TA

Answer 8

Tricuspid Atresia

no development of tricuspid valve

Question 9

TA with no other defect to compensate is _____

Answer 9

NOT COMPATIBLE WITH LIFE

Question 10

Defects with obstruction to blood flow

Answer 10

Coarctation of aorta (CoA, coarc)
Aortic Stenosis (AS)
Pulmonic Stenosis (PS)

Question 11

CoA

Answer 11

Coarctation of aorta

narrowing in the region of ductus arteriosus

Question 12

AS

Answer 12

Aortic Stenosis

causes blocking of blood flow between left ventricle and aorta

Question 13

PS

Answer 13

Pulmonic Stenosis

caused by blockage to blood flow from the right ventricle to the pulmonary artery

Question 14

Defects with mixed blood flow

Answer 14

Transposition of the Great Arteries (TGA)
Total Anaomolous Pulmonary Venous Return (TAPVR)
Truncus Arteriosus (Truncus)
Hypoplastic Left Heart Syndrome (HLHS)

Question 15

TGA

Answer 15

Transposition of the Great Arteries

the aorta starts from the right ventricle and the pulmonary artery from the left ventricle

Question 16

TAPVR

Answer 16

Total Anomalous Pulmonary Venus Return

all 4 pulmonary veins do not connect normally to the left atrium. Instead, the 4 pulmonary veins drain abnormally to the right atriumthough an abnormal/anomalous connection

Question 17

HLHS

Answer 17

Hypoplastic Left Heart Syndrome

underdeveloped LV; the mitral and aortic valves are either completely closed (atretic) or they are small (hypoplastic), the fist part of the aorta is really small

Question 18

Congenital Cardiomyopathy is a disease of the heart muscle that causes

Answer 18

the heart muscle to become enlarged, thick, or rigid

Question 19

As cardiomyopathy progresses, the heart becomes

Answer 19

weaker

It is less able to pump blood and maintain a normal electrical rhythm

this can lead to hf or arrhythmias

Question 20

Most cardiomyopathyies in children are considered _____ or _______.

Answer 20

primary or idiopathic

primary is a disease of the heart muscle itself, caused by another systemic condition

idiopathic means the cause is unkown

Question 21

If heart defects are left untreated, the result is

Answer 21

HF

heart muscles become damaged, unable to maintain cardiac output, decreased blood flow to kidneys results in fluid over laod and increased workload of the heart

pulmonary and venous congestion result

Question 22

Clinical Manifestations of HF, impaired myocardial function

Answer 22

Tachycardia Decreased blood pressure
Sweating (inappropriate)
Gallop on ausculation
Decreased urinary output
Fatigue
Weakness
Irritability
Decreased PO
Pale, cool extremities
Weak peripheral pulses

Question 23

Clinical Manifestations of HF, pulmonary congestion

Answer 23

Tachypnea
Grunting
Dyspnea
Decreased oxygen saturations
Retractions (infants)
Flaring nares
Exercise intolerance
Increased oxygen requirement
Cough, hoarseness

Question 24

Clinical Manifestations of HF, systemic venous congestion

Answer 24

Weight gain
Hepatomegaly (enlarged liver)
Peripheral edema, especially periorbital
Ascites
Neck vein distention (older children)

Question 25

Goals of treating HF

Answer 25

Improve cardiac function Remove accumulated fluid and sodium Decrease cardiac demands Improve tissue oxygenation

Question 26

Meds to improve myocardial function:

Answer 26

Digoxin –other drugs used more frequently now, trials have moved to FDA approval ACE Inhibitors- enalapril, lisinopril Beta blockers - propranolol

Question 27

Meds to remove accumulated fluid and sodium

Answer 27

Diuretics: Furosemide (Lasix) Chlorothiazide (Diuril) Spironolactone (Aldactone) *Fluid restricted diets, possible Na restricted diets*

Question 28

After meds, next steps:

Answer 28

Treat the underlying cause (may include surgical repair if indicated) Palliative care Heart Transplantation

Question 29

Heart Transplantation info

Answer 29

Option for those with worsening heart failure Physical and psychosocial assessment prior to transplant- must meet specific criteria Mortality high for those on waiting list Bridge device assists to improve outcomes – Berlin, LVAD, RVAD Posttransplant concerns Rejection Infection

Question 30

Acquired Cardiovascular Processes

Answer 30

Acquired: disease processes or abnormalities that occur AFTER birth -due to illness, infection, autoimmune response Left untreated, can lead to heart failure just as congenital defects do as well

Question 31

Rheumatic Heart Disease is a result of

Answer 31

an abnormal immune response to a group A strep (GAS) infection, usually pharyngitis

Question 32

Rheumatic Heart Disease affects

Answer 32

joints, skin, brain, and heart - the most significant complication is the mitral valve is most often affected

Question 33

clinical manifestations of Rheumatic Heart Disease

Answer 33

Tachycardia, new murmur, chest pain, EKG changes, painful joints, rash, fever, subcutaneous nodes, lab findings (elevated ESR, CRP)

Question 34

treatment of Rheumatic Heart Disease

Answer 34

antibiotics (PCN), anti-inflammatory therapy, and supportive care and management of HF in some; valve repair/replacement in some

Question 35

cardiomyopathy refers to abnormalities of the myocardium in which

Answer 35

the cardiac muscles’ ability to contract is impaired

Question 36

Possible etiologic factors of acquired cardiomyopathy include

Answer 36

familial or genetic causes, infection, deficiency states, metabolic abnormalities, and collagen vascular diseases

Question 37

treatment of acquired cardiomyopathy

Answer 37

manage heart failure; bridge to transplant

Question 38

Infective endocarditis is a bacterial infection on

Answer 38

the inner lining of the heart, generally with valve involvement

Question 39

infective endocarditis patho

Answer 39

Organisms enter the bloodstream from any localized site of infection

Question 40

clinical manifestations of infective endocarditis

Answer 40

low grade and intermittent fever, malaise, splinter hemorrhage, heart failure symptoms may present

Question 41

diagnostic evaluation of infective endocarditis is based on

Answer 41

clinical manifestations; antibiotic therapy definitive on causative agent in the bloodstream

Question 42

Kawasaki Desease

Answer 42

Form of vasculitis, blood vessels become inflamed throughout the body

Question 43

Kawasaki Disease etiology

Answer 43

unclear; usually precipitated by febrile illness for > 5 days; more common in children under 5 years old

Question 44

clinical manifestations of Kawasaki Disease

Answer 44

fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips, and throat.

Question 45

complications from Kawasaki Disease

Answer 45

coronary artery dilations and/or aneursyms

Question 46

Diagnosis of Kawasaki Disease

Answer 46

fever present for >5 days and four of the following: Rash Cervical lymphadenopathy Bilateral conjunctival injection Oral mucosal changes Peripheral extremity changes

Question 47

standard treatment of Kawasaki Disease

Answer 47

intravenous immunoglobulin therapy (IVIG) and aspirin