Pediatrics 335 > Cardiovascular > Flashcards

Cardiovascular Flashcards

(108 cards)

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1
Q

Preload

A

volume of blood in ventricles at end of diastole

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2
Q

afterload

A

resistance left ventricle must overcome to circulate blood

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3
Q

stroke volume

A

the volume of blood ejected by the ventricle with each contraction

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4
Q

in utero, why does blood bypass the lungs

A

because it gets O2 from the placenta

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5
Q

proximal pulse vs distal pulse

A

proximal: femoral
distal: brachial

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6
Q

S1

A

beginning of systole
AV valves close

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7
Q

S2

A

End of systole
closure of semilunar valves

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8
Q

what heart sound might be normal in children

A

S3
-related to rapid filling of ventricle

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9
Q

what is the first indicator of CHD

A

murmur

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10
Q

a murmur indicates

A

turbulent blood flow with high pressure to get through a narrowed valve or through a shunt

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11
Q

what is the cause of most CHD (congenital heart defects)

A

genetics or environmental

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12
Q

common causes of CHD

A

-fetal exposure to drugs
-viral infections
-increased maternal age
-chromosomal abnormalities

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13
Q

most defects occur during first ____ weeks of gestation

A

8

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14
Q

CHD are categorized by their underlying patho into 4 categories

A

-increased pulmonary blood flow (acyanotic)
-decreased pulmonary blood flow (cyanotic)
-obstructive
-mixed

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15
Q

acyanotic lesions

A

-increased pulmonary blood flow

-defect where blood flows left to right

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16
Q

Which heart defects have increased pulmonary blood flow (acyanosis)

A

PDA (patent ductus arteriosus)
ASD (atrial septal defect)
VSD (ventricular septal defect)

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17
Q

which heart defects have decreased pulmonary blood flow (cyanosis)

A

tetralogy of fallot

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18
Q

which heart defects have obstruction

A

CoA (Coarctation of the aorta)
HLHS (Hypoplastic left heart syndrome)

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19
Q

which heart defects have mixed blood flow

A

TGA (transportation of the great arteries)

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20
Q

patent ductus arteriosis (PDA)

A

-communication between left pulmonary artery and descending aorta

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21
Q

when does patent ductus arteriosis normally close

A

-within first 12-14 hours of life

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22
Q

is a PDA common

A

yes
-5-10% of all infants with CHD

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23
Q

what is a PDA

A

-blood is shunted from the aorta to the pulmonary arteries
-increases circulation to pulm. system

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24
Q

clinical manifestations of PDA

A

-may be asymptomatic
-continuous “machinery” murmur during systole and diastole (HUM)
-thrill in the pulmonic area
-dyspnea
-tachypnea
-tachycardia
-full bounding pulses

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25
PDA have high risk for
frequent resp. infections and pneumonia
26
hallmark sign of a PDA
HUM (machinery murmur)
27
PDA diagnostic test
echo
28
PDA treatment
-transcatheter closure by obstructive device
29
medication for PDA closure
-IV ibuprofen or indomethacin ---cannot be used if CHF is present
30
PDA prognosis
no long term effects if treated before pulm. vascular disease
31
Atrial Septal Defect (ASD)
opening in atrial septum permits left to right shunting of blood
32
ASD clinical manifestations -small to moderate
asymptomatic
33
ASD clinical manifestations -large
-CHF -easy tiring -poor growth -murmur
34
ASD murmur
a soft systolic ejection murmur with fixed WIDE SPLITTING OF S2
35
ASD -diagnostics
ECHO -large -excessive shunting -right hypertrophy present
36
ASD -treatment
-surgery to close patch
37
ASD -what may develop in postoperative period
-arrhythmias ----risk disrupting nodes
38
patients with ASD are at risk for what
stroke -due to turbulent blood flow
39
what is the most common CHD
ventricular septal defect (VSD)
40
what is VSD
opening in the ventricular septum results in increased pulm. blood flow -opening in the ventricles
41
VSD small clinical manifestations
no symptoms
42
VSD mod to large clinical manifestations
-CHF -poor growth -decreased exercise tolerance -increased number of pulmonary infections
43
VSD murmur
systolic 3-4 left intercostal space
44
VSD -diagnostics
ECHO -size and location of defect
45
VSD echo appearance
enlarged heart and pulm. vascular margins on chest radiograph
46
VSD treatment
-surgical closure -cardiac cath --after 1 year of age (unless CHF isn't being managed well)
47
Cyanotic lesions
-decreased pulmonary blood flow -defects where blood flows right to left
48
post op cath lab: -what to assess
vitals bleeding infection pressure dressing
49
Tetralogy of Fallot (TOF)
-decreased pulmonary blood flow (cyanotic)
50
four defects involved in TOF
-stenosis pf the pulmonary outflow tract or valve -right ventricular hypertrophy -ventricular septal defect -overriding of aorta
51
Tet of fallot: -diagnostic
radiograph echo
52
tet of fallot: -what will radiograph show
boot-shaped heart
53
tet of fallot: -when ductus arteriosis closes, what happens to oxygen
O2 stats start to drop
54
tet of fallot: -severe pulmonary stenosis can cause....
right vent. hypertrophy
55
TET spells
knee-chest position -toddlers with uncorrected defects squat to decrease the return of systemic venous blood to the heart
56
what does squatting increase
peripheral vascular resistance (PVR)
57
what does squatting decrease
the magnitude of the right-to-left shunt across the ventricular septal defect
58
TET spells change how blood is being what
shunted
59
nursing consideration for TET spells
keep kid calm give O2 if needed give morphine if needed
60
Tet spells require immediate....
intervention -place infants in knee-chest position
61
obstructive lesions=___________ blood flow is impaired
systemic
62
coarctation of the Aorta (CoA)
narrowing or constriction in the descending aorta -obstruction
63
newborns with CoA clinical manifestations
-cyanosis in lower extremities -heart failure -shock
64
CoA pulses -brachial -radial -femoral -pedal
brachial: bounding radial: bounding femoral: weak/absent pedal: weak/absent
65
CoA diagnostic tests
-MRI -chest radiograph: may reveal cardiomegaly, pulm. venous congestion, and indentation of the descending aorta
66
What does an MRI reveal
site of coarctation collateral circulation -new arteries to bypass obstruction
67
what do prostaglandins do?
helps keep ductus arteriosus open
68
PGE
synthetic prostaglandins
69
CoA treatment
surgical resection: -reduce risk for recoarctation balloon dilation: -stent placement -eventually need surg. repair
70
if someone is receiving IV PGE... what are nursing considerations? why is it important?
protect IV line at all costs when ductus art. closes, it cannot open back up
71
Hypoplastic left heart syndrome (HLHS)
obstructive -mitral and aortic valves are absent or stenosed -no left ventricle
72
HLHS clinical manifestations
within hours of birth.... -progressive cyanosis -signs of CHF -diminished pulse -pale -delayed cap refill
73
HLHS murmur
NO murmur only hear S2-loud
74
HLHS -diagnostics
CXR shows cardiomegaly and increased pulm vasc. congestion
75
HLHS -treatment
-start PGE immediately! ----help maintain ductus -surgery: multiple ----transplant
76
Transportation of the Great Arteries (TGA)
MIXED
77
treatment for TGA
give PGE
78
in TGA, does cyanosis improve with oxygen
no
79
TGA -diagnostic tests -----what does it reveal
CXR -egg shaped heart on a string echo -abnormal position of ventricles
80
TGA treatment
-PGE is administered to maintain a PDA -ballon septostomy -corrective surgery (arterial switch) is performed in the neonatal period
81
common post op complications
arrhythmias -may need pacer
82
what is the leading cause of acquired heart disease in children
Kawasaki disease
83
Kawasaki syndrome
-acute febrile, systemic vascular inflammatory disorder that affects small and midsize arteries, including the coronary arteries
84
Kawasaki disease: -clinical manifestations ------acute stage
-fever -conjunctival hyperemia -cervical lymph nodes -Strawberry tongue
85
kawasaki disease: -clinical manifestations ------subacute
-cracking skin (lips, fingers, toes) -coronary artery aneurisms
86
kawasaki disease: -clinical manifestations -----convalescent
symptoms are dormant
87
what age group and race does kawasaki disease effect
-school age -caucasian/asian
88
Kawasaki treatment
IV Ig aspirin
89
Kawasaki disease: -what do we need to monitor for
coronary artery aneurysms -may require bypass operation
90
cardiomyopathy
disorder of the heart's muscle results in changes to: -chamber size -wall thickness -contraction
91
dilated cardiomyopathy
-most common in children -enlargement of all cardiac chambers -cause blood clots and increased risk for embolism
92
treatment for dilated cardiomyopathy
-diuretics -digoxin -ACE inhibitors (similar tx to CHF)
93
hypertrophic cardiomyopathy
-risk of sudden athletes in children -thickened left vent. wall
94
hypertrophic cardiomyapathy treatment
-beta blockers -calcium channel blockers -implantable cardioverter or defibrillator or surgery
95
hypovolemic shock
inadequate tissue and organ perfusion
96
causes of decreased intravascular blood volume
-hemorrhage -plasma loss from burns, nephrotic syndrome, or sepsis -fluid (DI, DKA, dehydration)
97
how does the body first compensate to hemorrhage (or reduction in circulating blood)? why?
-increase HR to help profuse core organs
98
when blood loss exceeds 20-25 % the childs body can no longer compensate... what happens
BP falls
99
hypovolemic shock: cardiac system-early
-mild tachycardia -normal BP -weak distal pulses
100
hypovolemic shock: cardiac system-late
-HYPOTENSION -extreme tachy -absent distal pulses
101
hypovolemic shock: respiratory system-early
-mild tachypnea
102
hypovolemic shock: respiratory system-late
severe tachypnea
103
hypovolemic shock: neuro system-early
-normal -anxious
104
hypovolemic shock: neuro system-late
-comatose state
105
hypovolemic shock: skin system-early
-cap refill greater than 2 seconds -cool, clammy extremities
106
hypovolemic shock: skin system-late
-pale -cyanosis -cap refil greater than 5 seconds
107
hypovolemic shock: renal system-early
decreased urine output
108
hypovolemic shock: renal system-late
absent urine output
Pediatrics 335
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