Chapter 23: Cardiovascular Dysfunction

Question 1

What is the 2nd biggest cause of death for the first year of life?

Answer 1

congenital heart disease (prematurity is 1st)

Question 2

What is the most common cardiac anomaly in pediatrics?

Answer 2

ventricular septal defect

Question 3

What are the 3 major changes to fetal circulation that take place at birth?

Answer 3

– when a newborn takes first breath, 3 abrupt changes:
1. change from fetal circulation (with umbilical vein and umbilical arteries) to postnatal circulation
2. closure of foramen ovale – d/t pressure in L atrium > pressure in R atrium
3. beginning of closure of ductus arteriosus – d/t increased oxygen

Question 4

What are the 4 categories of cardiac defects?

Answer 4

1. acyanotic
2. obstructive
3. cyanotic
4. acquired

Question 5

What are acyanotic heart defects?

Answer 5

• AKA increased pulmonary blood flow defects
• L to R shunt –> increased volume on R side of heart –> R side hypertrophy and increased blood flow to lungs

Question 6

What are the 3 acyanotic defects?

Answer 6

1. atrial septal
2. ventricular septal
3. patent ductus arteriosus

Question 7

What is an atrial septal defect (ASD)?

3 aspects

Answer 7

• opening in septum between L and R atria –> causes mixing of oxygenated and deoxygenated blood
• s/s:
  – usually asymptomatic
  – can develop CHF
• treatments:
  – surgical repair
  – cardiac catheter in early childhood
  – can close spontaenously

Question 8

What is a ventricular septal defect (VSD)?

4 aspects

Answer 8

• opening in septum between L and R ventricles –> causes mixing of oxygenated and deoxygenated blood
• more common than ASD
• s/s:
  – commonly causes CHF
  – may be asymptomatic, but depends on size
• treatments:
  – surgical repair
  – cardiac catheter
  – sponatenous closing if small

Question 9

What is a patent ductus arteriosus (PDA)?

3 aspects

Answer 9

• ductus arteriosus (shunt between ascending aorta and pulmonary artery) fails to close after birth –> causes shunting to pulmonary artery and increased fluid to lungs and L side of heart
• s/s:
  – murmur
  – bounding pulses
  – may be asymptomatic
  – can have signs of CHF
• treatments:
  – meds: indomethicin or ibuprofen (only ibuprofen is clinically indicated for PDA closure, but both are used)
  – PDA ligation using cardiac catheter

Question 10

What are obstructive heart defects?

Answer 10

oxygenated blood is unable to flow to the rest of the body

Question 11

What are the 4 types of obstructive defects?

Answer 11

1. coarctation of the aorta
2. aortic stenosis
3. pulmonic stenosis
4. hypoplastic left heart syndrome (HLHS)

Question 12

What is a coarctation of the aorta?

4 aspects

Answer 12

• narrowing of the aorta –> causes restricted amount of oxygenated blood that travels to the rest of the body
• varying degrees of narrowing can occur
• s/s:
  – increased pressure in upper extremities (BP, bounding pulses, warm) and decreased pressure in lower extremities (BP, weak pulses, cool)
  – signs of CHF
  – at risk for aneurysm or stroke
• treatments:
  – surgical repair
  – cardiac catheter

Question 13

What is aortic stenosis?

3 aspects

Answer 13

• narrowing or fusion of the aortic valves –> causes decreased L ventricular outflow and L side hypertrophy
• s/s:
  – L side HF
  – pulmonary edema
• treatment:
  – surgical repair
  – cardiac catheter

Question 14

What is pulmonic stenosis?

3 aspects

Answer 14

• stiffening of pulmonic valve –> causes R ventricular hypertrophy and decreased pulmonary blood flow d/t resistance
• this is often a component of tetralogy of Fallot
• s/s:
  – can be asymptomatic
  – cyanosis
  – CHF
  – at risk for developing endocarditis

Question 14

What is hypoplastic left-sided heart syndrome (HLHS)?

4 aspects

Answer 14

• L side of heart is underdeveloped –> restriction of blood flow to rest of body
• higher mortality rates
• s/s:
  – mild cyanosis, but death will occur if not treated/ductal closure not prevented
• treatment:
  – maintenance of patent ductus arteriosus (PDA) to allow oxygenated blood from R ventricle to enter aorta to flow to rest of body
  – maintenance of patent foramen ovale (ASD) to improve mixing of oxygenated and deoxygenated blood in R atria –> R ventricle can help pump oxygenated blood to aorta via PDA
  – surgery
  – heart transplant

Question 15

What are cyanotic heart defects?

Answer 15

cardiac anomaly where oxygenated blood entering aorta is mixed with deoxygenated blood

Question 16

What are the 2 types of cyanotic defects?

Answer 16

1. tetralogy of Fallot
2. transposition of the great arteries

Question 17

What is tetralogy of Fallot (TOF)?

3 aspects

Answer 17

• condition involving 4 congenital defects:
  – VSD – allows mixing of oxygenated and deoxygenated blood
  – pulmonic stenosis – decreases blood flow to lungs
  – overriding aorta – aortic valve sits right above ventricular septal defect (VSD), further allowing mixing of oxygenated and deoxygenated blood when entering aorta from both ventricles
  – R ventricular hypertrophy
• s/s:
  – cyanosis that may progress
  – murmur
  – tet/blue spells – acute episodes of cyanosis and hypoxia
  – clubbing of fingers
  – poor growth – FTT
  – fatigue
• treatments:
  – surgery
  – squatting positions (knee-to-chest) – for tet spells; decreases return of systemic venous blood to heart

Question 18

What is transposition of the great arteries (TGA)?

4 aspects

Answer 18

• aorta and pulmonary artery are attached to opposite chambers of the heart (aorta to R ventricle, pulmonary artery to L ventricle), creating 2 completely separate circulations
• not sustainable with life unless mixing of blood is established
• s/s:
  – rapid/labored breathing
  – tachycardia
  – cool, clammy skin
  – cyanosis
  – cardiomegaly
• treatments:
  – surgery – switch procedure
  – balloon atrial septostomy
  – prostaglandin E – keeps foramen ovale/PDA open to allow blood mixing

Question 19

What are acquired heart defects/diseases?

Answer 19

heart anomalies that the child was not born with; includes infectious and inflammatory disorders

Question 20

What are the 6 types of acquired heart defects/diseases?

Answer 20

1. CHF
2. endocarditis
3. rheumatic fever
4. Kawasaki disease
5. hyperlipidemia
6. hypertension

Question 21

What is Kawasaki disease?

3 aspects

Answer 21

• inflammation of blood vessels throughout the body and surrounding the heart
• s/s:
  – fever lasting 5+ days
  – rash
  – red bloodshot eyes
  – bright red, swollen, cracked lips
  – strawberry tongue
  – swollen hands and feet
  – redness on palms and soles of feet
  – swollen lymph nodes
• treatments:
  – aspirin (ASA) – for fever and inflammation (usually contraindicated in peds d/t Reyes)
  – IV immunoglobulin
  – antiplatelets
  – Remicade – for inflammation