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Pediatrics Exam 4

Terms in this set (20)

Increased Pulmonary Blood Flow Defects
-blood can flow from higher-pressure left side to the lower-pressure right side of the heart
-symptoms similar to HF
-ASD, VSD, patent ductus arteriosus, Atrioventricular canal
Obstructive Defects
-blood exiting the heart meets an area of anatomic narrowing (stenosis) causing obstruction to blood flow
-pressure load on the ventricle and decreased CO
-signs similar to HF
**Coarctation of aorta, Aortic stenosis, Pulmonic stenosis
Decreased Pulmonary Blood Flow Defects
-obstruction of pulmonary blood and anatomic defect (ASD or VSD) causes pressure on right side to increase
-desaturated blood allowed to shunt to the left, causing desaturated blood to circulate
-signs of hypoxemia, cyanosis
**Tetralogy of Fallot and tricuspid atresia
Atrial Septal Defect
-abnormal opening between the atria, allowing blood flow to go from left to right
-can be asymptomatic, HF, characteristic systolic murmur
-Tx: surgical patch closure; ASD2 closure
-low mortality with operation
Mixed blood flow
**transposition of great arteries, Total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrom
Ventricular Septal Defect
-abnormal opening between right and left ventricles causing left to right blood flow
-often associated with other defects
-20-60% close spontaneously
-HF is common, characteristic loud holosystolic murmer, risk for bacterial endocarditis and pulm. vascular obstructive disease
-Tx: palliative or complete repair (Dacron patch), cardiopulmonary bypass
Atrioventricular Canal Defect
-large central AV valve that allows blood to flow between all four chambers
-usually show moderate to severe HF; loud systolic murmur; mild cyanosis that increases with crying
-high risk for dev'ing pulm. vascular obstructive disease
-Tx: palliative and complete
Patent ductus arteriosis
-fetal ductus arteriosis fails to close within first few weeks of life
-left-to-right shunt; increased workload on left side
-can be asymptomatic, HF, risk for BE and PVOD
Tx: indomethacin (prostaglandin inhibitor); surgery (thoracotomy); coils placed via cath lab
Coarctation of the aorta
-localized narrowing near the insertion of the ductus arteriosis
-can show as high BP, bounding pulses in arms, weak femoral pulses, cool lower extremities
-signs of HF in infants; can become acidotic and hypotensive
-older children may be dizzy, headaches, fainting
-risk for ruptured aorta, aneurysm, stroke
-surgical resection; balloon angioplasty
Aortic Stenosis
-narrowing of aortic valve, causing resistance to flow out of left ventricle, decreased CO, left ventricular hypertrophy and pulm. vascular congestion
-valvular AS can cause sudden death and surgical repair rarely results in normal valve - physical activity usually curtailed
-faint pulses, hypotension, tachycardia, poor feeding, exercise intolerance, chest pain, dizziness
-valve replacement, balloon dilation, aortic valvotomy (palliative)
Pulmonic Stenosis
-narrowing at the entrance to the pulmonary artery
-right ventricular hypertrophy, decreased pulm. flow
-can be asymptomatic, cyanotic, systolic ejection murmur
-Brock procedure (surgery - valvotomy), balloon angioplasty in the cath. lab
Tetralogy of Fallot
-four defects: VSD, pulmonary stenosis, overriding aorta and right ventricular hypertrophy
-cyanotic at birth, or progressive over 1st year
-"blue spells" or "tet spells"
-palliative shunt and complete repair
Tricuspid Atresia
-failure of tricuspid valve to develop, no communication btw. right atrium and right ventricle
-blood flow through AsD or patent foramen ovalue to left side and through VSD to right ventricle and out to lungs
-associated with PS and TGA
-complete mixing of blood on left side
-cyanotic, tachycardic, dyspneic; chronic hypoxemia and clubbing
-surgery: Fontan procedure; Glenn shunt; intratrial baffle
Transposition of the Great Arteries (TGA)
-aorta exists from right ventricle and pulm. artery from left ventricle
-no communication between systemic and pulmonary circulations
-usually associated with septal defects or PDA
-severe cyanosis at birth, or if have compensating defects may show signs of HF
-IV prostaglandin E1 to temporarily increase blood mixing
-cardiac cath, balloon atrial septostomy (Rashkind procedure), arterial switch procedure (surgery)
Total Anomalous Pulmonary Venous Connection
-rare defect
-failure of pulmonary veins to join left atrium, instead become superior vena cava
-mixed blood returned to right atrium and shunted from right to left through an ASD
-right atrium receives all the blood that normally would flow into the left atrium
-infants are cyanotic, HF, death if untreated
-corrective surgery
Truncus Arteriosis
-development of a single vessel that acts as both pulmonary artery and aorta, mixing blood
-pulmonary blood flow is increased, systemic decreased
-moderate to severe HF, cyanosis, poor growth and activity intolerance
-holosystolic murmur
-surgical repair in first month
Hypoplastic Left Heart Syndrome
-underdevelopment of left side of the heart
-ASD or patent foramen ovale allows saturated blood to mix and flow out through ductus arteriosis (PDA) into aorta
-mild cyanosis, signs of HF until PDA closes, then progressive deterioration
-prostaglandin E1 infusion
-Surgery - shunt, anastomosis
-transplantatioon
decreased RBC production anemia
-nutritional deficiency (iron, folate) or bone marrow failure (aplastic anemia, ALL, infection)
-pallor, tachycardia, headache, fatigue, SOB, muscle weakness
increased RBC loss anemia
-acute blood loss (epistaxis, hemophilia, ITP, DIC, hypersplenism)
-pallor, headache, fatigue, cool skin, decreased peripheral pulses, low blood pressure
Increased RBC destruction anemia
-hemoglobinopathies (SCD, thalassemia), enzymopathies, membrane defects
-immunologic, drugs/toxic substances (chemo, radiation), infection
-icteric sclera, pallor, fatigue, headache, dark urine, frontal bossing
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