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Gollahon Final: Alterations of Cardiovascular Function

Terms in this set (48)

Congenital Heart Defects
Major cause of death in the first year of life other than prematurity.
Congenital Heart Defect Risk Factors
- Prematurity
- Antepartal bleeding
- Chromosome aberrations
- Maternal rubella or increased age, diabetes, alcoholism, PKU, drugs, and hypercalcemia
Hemodynamic Alterations
- Right to left shunt
- Left to right shunt
Status of Tissue Oxygenation
- Cyanotic Defects
- Acynontic Defects
Acyanotic
- Increased pulmonary blood flow

- Obstruction to blood flow from ventricles
Cyanotic
- Decreased pulmonary blood flow

- Mixed blood flow
Coarctation of the Aorta
Narrowing of the lumen of the aorta that impedes blood flow
Coarctation Manifestations
- If severe decreased CO, acidosis, hypotension at birth

- If undiagnosed, no manifestations until find hypertension in upper extremities at older age
Aortic Stenosis
- Narrowing of the left ventricular outlet

- Causes increased workload on left ventricle and left ventricular hypertrophy

- Various Types
Aortic Stenosis Manifestations
- Risk for bacterial endocarditis

- Older children: may have complaints of exercise intolerance

- Infant: if significant faint pulses, hypotension, tachycardia, and poor feeding
Valvular Aortic Stenosis
- Malformed or fused cusps

- Progressive obstruction with episodes of myocardial ischemia

- Strenuous activity limited
Subvalvular Aortic Stenosis
- Stricture caused by a fibrous ring below a valve

- Konno procedure used to correct
Supravalvular
- Narrowing of the aorta just above the valve

- Single defect or as part of Williams syndrome
Pulmonic Stenosis
- Narrowing of the pulmonary valve causing resistance to flow from right ventricle to pulmonary artery

- Right ventricular Hypertrophy

- Pulmonary atresia
Pulmonic Stenosis Manifestations
- If severe: cyanosis from right to left shunt through atrial septal defect; decreased CO
Patent Ductus Arteriosus
- Failure of the ductus arteriosus to close

- Allows blood to shunt from the aorta to pulmonary artery, causing left to right shunt
Patent Ductus Manifestations
Asymptomatic or pulmonary overcirculation (dyspnea, fatigue, poor feeding)
Patent Ductus Arteriosus Complications
Risk for bacterial endocarditis
ASD Major Types
- Ostium primum defect

- Ostium secundum defect

- Sinus venosus defect
Atrial Septal Defect
Abnormal opening between the atria; blood flows from left atria right atria.
ASD Manifestations
- Asymptomatic at early age

- Pulmonary symptoms on exertion at later age
Ventricular Septal Defect
- Abnormal communication between the ventricles

- Most common type of congenital heart lesion
VSD Manifestations
- May be asymptomatic

- Increased pulmonary blood flow from left to right shunt; pulmonary hypertension
:Eisenmenger syndrome
Atrioventricular Canal Defect
- Results from incomplete fusion of the endocardial cushions

-Demonstrates abnormalities in the atrial and venticular septa & atrioventricular valves
AVC Manifestations
Left to right shunt and pulmonary overcirculation
Tetralogy of Fallot: represented by
- Ventricular Septal Defect
- Overriding aorta
- Pulmonary valve stenosis
- Right ventricle Hypertrophy
Tetralogy of Fallot: Manifestations
-Acute cyanosis at birth or gradual cyanosis

- Gradual clubbing, poor growth; Tet spells

- If untreated, emboli, stroke, brain abscess, seizures
Tricuspid Atresia
- Failure of the tricuspid valve to develop

- Lack of communication between the right atrium and right ventricle
Tricuspid Atresia: Asso. Defects
- Pulmonic Stenosis
- Transposition of the great arteries
Tricuspid Atresia: Manifestations
- Newborn, cyanosis, tachycardia, dyspnea, poor feeding

- Older child, signs of chronic hypoxemia
Transposition of the great arteries
Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle
Transposition Great Arteries: Manifestations
Depends on size and associated defects
Transposition Great Arteries: Results, Parallel circuits
- Unoxygenated blood circulates continuously through the systemic circulation

- Oxygenated blood circulates continuously through the pulmonary circulation

- Other defects allow mixing of these circuits
TAPVC: total anomalous pulmonary venous connection
- Pulmonary veins connect the right side of the heart, directly or indirectly through one or more systemic veins that drain into the right atrium
TAPVC: Point of attachment
- Supracardiac
- Cardiac
- Infracardiac
Truncus Arteriosus
- Failure of the embryonic artery and the truncus arteriosus to divide into the pulmonary artery and aorta

- The trunk straddles an always present VSD
-Types l, ll, and, lll
Heart Failure
- Heart is not able to maintain cardiac output at level that meets demands of body

- Results from poor ventricular function

- Complication of many congenital heart defects
HLHS: Hypoplastic left heart syndrome; Left sided cardiac
- obstruction to blood blow form the left ventricular outflow tract
Hypolastic Left Heart Syndrome
- Underdevelopment of the left ventricle, aorta, and aortic arch; mitral atresia or stenosis; coarctation of the aorta

- Manifestations occur early in newborn (cyanosis, tachypnea, decreased CO)

- Fatal in early life if untreated
HLHS Manifestations
- Occur early in newborn (cyanosis, tachypnea, decreased CO)

- Fatal in early Life if untreated
Kawasaki Disease
- Also known as mucocutaneous lymph nodes

- Acute, self-limiting systemic vasculitis that may result in cardiac sequelae

- Usually occurs in children under 5 years of age and in winter or spring
Kawasaki Disease: Stages
- Acute
- Subacute
- Convalescent
- Postconvalescent
Kawasaki Acute
Capillaries, venules, arterioles, and the heart become inflamed
Kawasaki Subacute
Inflammation of larger vessels; coronary aneurysms appear
Kawasaki Convalescent
Medium-sized arteries begin granulation process; small vessel inflammation decreases
Kawasaki Postconvalescent
Scarring of vessels, thickening of tunica intima, calcification, coronary artery stenosis
Kawasaki Diagnosis
- Fever for 5 days or more (unresponsive to antibiotics)
- Bilateral conjunctivitis without exudation
- Erythema of oral mucosa (strawberry tongue)
- Changes in the extremities, such as peripheral edema and erythema with desquamation of palms and soles
- Polymorphous rash
- Cervical lymphadenopathy
Systemic Hypertension
- Often has an underlying disease

- Renal disease or coarctation of aorta

- A cause of the hypertension in children is almost always found

- Seeing increased incidence of primary hypertension in older children related to obesity
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