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PN2200 CHAPTER 19 CARDIOVASCULAR DISORDERS

Terms in this set (75)

LUNGS
Blood flows from the right ventricle to the pulmonic arteries to the:
BODY
Blood comes from the lungs to the left atrium, to the left ventricle and then to the Aorta to the:
LUNGS
Blood from the right side of the heart goes where?
BODY
Blood from the left side of the heart goes where?
ARTERIES
Blood leaves the heart via:
VEINS
Blood comes to the heart via:
FORAMEN OVALE & DUCTUS ARTERIOSUS
Two structures in the fetal heart decrease the flow of blood to the fetal lungs. They are:
FORAMAN OVALE
This (in the fetus) connects the two atria, allowing blood to flow from the left atrium into the right atrium.
DUCTUS ARTERIOSUS
This (in the fetus) connects the blood flow from the pulmonary artery into the aortic arch.
DUCTUS ARTERIOSIS
this shunt in the fetus connects to the pulmonary arteries (to the lungs) and directly into the Aorta Arch.
FORAMAN OVALE
This shunt is directly from the left to right atrium, causing blood to bypass the left ventricle.
STROKE VOLUME
Amount of blood forced out by the ventricles during a heart contraction
CARDIAC OUTPUT
Total volume of blood forced out of the ventricles in 1 minute
PRELOAD
Volume of blood in the ventricles at the end of diastole
AFTERLOAD
Resistance against which the ventricles pump
CONTRACTILITY
Ability of the ventricles to stretch
SQUATTING
this (child's body posture) is often seen in a child with Tetralogy of Fallot
HYPEREXTENSION OF THE NECK
This (child's body posture) is often seen in child with hypoxia
CARDIOVASCULAR
Children with ___________ problems will show weakness & fatigue upon physical exertion, cyanosis, edema, dizziness & poor weight gain. Will also tire out during feeding.
GROWTH RETARDATION & DYSPNEA
Classic signs of congenital heart defects are:
LIGATION
Obstructing a vessel or duct using suture or wire ligature
RASHKIND PROCEDURE (BALLOON ATRIAL SPETOSTOMY)
(aka balloon atrial septostomy) Procedure in which en enlargement of the existing opening in the cardiac septum is made, allowing better mixing of oxygenated blood from the lungs with the systemic blood
PULMONARY STENOSIS
Narrowing of the pulmonary valve. As right ventricle tries to push blood thru the right pulmonary valve, the ventricular muscle enlarges (hypertrophies).
CLUBBING
Enlargement of the end of the fingers associated with disorders that cause cyanosis
COARCTATION
Narrowing or constricting, especially of the aorta or of a blood vessel
TRANSPOSITION OF THE GREAT ARTERIES
Condition in which the aorta is attached to the right ventricle, and the pulmonary artery is attached to the left ventricle, causing the blood to be insufficiently oxygenated
INOTROPIC
Affecting the contraction of muscle, especially heart muscle
HYPERLIPIDEMIA
Condition characterized by increased total cholesterol, low-density lipoproteins and triglycerides accompanied by decreased high-density lipoproteins
CONJUCTIVAL HYPEREMIA
Increased amount of blood in the conjunctiva
FISSURES
Cracks or lines present on skin tissues
ERYTHEMA MARGINATUM
A red skin rash that sometimes occurs with rheumatic fever, characterized by nonpruritic, red, macular lesions that blanch in the center on chest, abdomen, buttuocks & proximal limbs.
ST VITUS'S DANCE
aka Syndeham Chorea; occurring chiefly in children and associated with rheumatic fever, means CNS is involved. Child experiences involuntary facial & upper extremity movements. Abnormal EEG findings. Can last as long as a few weeks or 2 years.
CHOREA
Involuntary, spasmodic movements of the limbs and face
CARDITIS
Inflammation of the heart
INCREASE
Atrial Septal Defect (ASD), Patent (open) Ductus Arteriosus (PDA) and Ventricular Septal Defect (VSD) will _______ blood flow to the pulmonary system.
ATRIAL SEPTAL DEFECT (ASD)
This is an opening in the septum (wall) BETWEEN THE LEFT AND RIGHT ATRIA that remains when the foramen ovale fails to close after birth. Blood flows directly from L atrium into R side of heart, INCREASING pressure on right side of the HEART and results in R ventricular hypertrophy (enlarge) & increased pulmonary artery blood flow, because blood from the right side of the blood goes to the lungs. Cardiac catheterization with septal ocluder (to plug the hole) will be done to correct.
ATRIAL SEPTAL DEFECT (ASD)
Child with this may be asymptomatic. Is common not to be diagnosed till preschool. Will show fatigue, delayed growth (<5% on growth chart), congestive heart failure, soft systolic murmur (increase in pulmonary artery blood flow - blowing sound). Will squat frequently during periods of activity. Wants naps. Will get tired w/exercise and have difficulty breathing & shortness of breath.
ATRIAL SEPTAL DEFECT (ASD)
In this condition, blood will flow directly from the L to R atria, increasing pressure on the right side of the heart.
PATENT DUCTUS ARTERIOSUS (PDA)
This occurs when the ductus arteriosus fails to close. Normally closed with first breath. BLOOD IS PUSHED FROM THE AORTA to the pulmonary artery, resulting in increase in blood flowing to the lungs. Increase blood flow to lungs causes R ventricle hypertrophy (enlarge) & increased pressure in pulmonary circulation.
PATENT DUCTUS ARTERIOSUS (PDA)
In this condition, blood will flow from the aorta to the lungs again & again. Causes pulmonary congestion & difficulty breathing.
PATENT DUCTUS ARTERIOSUS (PDA)
S & S of this condition are full bounding pulse, dyspnea, Tachypnea & delayed growth. Will have continuous systolic murmur (mechanical, machine sound). Pulmonic thrill may be palpated at left sternal border. At risk for respiratory infection, endocarditis & CHF, hepatomegaly & intercostals retractions.
PATENT DUCTUS ARTERIOSUS (PDA)
This patient may be treated with indomethacin/iboprofin (a prostaglandin inhibitor) IV to stimulate closure of the ductus arteriosus or a surgical ligation (obstructing vessel or duct using suture or wire ligature).
VENTRICULAR SEPTAL DEFECT (VSD)
This is an abnormal opening in the septum between the VENTRICLES. Allows blood to flow directly from L to R ventricle. Size of this (opening) will determine degree of problem child will have. May close spontaneously if small. Perform Rashkind (balloon) procedure for permanent closure of opening. Administer antibiotics post op. At risk for endocarditis after surgery. Surgery should be done prior to 2 years of age to prevent pulmonary artery hypertension.
VENTRICULAR SEPTAL DEFECT (VSD)
Most children with this (heart) condition are be asymptomatic and MAY have NORMAL GROWTH & DEVELOPMENT. If symptoms are present may have dyspnea, Tachypnea, delayed growth, reduced fluid intake, congestive heart failure, pulmonary disease & pulmonary hypertension & a systolic murmur. Child may be cyanotic.
DECREASE
Tetralogy of Fellot (TOF) causes _______ pulmonary blood flow.
TETRALOGY OF FALLOT (TOF)
This is a combination of four defects: pulmonary stenosis, VSD, right ventricular hypertrophy & overriding aorta.
TETRALOGY OF FALLOT (TOF)
In this (heart) condition, the right ventricle tries to push blood thru the tight pulmonary valve, causing right ventricular hypertrophy. As pressure rises in R ventricle, blood is pushed thru a ventricular septal defect (hole between the ventricles - VSD), it mixes with oxygenated blood from L ventricle & pumped to the body, mixing oxygenated & unoxygenated blood and showing up as cyanosis.
TETRALOGY OF FALLOT (TOF)
this heart condition causes unoxegenated blood to enter systemic circulation, causing cyanosis, hypoxia, delayed growth, polycythemia, metabolic acidosis, exercise intolerance & clubbing of fingers. Surgery should be done by 6 months if severe, if not severe can wait 1-2 years.
CYANOSIS
This is a classic sign of Tetralogy of Fallot (TOF) and is common w/exertion, feeding & playing.
TET SPELL
A child with Tetralogy of Fallot (TOF) responds to this by squatting, which will increase blood flow back to the heart. It is a period of cyanosis.
COARCTATION OF THE AORTA
This heart anomaly is a narrowing of the aorta, usually at the arch, which restricts blood flow to the body. Causes L ventricle to work harder to force blood out thru the narrowed aorta. Will have higher blood pressure in arms than legs. Bounding pulses in arms, neck & head, weak pulses in legs. Weakness and pain in legs with exercise. Balloon dilation, anastomosis or surgical resection to fix.
TRANSPOSITION OF THE GREAT ARTERIES
This is when the Aorta is connected to the Right ventricle (instead of left) and pulmonic artery is connected to the L ventricle (instead of the right). No amount of oxygen will relieve the cyanosis. Unoxygenated blood moves in and out of the heart to the body. Oxygenated blood moves thru heart & lungs.
BLUE & RED
Right side of the heart is _____, Left side of the heart is _____.
PROSTAGLANDIN E1
This med is given to newborns IV to maintain patency of the ductus arteriosus, prior to surgical intervention (arterial switch) when the child has Transposition of the Great Arteries.
DUCTUS ARTERIOSUS
It is vital to keep this shunt open in the child who has Transposition of the Great Arteries.
CARDIOGENIC SHOCK
This is when the heart fails, cardiac output and blood pressure decrease. Blood backs up into lungs, causing pulmonary edema. Inadequate amounts of oxygen reach the myocardium, impairing heart's pumping action.
CARDIAC
Congestive Heart Failure (CHF). 3 categories. This category symptoms are: Tachycardia, poor capillary refill, peripheral edema, fatigue, restlessness & cardiomegaly
PULMONARY
Congestive Heart Failure (CHF). 3 categories. This category symptoms are: Dyspnea, Tachypnea, cyanosis, feeding difficulties (tires out), crackles, wheezing on auscultation
METABOLIC
Congestive Heart Failure (CHF). 3 categories. This category symptoms are: Slow weight gain, perspiration (infant should not sweat).
INOTROPIC
This category of meds increase myocardial contractility
CHF
This condition is treated with diuretics, potassium supplements & inotropic meds. Monitor for fluid overload
FLUID OVERLOAD
When monitoring for this, check daily weights same time each day, I & O's and monitor for edema
VOMITING
sign of digoxin toxicity is:
LANAXON (DIGOXIN)
This drug is used to increase myocardial contractility (cardiac output). Given IV & PO. Check apical pulse before giving. <100 (newborn) do not give. <70 (child 1 yr & up) do not give
LASIX
This drug is used to remove extra fluid. Reduces Venus & systemic congestion. Route PO IV. Monitor I/O, daily weights, give potassium foods.
KAWASAKI SYNDROME (aka mucocutaneous lymph node syndrome)
Thisis an acute systemic inflammatory illness. Is the most common cause of acquired heart disease in children. Causes inflammation in walls of small and medium sized arteries throughout the whole body. Has 3 phases: Acute, subacute & convalescent. Most typically, children will fully recover.
KAWASAKI SYNDROME
This syndrome will present as fever, conjuctival hyperemia & red throat, swollen hands & feet and a rash. Enlarged cervical lymph nodes. In second phase, skin on lips, hands & feet slough off in layers, leaves fissures (open to infection). Joint pain, thrombosis of heart, causes aneurysms of coronary arteries & myocardial infarction. Will be admitted to hospital in initial phase. Give IV immunoglobulins and large doses of aspirin to prevent heart damage - 80-100mg/kg/day. Most children fully recover, but damage to heart is permanent.
ACUTE RHEUMATIC FEVER (ARF)
this is not common in the US. Usually occurs 6-15 years of age. Follows 1-4 weeks after a strep infection. Autoimmune response damages heart, joints, CNS & skin. Presents with enlarged, painful inflamed joints, red rash & temp 100.4 or higher. Knees, elbows & wrists. Rash called Erythema marginatum.
ACUTE RHEUMATIC FEVER (ARF)
Diagnosis of this is done by clinical manifestations & antistreptolysin O titer (anti-strep antibody) rising or elevated. Elevated C reactive protein or Sed Rate. Administer antibiotics, anti-inflammatories & steroids for severe carditis.
ANTIBIOTICS
Patients who have had Acute Rheumatic Fever will be prescribed prophylactic ______ in the future for invasive procedures.
FLUID RETENTION
This is evidenced by bulging fontanels, fewer than 6 wet diapers per day, moist lung sounds & generalized tissue edema.
RESPIRATORY DISTRESS
Signs of this are Tachypnea, orthopnea, grunting, flaring nostrils & chest retractions.
LEFT SIDE
symptoms of ____ _____ heart defects (in children) are: cyanosis, dyspnea, respiratory rales, orthopnea, tachycardia, fatigue & restlessness.
RIGHT SIDE
Symptoms of ______ ______ heart defect (in children) are: distended neck veins, tachycardia, liver enlargement, weight gain & edema.
ASPIRIN
Polyarthritis of ARF responds better to the anti-inflammatory effects of _____ than to acetaminophen or ibuprofen. But be careful, can cause Reye's syndrome.
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