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HEHI Peds Cardiac
Terms in this set (108)
what are the 3 basic principles of ped cardiac blood flow?
1. blood flows from high pressure to low pressure
2. the higher the resistance, the less of flow
3. the larger the opening, the more blood flow
what are the 2 pathways that bypass the lungs in fetal heart?
1. foramen ovale
2. ductus arteriosus
they are there so blood can bypass the fetal lungs
should close upon birth
in fetuses, which side of the heart has higher resistance?
the right side bc the lungs are not inflated so pulmonary vascular resistance is higher; so blood flow from right to left
what happens to resistance upon birth when the lungs expand?
big change in circulation when the lungs inflate; the pulmonary vascular resistance goes down and the foramen ovale and ductus arteriosus CLOSE
now we have oxygenating lungs and no longer need bypass pathways
Now, left side of heart has higher pressure!!!!!
what are the 5 prenatal risk factors?
-Maternal chronic health conditions
-Maternal alcohol use
-Maternal illicit drug use
-Exposure to infections
what things increase morbitity and mortality of newborn with cardiac defect?
-down syndrome with septal defect
-age at time of surgery for defect repair - we want baby to be healthier, stronger, and older for them to go surgery
what type of diagnostic tests can you do for cardiac defects?
what is a EKG? describe components
measures electrical activity of heart
12 or 15 lead EKG
non-invasive, painless test that can be very frightening
describe cardiac monitoring
3 lead - lead placement by color
5 lead - lead placement by color
3 lead EKG placement
black, red, white
"smoke over fire (L chest), white to the right"
5 lead EKG placement
black, red, white, green, brown
-"smoke over fire" (L chest)
-"snow over grass" (R chest)
what is an echocardiogram?
non-invasive, diagnostic tool
sound waves produce an image of the heart
describe cardiac catheterization
inserted through femoral vein
used as an intervention - open heart surgery can be done with cardiac catheterization
what is the biggest possible complication with cardiac cathetrization?
what assessment data is gathered to monitor for possible hemorrhage?
-drop in BP
-initial increase in HR
-weak pulse in operative leg
-pale on operative
-decreased cap refill on operative
-sudden change in behavior (lethargy)
what is the post-cardiac catheterization care?
pressure dressing over insertion site
lie flat for 4-8 hours afterwards
what causes CHF?
heart is unable to pump an adequate of blood to meet the body's demand
-increased output demands
in children, what most commonly causes CHF?
a congenital cardiac defect
in right sided heart failure, there is back up in what?
back up into R atrium - the venous system
leads to increased venous pressure and increased systemic venous engorgement (edema)
in left sided heart failure, there is back up in what?
back up to L atrium, in pulmonary side
see pulmonary congestion, pressure, and pulmonary edema
what are the signs and symptoms of CHF?
-impaired myocardial function (not playing)
-systemic venous congestion (R sided)
what are the signs of impaired myocardial function?
tachycardia at rest,
easily fatigued (not playing),
decreased cap refill,
what are the signs of pulmonary congestion?
feeding intolerance, poor weight gain, tachypnea
what are signs of systemic venous congestion?
weight gain - edema, dependent edema, distended neck veins
what are the signs of CHF in infants?
poor weight gain
activity intolerance (not playing)
what is the KEY FACTOR in preventing and treated CHF in children??
what is the tx for CHF?
-medication to increased cardiac function (digoxin)
-remove excess fluid (lasix)
-decrease cardiac demand
-increase tissue oxygenation
what are some ways to decrease cardiac demand in ped patients?
1. regulate thermal environment (warm room)
2. treat and prevent infections
3. maximize chest expansion
4. provide rest - schedule rest periods - rest before eating
what meds do we use to treat CHF?
-diuretics (lasix) furosemide
digoxin for CHF
positive ionotropic (increases strength of contraction
safe for infants and children
take apical pulse for one minute before
what are interventions when using diuretics in children with CHF?
-strict intake & output
-possible fluid restriction in acute CHF
what are some interventions we can do to make sure kid with CHF gets proper nutrition????
-feed at 1st sign of hunger
-decrease work of feeding
-limit length time feeding
-rest before, during, after feedss
-use of NG/G Tube
what are congenital defects classified by? 4 categories
blood flow pattern
1. increased pulmonary blood
2. decreased pulmonary blood
4. mixed blood
with which defects are there increased pulmonary blood flow?
patent ductus arteriosus
ventricular septal defect
atrial septal defect
with which defects are there decreased pulmonary blood flow?
tetralogy of fallot,
how do babies with decreased pulmonary defect appear?
blue babies - cyanotic
with which congenital defects is there obstructive blood flow?
coarctation of the aorta,
with which congenital defects is there mixed blood flow?
transportation of great arteries
hypoplastic L heart syndrome
what is patent ductus arteriosus (PDA)?
Ductus arteriosus does not close between aorta and pulmonary artery after birth
how is the blood transported in PDA?
Blood is recirculated through lungs and returned to LA and LV => ↑ workload on L heart
blood goes from left to right back into lungs
how does PDA present?
-May be asymptomatic or CHF
-Machinery type murmur
-Widened pulse pressure
-Risk for bacterial endocarditis
what is there an increased risk of with PDA?
bacterial endocarditis - acquired cardiac issue
how do we treat PDA?
indomethicin - prostaglandin inhibitor can close PDA
if indomethacin is not effective in closing a PDA, what can you do?
surgical ligation - to close open DA
what is the prognosis with PDA?
what is a ventricular septal defect? VSD
opening between L & R ventricle
-can vary in size
-can spontaneously close in 1st yr
T/F: VSD is frequently associated with other defects
what does ventricular septal defect cause?
L to R shunting
-normal blood flow until reaches RV
-increased blood flow to lungs
-increased pressure to R heart
-leads to R sided hypertrophy
how does a VSD baby present?
pink baby -acyanotic
what are manifestations of VSD?
CHF is common
risk for bacterial endocarditis
what is the management for VSD?
palliative pulmonary bonding - decreases extra pulmonary blood flow
surgical repair with sutures or patch
nonsurgical closure during cardiac cath
what is the prognosis for VSD?
what is Tetralogy of Fallot?
constellation of 4 defects and there is decreased pulmonary blood flow
cyanotic, blue baby
what are the 4 defects seen in tetralogy of fallot?
1. large VSD
2. pulmonic stenosis
3. overriding aortic arch
4. hypertrophy of R ventricle (blood goes back and forth)
what is the manifestations of tetralogy of fallot?
-risk for emboli, loss of consciousness, sudden death
what are TET spells?
acute episodes of cyanosis and hypoxia
02 requirements exceed blood supply due to obstructed pulmonary blood flow
describe the maneuver you do for TET spell r/f Tetralogy of Fallot?
place kid in knee chest position
to decrease venous return from legs and increase systemic vascular resistance - diverting more blood into pulmonary artery
what is the management for tetraology of fallot?
palliative shunt - Blalock-Taussig shunt from L to R subclavian artery
increase blood flow to pulmonary artery
if palliative shunt for tetralogy of fallot does not work, what can you do?
surgical repair - close VSD, correct stenosis, pericardial patch to enlarge R ventricle
what is the prognosis for tetralogy of fallot?
what is the coarctation of the aorta?
localized narrowing of aorta
leads to increased pressure proximal to defect (head and neck)
leads to decreased pressure in LEs
where is the narrowing usually located on the aorta in coarctation of aorta?
top of aorta which supplies head and neck - increased pressure in head and neck
what is the presentation of coarctation of aorta?
high BP and bounding pulses in UE
weak, absent femoral pulses
cool LEs, lower BP in LE
if you observe bounding pulses in UE and weak pulses in LEs, what should you do next?
take 4 extremity blood pressures
if coarctation, will be high in uppers and low in lowers
what is the management of coarctation of aorta?
surgical repair - before age 2 to prevent hypertension
nonsurgical - balloon angioplasty
what is the prognosis with coarctation of aorta?
<5% mortality with isolated defect
what defect is there mixed blood flow?
transposition of the great vessels
what happens when a kid has transposition of great vessels?
-pulmonary artery exits LV
-aorta exits from RV
NO communication between sides of heart
if you have transposition of the great vessels, what must you have to survive?
septal defect- patent DA
what is the management of transposition of the great vessels?
prostaglandin E to keep PDA open
surgical - arterial switch in 1st weeks of life
what is the prognosis with transposition of great vessels?
what is hyoplastic left heart syndrome?
under-developed L heart - LV, mitral valve, aortic valve, ascending aorta
what does hypoplastic left heart syndrome require?
3 surgical procedures
may require heart transplant
T/F: hypoplastic left heart syndrome can be fatal without intervention
what are the 3 acquired cardiovascular disorders?
2. rheumatic fever
3. kawasaki disease
what is bacterial endocarditis?
infection of valves and inner lining of the heart
often a sequelae of bacteremia in children with anomalies of the heart (repaired or unrepaired)
what are the presenting symptoms of bacterial endocarditis?
often non-specific "don't feel good"
fever, malaise, headache, weight loss, diaphoresis, new murmur
what are the portals of entry for bacterial endocarditis?
1. oral - dental procedure
2. UTI post catheter
3. blood - indwelling catheters
what is one of the mainstays of bacterial endocarditis tx?
what is the management for bacterial endocarditis?
high doses of antibiotics IV for 2-8 weeks
what is rheumatic heart disease?
inflammatory disease post Group A beta hemolytic strep pharyngitis
where in heart is carditis most commonly seen?
in mitral valve - causing mitral regurgitation
rheumatic heart disease may lead to what?
CHF - may require surgical valve repair or replacement
how do you diagnose rheumatic heart disease?
what is kawasaki disease?
Acute febrile illness affecting children younger than 5 years with unknown etiology
what is the most serious potential complication with kawasaki disease?
acute systemic vasculitis (inflammation of arteries) including coronary is most serious potential one
what can happen if kawasaki disease if left untreated?
can have significant cardiac sequelae in 25-50% - esp. weakening and dilation of coronary arteries or aneurysm formation leading to MI
what are the signs/symptoms of kawasaki disease?
painful rash on mouth and tongue,
red sclera (scleral injection),
very painful edematous rash on palms of hands & soles of feet (don't want to bear weight on feet or hold things in hands)
how do we manage kawasaki disease?
-high doses of IV immunoglobulin
-high dose of aspirin
-good prognosis with management
what is sepsis?
generalized bacterial infection in bloodstream
which population is high susceptible to sepsis?
neonates - have diminished specific and non-specific immunity
what is essential to increasing chance of survival with sepsis in neonates?
early diagnosis and treatment
what are the prenatal, perinatal, and postnatal sources of infections?
prenatal: acquired across placenta from prolonged ruptured membranes
perinatal: early onset, birth until 6 days, direct contact with maternal organisms from GI & GU tract, E coli and group B strep
post natal: late onset >7 days of age
prenatally, the longer the protective membranes have been ruptured, the __________________ chance we have an ascending infection (from vagina, uterus, and to baby)
what is a febrile neonate?
fever in newborn up to 60 days of age (> 100.4)
can be an indicator of sepsis or serious bacterial infection
if a baby under 1 month old presents to the hospital with a fever >100.4, what should you do?
complete evaluation and admission for conservative therapy - admit with the assumption of sepsis
if a baby 1-2 months of age presents to the hospital with a fever 100.4, what should you do?
may not be admitted if appears healthy, have benign lab findings, or has focus of infection
what does a mottled appearance in a newborn mean?
what are the signs and symptoms of sepsis?
-can be vague, nonspecific
-fever OR hypothermia
-change in level of activity
-change in feeding pattern
-change in color
-vomiting and diarrhea
-change in urine output
-poor muscle tone, floppy
what is a toxic appearance in a newborn?
how is sepsis diagnosed?
-cath urine for culture & analysis
-spinal tap for CSF
-chest x ray
how should we treat neonatal sepsis?
early antibiotics in most ill appearing infants - after all lab work is complete
with positive culture may treat with antibiotics 12-21 days
what is SIDS?
sudden death in an infant under 1 year of age
cause is unknown
what is the peak age for SIDS?
95% occur by 6 months
what are risks factors for SIDS upon birth?
higher incidence in preterm infant, low birth weight, multiple births, neonates with low APGAR score
what are maternal risk factors for SIDS?
young age, cigarette smoking, poor prenatal care, substance abuse
what things about a sleep environment increase risk of SIDS?
-prone sleeping position
-pillow and soft bedding
-non-infant sleep surface
-co sleeping with adult
-tobacco smoke exposure
what are the types of injury in newborns and infants?
-motor vehicle accident
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