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104 Cards in this Set

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Fetal Circulation: Ductus Venosus -
Shunts blood past portal circulation
Fetal Circulation: Ductus Arteriosus -
Shunts blood past the lungs
Fetal Circulation: Foramen Ovale -
Shunts blood past lungs
Right Side of Heart:
SVC/IVC
RA
Tricuspid Valve
RV
Pulmonic Valve
Pulmonic Artery
Lungs
Left Side of Heart:
Pulmonary Veins
LA
Mitral Valve
LV
Aortic Valve
Aorta/Lg. Arteries/Capillaries/VC
Cardiac Output:
Volume of blood ejected from heart in 1 min.
CO = HR x SV
Stroke Volume:
Amount of blood ejected by heart in any 1 contraction
3 Factors that Influence Stroke Volume:
Preload
Afterload
Contractability
Preload:
Volume of blood returning to heart
Afterload:
Resistance against which ventricles must pump when ejecting blood
Contractility:
Efficiency of the myocardial fiber to act as a pump
Subtle Symptoms of CV Dysfunction:
Duskiness w/ feeding & exertion
Dyspnea w/ physical effort
Fatigue
Sweating w/ feeding
Excessive sweating
Expiratory grunt
Squatting
Clubbing (LT)
Failure to Thrive
Diagnosing CV Dysfunction:
Radiography
ECG
Echocardiography
Cardiac Catheterization
Radiography:
Permanent record of heart size and configuration, it's chambers and great vessels
ECG:
Detects arrhythmias, muscular damage, hypertrophy, effects of electrolyte imbalance
Echocardiography:
Uses high frequency sound waves obtained by a transducer to produce an image of cardiac structure
Cardiac Catheterization:
Uses radiopaque catheters placed in peripheral blood vessel and advanced into heart to measure pressures and oxygen levels in heart chambers & visualize heart structures & blood flow patterns.
Defects of Increased Pulmonary Flow:
Patent Ductus Arteriosus (PDA)
Atrial Septal Defect (ASD)
Ventrical Septal Defect (VSD)
Artioventricular Canal Defect (AVC)
Defects of Increased Pulmonary Flow: Patent Ductus Arteriosus (PDA)
Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close w/in the 1st weeks of life.
Patent Ductus Arteriosus (PDA): Symptoms -
May Be Asymptomatic
CHF
Full Bounding Pulses
Machine Like Murmur
Patent Ductus Arteriosus (PDA): Treatment -
Prostaglandin Inhibitors
Surgical Ligation
Patent Ductus Arteriosus (PDA): Risks -
Bacterial Endocarditis
Pulmonary Vascular Obstructive Disease later in life
Defects w/ Increased Pulmonary Flow: Atrial Septal Defect (ASD) -
Abnormal opening RA and LA that allows blood from the higher pressure LA to the lower pressure RA. Larger the hole larger the problem.
Atrial Septal Defect (ASD): Symptoms -
May be Asymptomatic
CHF
Murmur
Atrial Septal Defect (ASD): Treatment -
Surgical Patch Closure
Atrial Septal Defect (ASD): Risks -
Bacterial Endocarditis
Atrial Dysrhythmias
Defects w/ Increased Pulmonary Flow: Ventrical Septal Defect (VSD) -
Abnormal opening between the RV and LV. Blood goes from higher pressure LV to lower pressure RV.
Ventrical Septal Defect (VSD): Symptoms -
CHF
Murmur
Frequently assoc. w/ other defects
Ventrical Septal Defect (VSD): Treatment -
Pulmonary Artery Banding
Suture or Patching
Ventrical Septal Defect (VSD): Risks -
Bacterial Endocarditis
Pulmonary Vascular Obstructive Disease
Defects w/ Increased Pulmonary Blood Flow: Artioventricular Canal Defect (AVC) -
Incomplete fusion of the endcardial cushions.Large opening in the center of the heart which allows blood to flow between all four chambers. Common in DS children.
Artioventricular Canal Defect (AVC): Symptoms -
Mod - Sev. CHF
Murmur
Mild cyanosis w/ crying
Artioventricular Canal Defect (AVC): Treatment -
Banding
Patch Closure
Artioventricular Canal Defect (AVC): Risks -
Bacterial Endocarditis
Pulmonary Obstructive Vascular Disease
Defects w/ Decreased Pulmonary Flow:
Tetralogy of Fallot
Tricuspid Atresia
Defects w/ Decreased Pulmonary Flow: Tetralogy of Fallot -
4 Classic Defects:
VSD
Aorta laying over VSD
Pulmonary Stenosis
Right Ventricular Hypertrophy
Tetralogy of Fallot: Symptoms -
Cyanosis
Murmur
Tet Spells
Tetralogy of Fallot: Tet Spells -
Acute spells of cyanosis w/ hyperpnea (deeper more rapid respirations). May occur during crying, defecating of feeding.
Tetralogy of Fallot: Treatment of Tet Spells -
Calm infant
Place in knee to chest position
Give blow by O2
Call for assistance
IV Morphine
Fluid Replacement
Tetralogy of Fallot: Treatment -
Surgical Repair
Defects w/ Decreased Pulmonary Blood Flow: Tricuspid Atresia -
Failure of tricuspid valve to develop resulting in lack of communication between RA and RV. PDA allows child to remain alive.
Tricuspid Atresia: Symptoms -
Cyanosis
Tachycardia
Dypnea
Hypoxemia
Clubbing (LT)
Tricuspid Atresia: Treatment -
Prostaglandin to maintain patency of PDA
Surgical Repair
Tricuspid Atresia: Risk -
Bacterial Endocarditis
Obstructive Defects:
Aortic Stenosis
Pulmonic Stenosis
Coarctation of the Aorta
Obstructive Defects: Aortic Stenosis -
Narrow aortic valve d/t thickened or deformed valve cusps.
Aortic Stenosis: Symptoms -
Murmur
Decreased CO2
Faint Pulses
Hypotension
Tachycardia
Poor Feeding
Exercise Intolerance
Aortic Stenosis: Risks -
Bacterial Endocarditis
Coronary Insufficiency
Ventricular Dysfunction
Aortic Stenosis: Treatment -
Balloon Angioplasty
Aortic Valvotomy
*Rarely results in "normal" valve*
Obstructive Defects: Pulmonic Stenosis -
Narrowing at the entrance to the pulmonary artery.
Pulmonic Stenosis: Symptoms -
May be asymptomatic
Murmur
CHF
Cyanosis (severe)
Pulmonic Stenosis: Risks -
Bacterial Endocarditis
Ventricular Hypertrophy
Pulmonic Stenosis: Treatment -
Balloon Angioplasty
Obstructive Defects: Coarctation of the Aorta -
Localized narrowing of the aorta near the ductus arterosis
Coarctation of the Aorta: Symptoms -
Increased pressure in head & upper extremities
Decreased pressure in body and lower extremities
*BP and Pulse vary between upper and lower extremities
Coarctation of the Aorta: Treatment -
Balloon Angioplasty
Mixed Blood Flow Defects:
Transposition of the Great Vessels
Truncus Arteriosus
Hypoplastic Left Heart Syndrome
Mixed Blood Flow Defects: Transposition of the Great Vessels -
No communication between systemic and pulmonary circulation. PDA keeps patient alive.
Transposition of the Great Vessels: Symptoms -
Dependant on severity and PDA:
Cyanosis
CHF
Depressed Functioning
Transposition of the Great Vessels: Treatment -
Surgery - arterial switch
Mixed Blood Flow Defects: Truncus Arteriosis -
One artery arises from the heart and forms both aorta and pulmonary artery
Truncus Arteriosis: Symptoms -
May be asymptomatic
Variable cyanosis
Poor growth
Activity intolerance
Truncus Arteriosis: Risks -
Bacterial Endocarditis
Truncus Arteriosis: Treatment -
Surgical Repair
Mixed Blood Flow Defects: Hypoplastic Left Heart Syndrome -
Underdevelopment of the left side of the heart.
Hypoplastic Left Heart Syndrome: 4 Common Defects -
Hypoplastic left heart & ascending aorta
Coarctation of the aorta
Aortic and mitral valve defects
Progressive deterioration and cardiovascular collapse if PDA closes
Hypoplastic Left Heart Syndrome: Symptoms -
Mild Cyanosis
CHF until PDA closes
Hypoplastic Left Heart Syndrome: Treatment -
Multi-stage surgical repair
Congestive Heart Failure:
Inability of the heart to pump an adequate amount of blood to systemic circulation to meet body demands.
CHF: Causes -
Volume Overload
Pressure Overload
Decreased Contractility
High Cardia Output Demands
CHF: Manifestation Classifications -
Impaired Myocardial Function
Pulmonary Congestion
Systemic Venous Congestions
CHF: Symptoms of Impaired Myocardial Function -
Tachycardia
Inappropriate Sweating
Oliguria
Fatigue/Weakness
Restlessness
Anorexia
Weak Peripheral Pulses/Pale Cool Extremities
Hypotension
Gallop Rhythm
Cardiomegaly
CHF: Symptoms of Pulmonary Congestion -
Tachypnea
Dyspnea
Retractions (infants)
Flaring Nares
Exercise Intolerance
Feeding Difficulties
Cyanosis
Irritability
Wheezing/Crackles/Grunting/Cough
CHF: Symptoms of Systemic Venous Congestions -
*Weight Gain
Hepatomegaly
Peripheral Edema
Ascites
Neck Vein Distension
CHF: Signs of Impending Heart Failure -
Increase in:
Weight
Pulse
Cyanosis
CHF: Goals of Treatment -
Improve Cardiac Function
Remove Accumulated Fluid and Sodium
Decrease Cardiac Demands
CHF: Medications to Improve Cardiac Function -
Digoxin
ACE Inhibitors
CHF: Digoxin -
Increases contractility
Slows conduction through AV node
Enhances diuresis
CHF: Digoxin Toxicity -
Bradycardia
Nausea
Vomiting
Visual Disturbances
CHF: Digoxin Administration -
2 RN's check dosage
1 min. apical pulse
Hold if pulse below 100
Monitor I&O
Between 0.8-2ug/L
CHF: ACE Inhibitors -
Blocks conversion of angiotension I to angiotension II.

EX:
Catopril
Enalapril
lisinopril
CHF: Treatment of Fluid Accumulation -
Diuretics
Fluid Restriction
CHF: Treatment to Decrease Cardiac Demands -
Minimize metabolic needs (avoid cold stress)
Treat infection
Reduce breathing effort (semi-fowlers)
Sedation
Rest
Frequent small meals
Administer ordered O2
Hypoxemia:
Arterial oxygen tension (or pressure) that is lower then normal. Identified by measuring arterial oxygen saturation (SaO2) or PaO2.
Hypoxemia: 2 Physiological Changes -
Polthycemia
Clubbing
Hypoxemia: Polthycemia -
Increased number of RBC's
Hypoxemia: Clubbing -
A thickening and flattening of the tips of the fingers and toes.
Acquired Cardiovascular Disorders:
Bacterial Endocarditis
Rheumatic Fever
Kawasaki Disease
Bacterial Endocarditis:
Infection of the valves and inner lining of the heart. Most commonly caused by Strepococcus viridians but many also be caused by Staphlococcus aureus or Candida albicans
Bacterial Endocarditis: Symptoms -
Low grade fever
Anorexia
Malaise
Headache
Weight loss
New/different murmur
Osler Nodes
Janeway Spots
Bacterial Endocarditis: Diagnosis -
Echocardiogram
ECG
Blood Cultures
Rheumatic Fever:
An autoimmune illness resulting from a systemic inflammatory collagen disease that follows a group A beta hemolytic streptococcal infection.
Rheumatic Fever: Compilications -
Rheumatic Heart Disease
Rheumatic Fever: Aschoff Bodies -
Inflammatory hemorrhagic bullous lesions in connective tissue, blood vessels, brain, joints, pleura
Rheumatic Fever: Prevention -
Screen all sore throats
Rheumatic Fever: Treatment -
Antibiotic
Aspirin
Bed rest
Long term antibiotic prophylaxis
Kawasaki Disease:
Mucocutaneous Lymph Node Syndrome. Acute systemic vasculitis of unknown cause.
Kawasaki Disease: Diagnostic Criteria -
Fever lasts 5+ days
5 of 6 of the following:
Bacterial conjunctivitis w/out exudate
Changes in oral mucosa (erythema, dryness, lip fissures, strawberry tongue)
Changes in extremities (peripheral edema, erythema of palms/soles, peeling of hands/feet)
Cervical lymphadenopathy
Polymorphous rash
Kawasaki Disease: Risks -
Damage to CV system
Leading cause of acquired HD in US (scarring)
Systemic Hypertension:
Consistent elevation of B/P
Systemic Hypertension: Causes -
Renal dysfunction
CV dysfunction
Endocrine dysfunction
Neurologic dysfunction
Drugs
Systemic Hypertension: Symptoms -
Frequent headaches
Dizziness
Vision changes

Infants:
Irritability
Head banging/rubbing
Night screaming
Hyperlipidemia:
Increased amount of lipids. Play and important role in producing atherosclerosis leading to coronary artery disease
Hyperlipidemia: Plaque Detection -
May be seen as early as 2yrs old.