peds exam 2: cardiovascular part 2

what 3 congenital heart defects are classified by increased pulmonary blood flow

-atrial septal defect (ASD)

-ventricular septal defect (VSD)

-patent ductus arteriosus (PDA)

what 2 congenital heart defects are classified by decreased pulmonary blood flow

-tetralogy of fallot

pulmonic stenosis

what congenital heart defect is classified as obstructed systemic blood flow

coarctation of the aorta

in increased pulmonary blood flow defects, where is the pressure greater and what is the result

-pressure on the left side of heart is higher than the right side

-increases amount of blood that is circulated to the lungs

following the treatment for ASD, how long until the heart returns to normal size

4-6 months

if a patient has a chest tube, what things do we need at the bedside

sterile water, vaseline, gauze, emergency suction, hemostats

what are the treatment options for PDA (patent ductus arteriosus)

surgical ligation, insertion of coil

how does coarctation of the heart effect the pulses and BPs

BP are higher in arms and lower in legs; pulses are bounding in arms and weak in legs

what will always be taken when nurses suspect coarctation of aorta

4 BPs (one in each arm and each leg) will be taken because they will be higher in the arms

mild, moderate, and severe pulmonic stenosis s/sx

mild: no symptoms

moderate: dyspnea and fatigue on exertion

severe: CHF symptoms

clinical therapy for pulmonic stenosis

dilation by balloon valvuloplasty during cardiac cath

what 4 things occur in the heart of a patient who has tetralogy of fallot

1- right ventricular hypertrophy

2- pulmonic stenosis

3- VSD

4- overriding aorta

what is a hypercyanotic episode

When an infant becomes cyanosis and is having difficulty breathing; severe decompensation occurs

*life threatening and immediate intervention necessary*

what kind of thing cause a hypercyanotic episode

activities like crying, sudden onset of tachycardia, BMs, playing

-basically any activity that requires increased CO

what position do we need to put the baby in that is having a hypercyanotic episode

place the infant in a knee to chest position

(it reduced blood flow to legs, increasing systemic vascular resistance which in turn increases blood flow to the lungs)

what other things do we do for a baby who is having a hypercyanotic episode

-calm the infant

-give oxygen

-morphine IV/IM (suppresses respiratory center)

-beta blockers (reduce HR)

which defect repair may have an additional risk for arrhythmias due to the normal conduction of the heart?

ventricular septal defect

which congenital heart defect has a distinctive murmur that sounds like a machine?

patent ductus arteriosus

what is infective endocarditis

infection of the tissue lining the heart chambers

what is the clinical therapy for infective carditis

IV antibiotics for 4-6 weeks

what is rheumatic fever

inflammatory connective tissue disorder following an infection by group A beta-hemolytic streptococci

when does rheumatic fever occur

occurs 1-3 weeks after an untreated strep infection

what is the most significant manifestation of rheumatic fever

carditis: involvement of mitral or aortic valve and it may cause long term damage

how do you diagnose rheumatic fever

presence of two or more major clinical manifestations, positive step test, and elevated antistreptolysin-O titer

clinical therapy for rheumatic fever

antibiotics and ASA

since we give ASA to kids with rheumatic fever, what do we need to look out for

Reyes syndrome

what is Kawasaki disease

acute febrile illness causing inflammation of the blood vessels

-leading acquired heart disease in children

clinical manifestations of kawasaki disease

-*high fever* for longer than 5 days

-eye redness

-red, dry, cracked lips + strawberry tongue

-red swollen palm of hands and feet

what medications are given for Kawasaki disease

-immune globulin IV for 7-10 days

-high dose ASA, then low dose until platelet count is normal

what is SVT (supraventricular tachycardia)

abrupt onset of rapid regular HR, too fast to count

what is the HR in infants and older children in SVT

infants: >220

older children: >180

clinical therapy for SVT

vagal maneuvers, synchronized cardioversion, oral medications, radio frequency ablation

what kind of vagal maneuvers are used for infants vs older children

infant: ice to face

older children: blow through closed nose, bear down as if having BM

if the vagal maneuvers are unsuccessful for SVT, what do we give

IV adenosine

what does adenosine do for SVT

causes hear to stop very briefly to restart in normal rhythm

clinical manifestations of bradycardia

fatigue, exercise intolerance, dizziness, and syncope

what is dyslipidemia

one or more lipids have an abnormal level in the blood

what does dyslipidemia lead to in adulthood

coronary artery disease

how is the diagnosis of hypertension based in children

three separate readings a week apart

infective endocarditis is an infection of what ...?

endocardium