Peds Exam 2 - Cardiac

Congenital Heart Disease (CDH)

present at birth

Acquired Heart Disease

disorders that occur after birth

Tetralogy of Fallot

congenital

DECREASED pulmonary blood flow

heart defect made up of 4 cardiac abnormalities:

• Pulmonary stenosis

• Right ventricular hypertrophy

• Overriding aorta

• Ventricular septal defect

manifestations:

• cyanosis

• clubbing

• hypoxic spells (“tet spells”)

  • knee to chest position OR squats

Patent Ductus Arteriosus (PDA)

congenital

INCREASED pulmonary blood flow

ductus arteriosus remains open → blood into lungs

manifestations:

• heart murmur

• HF sx

• wet sounding breath sounds (crackles)

• poor wt gain

Coarctation of Aorta

congenital

OBSTRUCTIVE disorder

narrowing of aorta between upper and lower extremeties

• above constriction → pressure = high

• below constriction → pressure = low

manifestations:

• HTN in older children

• few sx

• diminished femoral pulses

• cardiomegaly + (R) HR secondary to aortic constriction

• HA

Hypoplastic Left Heart Syndrome (HLHS)

congenital

pulmonary venous congestion

manifestations:

• asx until PDA closes → take PROSTAGLANDIN E to keep open

• ashen skin

• rapid & difficulty breathing

• difficulty feeding

• usually fatal within first days/months of life unless treated

Ineffective Endocarditis

acquired

• bacterial infection of endothelial surfaces of the heart → valves (most common), chamber walls, septum

• high risk w/ prosthetic values (children w CHD)

**requires abx (/antifungal) tx (4-6wk) → prophylactic abx before dental/surgical procedures

manifestations:

• low-grade fever

• petechiae on peripheral conjunctiva, oral mucosa, extremeties

• splinter hemorrhages

• janeway lesions → painless, flat, red/blue hemorrhagic lesions on palms/soles

• osler nodes → small, tender nodules on pads of toes/fingers

• EKG → prolonged PR int/dysrhythmias

• murmur (new)

• splenomegaly

Acute Rheumatic Fever

acquired

caused by untreated Group A Strep

manifestations:

• abd pain

• nosebleeds

• affects heart valves

• join pain

• fever

prevention:

• complete abx

Heart Failure

acquired

tachycardia + tachypnea = often first indicators in infants/older child

Cardiomyopathy

acquired

• myocardium does not contract properly

• dilated

  • enlarged ventricles → decreased contractility → HF

  • familial tendency

manifestations:

• fatigue

• dyspnea

• edema

• palpitations

• **may present as HF/cardiac arrest

Cardiomyopathy - nursing mgmt

**daily weights → monitor for peripheral edema

**therapeutic mgmt directed toward improving heart function/decreasing workload + BP

**vasoactive meds + vent usually needed

• intensive care initially

• monitor for:

  • blood clots/arrhythmias

  • HF

  • complications

• choose activities that fit restrictions

• emotional support for pt & family

Kawasaki Disease

acquired

systemic inflammation of blood vessels in the body

manifestations:

• distinctive rashes → STRAWBERRY TONGUE, PALMAR ERYTHEMA

• high fever for 5 days (unresponsive to abx)

• bilateral conjunctivitis w/o exudate

• painful joints

• chills

• HA

• malaise

• extreme irritability

• desquamation of perineum, fingers, toes

• vomiting

• diarrhea

• abd pain

• vessels vasculitis

Kawasaki Disease - Tx

IVIG & aspirin