session 7 cardiac

lt side of heart are typically ____ than the pressures in the rt side

higher

if there is an abnormal opening in the septum btwn rt and lt sides what happens

blood flows from left to right atrium

lt to rt shunt

cardiac defect causing blood to shunt from lt side of heart to rt side

• VSD, ASD, PDA

lt to rt shunt clinical manifestations

• infant is not cyanotic

• tachycardia due to pushing increased blood volume

• cardiomegaly d/t increased workload of the heart

=

• dyspnea and pul. edema d/t lungs receiving blood under high pressure from the rt ventricle

• increased risk of respiratory infections d/t blood pooling in the lungs

cardiac pts and calories to know

give pt smaller volume of calories because they already have a hard time with breathing and feeding

rt to lt shunts

• occurs when pressure in the rt side of the heart is greater than the left side of the heart

  • resistance of the lungs is abnormally high

  • pulmonary artery is restricted (think narrow straw vs normal straw)

• deoxygetated blood from the rt side shunts to the lt

• tetralogy of fallot

hole in septum + obstructive lesion

deoxygenated blood from the rt side of the heart shunts to the lt side of the heart and out into the body

rt to lt shunt clinical manifestations

• hypoxemia (tissue deoxygenation)

• polycythemia (increased RBC production d/t body’s attempt to compensate)

  • risk for stroke!

• increase viscosity of the blood = heart has to pump harder

rt to lt shunt complications

• clots form

• brain abscess or stroke d/t deoxygenated blood bypassing lungs

patent ductus arteriosus

• ductus normally closes within hours of birth (if open bad)

• connection between pulmonary artery (low pressure) and aorta (high pressure)

• no cyanosis!

• lt to rt shunt

patent ductus arteriosus have a high risk of

pulmonary hypertension

patent ductus arteriosus dx

• chest x ray (enlarged heart and pulmonary artery)

• echocardiogram (shows opening btwn pulm artery and aorta)

patent ductus arteriosus tx

• cardiac catheterization

• closed heart surgery

• indomethacin PO/IV

atrial septal defect

opening between the atria

• blood in lt atrium flows into rt atrium

• pulmonary hypertension

• reduced blood volume in systemic circulation

lt to rt shunt

if ASD (atrial septal defect) is left untreated

leads to pulm hypertension, CHF, or stroke as an adult

atrial septal defect dx and tx

heart murmur heard in pulm valve area

• via echocardiogram used to find hole

tx: surgery

ventricular septal defect

• most common defect

• opening in the ventricular septum

• rt ventricular hypertrophy

• lt to rt shunt , no cyanosis

• deficient systemic blood flow

ventricular septal defect can lead to

heart failure if left untreated

• medium to moderate holes

• will cause decreased pressure and blood will flow into path of least resistance

when would VSD (ventricular septal defect) be asymptomatic

when there are only small holes

VSD (ventricular septal defect) tx

• diuretics for CHF

• digoxin

normal HF tx

• FTT pts need higher calories

• prophylactic antibiotics

• surgery

coarctation of aorta (COA)

congenital narrowing of the descending aorta

• 80% have aorta-valve anomalies

• difference in BP in arms and legs (severe obstruction)

• high r/f stroke

• high bp before point of coarctation and low bp beyond pt of coarctation

coarctation of aorta (COA) dx/tx

• 50% not as severe for sx

• prostaglandins to keep PDA open to reduce pressure changes

  • connection between pulmonary artery and aorta (bc narrowed) will reduce pressure going to upper extremities

  • helps with stroke risk in pts

• surgery

• abx

most common cardiac malformation responsible for cyanosis in a child over 1 year

tetralogy of fallot

tetralogy of fallot (TOF)

four abnormalities that result in insufficiently oxygenated blood pumped to the body

• valves are narrows and heart pumps harder

• babies become slightly cyanotic bc heart has four separate diagnoses all tg

tetralogy of fallot (TOF) symptoms

• crying, distressed, pooping — slight cyanosis (tet spell)

• KNEE TO CHEST DURING CYANOTIC SPELL

• resolves within a minute or so, cyanosis should disappear

tetralogy of fallot (TOF) four abnormalities

1. pulmonary stenosis: narrowing of the pulmonary valve

2. hypertrophy: thickening of wall of right ventricle

3. displacement of aorta over ventricular septal defect (overriding)

4. ventricular septal defect: opening between the left and right ventricles

tetralogy of fallot (TOF) dx

• cyanosis

  • oxygen little affect on cyanosis

• loud heart murmur via echocardiogram

main med given to keep PDA open to reduce pressure changes

prostaglandins

complete repair of tetralogy of fallot (TOF)

done when infant is about 6 mo of age

• closure of the VSD

• narrowed pulm valve is enlarged

• coronary arteries repaired

• hypertrophy of rt side remodeled

transposition of the great arteries (or vessels)

pulmonary artery leaves the left ventricle and aorta exits from the lt ventricle (switched)

• moderate to severe cyanosis

• blue blood circulating systematically

• no communication between the systemic and pulmonary circulations

most common defect associated with TGA (transposition of the great arteries)

patent foramen ovale

(should be closed)

• another is VSD

transposition of the great arteries (or vessels) dx/tx

dx:

• fetal ecg, echo

tx:

• prostaglandins — maintains ductal patency

• catheterization

heart failure and age timeline

• major manifestation of cardiac disease

• under 1 year of age d/t congenital anomaly

• over 1 year with no congenital anomaly → d/t acquired heart disease

clinical manifestation of heart failure

• systemic venous congestion - wt gain, hepatomegaly, edema, jvd

• pulomonary venous congestion - tachypnea, dyspnea, cough, wheezes

• compensatory response - tachycardia, cardiomegaly, diaphoretic, fatigue, failure to grow

do’s and don’ts of digoxin

do NOT give med if brady (below the baseline) — call dr

• take apical pulse for a full minute before every dose

• check potassium lvls!

bradycardia parameters for age ranges

• < 100 bpm - infant/toddler

• < 80 bpm - in older children

• < 60 bpm in adolescents (reg adult baseline)

digoxin toxicity sx

• bradycardia

• arrhythmias

• n/v, anorexia

• weakness and fatigue

hf interventions

• fluid restriction

• diuretics

• bed rest

• o2, pulse oz

• small frequent feedings — for adequate calorie intake

• sedatives if needed

bacterial endocarditis: def & risk factors

infection of endocardial surface of the heart

• hx of chd, kawaski, rheumatic fever, prosthetic valves more susceptible

• prophylactic abx for dental care, infections, or surgery

• normally long stay at hospital — affects growth and development

rn rsp for bacterial endocarditis

• edu TAKE ALL abx!

• clean iv lines properly

kawasaki disease

acute self limiting disease

• generalized vasculitis (inflamed bv’s) — affects cardiac output

• peak incidence 6 mo to 2 yrs

• most common in japanese males

• affects vessels, causes clots and damage to heart

kawasaki disease goal

prevent damage to tiny vessels in the heart

why is baseline echo done for pts with kawasaki disease?

• determines disease diagnosis

• looking for inflammation in the heart to compare b4 and after tx

KD (kawaski disease) 3 phases AFTER DIAGNOSIS

• acute phase

• subacute phase

• convalescent phase

which phases of KD are normally spent in the hospital?

acute and subacute phase

KD (kawaski disease) acute phase

sudden high fever, unresponsive to antipyretics and abx

what meds can you give during the acute phase of KD

• IVIG to have bdy stop attacking self

• aspirin to prevent blood clots

KD (kawaski disease) subacute phase

lasts from the end of fever thru the end of all KD clinical signs

KD (kawaski disease) convalescent phase

clinical signs have resolved but lab values have not returned to normal

still recovering

• ends when normal values have returned (6-8 wks)

• go home on low dose of aspirin

KD (kawaski disease) clin mani

• elevated WBCs, ESR, Platelets

• high fever

• conjunctivitis — no drainage

• strawberry tongue

• edema of hands and feet

• reddening of palms and soles

• lymph node swelling

more important to act on it and take care of it asap than to know the cause

KD (kawasaki disease) interventions

• baseline echocardiogram — to assess coronary artery status

• high dose of ASA in hospital, low at discharge

• iv gamma globulin

pt with KD (kawaski disease) what do you NOT do

do not give steroid before baseline echo

• can decrease inflammation and will mask it on echo

• do echo first!

rheumatic fever

inflammatory disease occurs after strep

• bacterial infection! — tx is abx

• not rlly seen in US

• self limiting

  • affects joints, skin, brain, serous surfaces, and heart

  • cardiac effects irreversible

most common complication of RF

rheumatoid heart disease (RHD)

• damage to valves as a result