4.4 - PHYSICAL & DEVELOPMENTAL DISORDERS OF THE CARDIOVASCULAR SYSTEM

Assessment of Cardiovascular Diseases

• careful history taking (thorough child and family history; height, weight, BMI, VS)

• general appearance (check for capillary refill; mucous membrane of the mouth)

• physical examination (PMI-4th-5th intercostal space, midclavicular line)

• frequently have many comorbidities such as poor feeding, reactive airway disease, or diminished cognitive abilities, all of which may require other medical treatments, medications, and intervention

• multisystem assessment - other systems may be directly or indirectly affected by the cardiac disorder

Thrill

vibration felt secondary to significant cardiac murmurs & feels like throat of purring cat, occurs due to turbulent blood flow

Lift

forceful cardiac contraction that causes hand to move up

Heave

very forceful cardiac contraction that actually causes the hand to move up and laterally

First Heart Sound (S1)

• produced by mitral and tricuspid valve closing

• this action is termed systole.

Second Heart Sound (S2)

• produced by closure of aortic and pulmonic (semilunar) valves

• relaxation of the heart is termed diastole

Third Heart Sound (S3)

• produced from rapid filling of ventricles in early diastole

  • Some cardiac diseases are associated w/ this sound, especially myocardial dysfunction or volume overload conditions

Fourth Heart Sound (S4)

• produced by atrial contraction in late diastole, always pathologic

• gallop rhythm likened to “Ten-ne-see” w/ 1st syllable being S4 sound

• noted in conditions associated with decreased ventricular compliance

Murmurs

• turbulent flow through an abnormal valve, vessel, or chamber

• can be either innocent or pathologic

• heard immediately after 1st heart sound – left midsternal area/left lower sternal border

Chemistry and Hematology Tests

provide insight into child’s electrolyte balance, hematologic state, & acid–base balance

Echocardiography, Electrocardiography, and Cardiac Catherization

confirm diagnosis, guide therapy, determine need for surgical intervention

Chest X-Rays

provide understanding of heart’s size & orientation, pulmonary blood flow, any associated lung disorders including fluid collections (effusions)

Exercise Stress Testing (EST)

treadmill, bicycle, 6-minute walk

Cardiac Catheterization

use small side of stethoscope or pediatric stethoscope for heart

• Chemistry and Hematology Tests

• Echocardiography, electrocardiography, cardiac catheterization, diagnostic imaging

• Chest X-rays

• Holter/Event Monitor

• Exercise Stress Testing (EST)

• Cardiac Cathetherization

Diagnostic/Laboratory for Cardiovascular Diseases

Congestive Heart Failure

• Inability of heart to supply adequate oxygenated blood to meet metabolic demands of the body

• A cluster of symptoms and physical examination findings that are secondary to an underlying process

• Primary processes can be systemic or directly related to the heart

• congenital heart defects that produce excessive workload on myocardium

• cardiomyopathies due to metabolic disorders

• infectious diseases

• Drugs

• Kawasaki disease

• myocardial dysfunction after heart surgery

Most common in CHF Children

• Tachycardia and Tachypnea

• Poor feeding and failure to thrive

• Fatigue, exercise intolerance, breathlessness

Assessment of CHF

Right-sided Failure

leads to hepatomegaly (enlarged liver), increased venous pressure noted in jugular venous distention in older children, periorbital edema

Left-sided failure

• results in increased pulmonary pressures, rales, tachypnea, shortness of breath

• back pressure causes blood to accumulate in pulmonary system, causing orthopnea

Orthopnea

difficulty breathing except in an upright position due to increased pulmonary congestion

Ascites

Water in the abdomen

Digoxin (Lanoxin)

• to treat heart failure, usually along with other medications

• also treat certain types of irregular heartbeat (chronic atrial fibrillation)

• side effects: nausea and vomiting, dizziness, diarrhea, headache, arrhythmia, and bradycardia