cardiac

carries oxygenated blood from mother to infant

ductus venosus

allows blood from aorta and pulmonary artery to flow and mix oxygenated blood

ductus arteriosus

allows for blood to flow from R to L atrium

foramen ovale

why are infant at a high risk for developing heart failure?

they are sensitive to volume and pressure overload

at what age do the heart muscle fully develop, allows for cardiac output to be less dependent on heart rate?

five years

murmurs that are soft, short, systolic or vibratory in quality care considered -

innocent murmurs

what are two circumstances in which a murmur would be considered abnormal?

systolic murmurs that are loud (greater than a Grade 3) or holosystolic/pansystolic (diastolic or continuous)

are systolic or diastolic murmurs always abnormal?

diastolic

what would you suspect if a child’s blood pressure is higher in their upper extremities and lower in the lower extremities?

conarctation of aorta

what are serial blood pressures used to diagnose?

hypetension

what two circumstances occur to create acyanotic CHDs?

increased pulmonary blood flow and obstruction of blood flow from the ventricles

what are the two circumstances that create cyanotic CHDs?

decreased pulmonary blood flow and mixed blood flow

a infants passes their pulse oximetry test the first 24 hours if -

they remain at or above 95% and there is less than a 3% difference between hand and foot

atrial septal defect is defined by -

opening between the left and right atria

atrial septal defect is more common in -

females

in a child you would monitor for what?

other heart deformities (50% have other heart defects)

acyanotic or cyanotic: atrial septal defect

acyanotic

in atrial septal defect, the left side of the heart has what kind of pressure?

normal

adults with atrial septal defect are at increase risk for what?

stroke

children with ADS often have what manifestations?

asymptomatic; may have failure to thrive or CHF if large

is ADS affected by respiratory pattern?

no

what murmur is expected with ASD?

soft systolic murmur

what is the first line treatment for ASD?

monitor and wait for it to close around 2 years of age

what interventions can be done if ASD dose not naturally resolve?

cardiac catheterization or open surgery to place a patch

when can a child receive open heart surgery to fix ASD?

preschool age

what is the most common CHD?

ventricular septal defect

acyanotic or cyanotic: ventricle septal defect?

acyanotic

patient presents with left heart enlargement and pulmonary venous congestion - what CHD do you suspect?

ventricular septal defect

small or moderate VSDs are common and are usually -

asymptomatic

a infant with VSD has signs and symptoms similar to CHF including tachypnea, diaphoresis, fatigue, and failure to thrive. you suspect that this is because -

their defect is large

what murmur is expected with VSD?

loud holosystolic murmurs (through S1 and S2)

what is the first line treatment from a VSD?

most close naturally within six months

if a child has a large VSD, what treatment is used to manage symptoms until surgery can be done?

medications such as digoxin, ACE inhibitors, and diuretics, and a high calorie formula

when can surgery be done to fix VSD?

3-12 months

what increases an infants risk for developing patent ductus arteriosus?

premature infant

a infant presents with pounding pulses and widened pulse pressures, what CHD do you suspect?

PDA

what treatment is given for PDA?

indomethacin and ibuprofen

what does indomethacin do to treat PDA?

inhibits the release of prostaglandin allowing the ductus arteriosus to close

if indomethacin dose not close the DA, what is done next?

cardiac cauterization to plug the DA; further surgery is done if the plug doesn’t work or when the child is older

a parent is worried about their child following successful PDA repair surgery. what should you say to them?

prognosis is normally excellent following repair

what is the leading cause of heart failure in a neonate?

coarchtation of the aorta combined with another anomaly

an infant with coarctation of the aorta will develop what after the ductus arteriosus closes?

CHF

an older child presents with decreased pulse and cold skin in their lower extremities and hypertension in upper extremities. what do you suspect?

coarctation of the aorta

what medication is commonly given to treat coarctation of the aorta?

prostaglandin

what affect does prostaglandins have that helps treat coarctation of the aorta?

reopens ductus arteriosus

what are two ways coarctation of the aorta can be treated?

dilation of affected area (i.e. with a balloon) or surgical removal and reattachment

what are the three locations PS can occur?

valvar, subvalvar, and supravalvar

what are individuals with PS at risk for developing?

right ventricle failure

an infant develops cyanosis when they are crying and feeding, but returns to normal after rest. what do you suspect?

pulmonary stenosis (PS)

what is the expected treatment of an infant with moderate to severe pulmonary stenosis (PS)?

balloon valvuloplasty or valvotomy

what is the expected treatment for a critical neonate with pulmonary stenosis (PS)?

infusion of prostaglandin (keeps PDA open)

what should you educate parents on for lifelong treatment of children with pulmonary stenosis (PS)?

endocarditis prophylaxis

what four defects create the tetralogy of Fallot?

VSD, PS, right ventricular hypertrophy, overriding aorta

what is the most common cyanotic heart defect?

tetralogy of Fallot

the aorta is located between the left and right ventricles -

overriding aorta

what occurs when there is an overriding aorta?

oxygenated and unoxygenated blood flows into the aorta

what determines the severity of ToF?

the degree of pulmonary stenosis

what is the test to determine the severity of ToF called?

“pink test”

an infant with ToF develops profound cyanosis when they are feeding or crying - this tendency is known as -

hypercyanotic “tet spells”

a common symptom of ToF seen in the extremities is -

clubbing

what would an CXR of an infant with ToF have?

a boot shaped heart (due to right ventricle hypertrophy)

a child squatting into a knew chest position is a clear indication of what physiologic response? what CHD is causing this?

hypercyanotic spell; TOF

what treatment is given to children with TOF?

supplemental oxygen and medications

what medications are given to infants with TOF? why?

morphine (sedative effect) and Propranolol (reduce obstruction across the RV outlet)

what is done in the first few months to treat TOF?

palliative correction (replace the ductus arteriosus)

when can a child with TOF receive total corrective surgery?

between birth and two years of age

how often will the pulmonary valve need to be replaced?

every 10-15 years

why dose the pulmonary valve need to be periodically replaced?

decrease arrythmias and enhance exercise performance

mixed defects are defined by -

mixing of blood from both pulmonary and systemic circulation and desaturation of blood in circulatory system

what is the main issues with TGA?

no oxygenated blood is getting into systemic circulation

what other defects may be seen with TGA?

VSD and ASD

an infant presents with cyanosis a few hours of life but has no respiratory distress and no murmurs - what do you suspect?

transposition of great arteries (TGA)

what is done to confirm TGA?

cardiac catheterization

what is done to stabilize and infant with TGA?

mechanical vent and prostaglandins

what procedure is done to fix TGA?

arterial switch operation

when is arterial switch operation done?

day 4-7

a stenosed mitral and aortic valves and a small, non-functional LV are characteristics of -

hypoplastic left heart syndrome (HLHS)

what is the leading cause of death in newborns less than 1 month?

HLHS

what is the only way blood enters the aorta is through the -

ductus arteriosus

what is always present in HLHS?

ASD

an infant with HLHS was stable at birth, but has now developed cyanosis - why did this occur?

the ductus arteriosus closed

what medication is given to keep the DA open in HLHS?

prostaglandin

what is an important consideration when treating an infant with HLHS?

they are not given oxygen

what should pulse ox be kept at for an infant with HLHS?

65-80%

why is supplemental oxygen not give to infants with HLHS?

to decrease pulmonary resistance and increase pulmonary blood flow

what is the treatment for HLHS?

transplant

inadequate emptying of the heart due to poor pumping is know as -

congestive heart failure

left sided heart failure is associated with -

increased pulmonary venous congestion

right sided heart failure is associated with -

increased systemic venous congestion hepatosplenomegaly, and edema

what classes of medications are commonly given to treat congestive heart failure?

diuretics, positive inotropes, ACE inhibitors, angiotensin II receptor blockers

what are three considerations that need to be made when giving digoxin?

double check dosage calculation, assess apical pulse and K+ level, and asses for bradycardia for one minute for administration

what is the leading cause of acquired heart disease in developing countries?

acute rheumatic fever (ARF)

what infection does ARF most commonly follow?

group A streptococcal pharyngitis

how long after infection does ARF typically occur?

1-3 weeks

what is the most common benign symptom associated with ARF?

polyarthritis

what criteria must be met for a diagnosis of ARF?

2 major symptoms or 1 major and 2 minor symptoms plus evidence of a group A strep infection

what is an important nursing consideration for ARF?

family education to complete ALL antibiotics

what medication can be given to treat ARF?

penicillin

following getting ARF, what should you educate parents on moving forward?

frequently follow up with cardiology and possibly get prophylactic antibiotics because recurrence is high

an acute febrile illness of unknown cause hallmarked by systemic vascular inflammation is -

Kawasaki disease