Diuril, less frequently used than lasix, has common s/e of
Aldactone blocks action of?
potassium sparing diuretic
Do NOT administer potassium supplements!!!
What for what when diong cardiac catheterization?
Labs to watch for when doing radiopaque catheter?
Typical reactions from caridac catheterization
1.) Acute hemorrhage from entry site
2.) low grade fever
5.) Loss of pulse in the catheterized extremeity (usually transient)
6.) transient dysrhythmias
Asses and mark what prior to cardiac catheterization
Prior to cardiac catheterization note the baseline what?
Sedation fr cardiac catheterization (food)
NOP 4-6 hours prior
A major cause of death, other than prematurity in the first yera of life
Congenital heart disease
Most common heart anomaly in congenital heart diease
VSD, ventricular septal defect
Factors conmtributing to congenital heart disease
chromosomal abnormalities (DOWNS)
Left to right shunt
Right to left shunt
Mixing of oxygenated and deoxygenated blood withing the heart chambers.
Not much cyanosis seen in which shunt direction?
Left to right
Abnormal opening between the atria
Atrial septal defect (ASD)
Defects related to increased pulmonary blood flow
Patient may be asymptomatic
Could develop CHF
Characteristic murmor see in
Surgically repaired defect related to increased pulmonary blood flow
Very favorable prognosis in what defect related to increased pulmonary blood flow?
Abmnormal opening between right and left ventricles
CHF is common in this defect related to increased pulmonary blood flow
Risk for bacterial endocarditis with this defect related to increased pulmonary blood flow
At risk for pulmonary vascular disease with what defect related to increased pulmonary blood flow
Prognosis is dependent on location of the defect and number of defects with this defect related to increased pulmonary blood flow
Failure of ductus arteriosis to close within first weeks of life
Patent Ductus Arteriossus (PDA)
May be asymptomatic or amy show CHF with this defect related to increased pulmonary blood flow
Characterisitic machinerly like murmur heard with which defect related to increased pulmonary blood flow
Bounding pulses are associated with which defect related to increased pulmonary blood flow?
TX for PDA are
Meds, surgerya nd coidl occlusion
What med is used to treat defects related to increased pulmonary blood flow?
For classic defects seen in Tetralogy of Fallot
1.) Ventricular septal defect
2.) Pulmonic stenosis
3.) Overriding aorta
4.) Right ventricular hypertorphy
Clinical maifestation of Tetraology of Fallot seen in infants
Acutely cyanotic at birth
May have mild cyanosis that will progress over 1st year of life
Anoxic spells during crying or after feeding
Acute episodes of cyanosis and hypoxia seen during TOF Tetraology of Fallot
Blue spells or tet spells
Hypoxia is seen in impaired cellular processes such as
Most charctereistic of childnre with tetralogy of Fallot !!!!!!!!!!!!!!!!!! TEST QUSTION
Squatting see in
Unconsciouss attempt to releive chronic hypoxia during exercise
If a child is in a hypercyanotic spell put them in what position?
Raise HOB, knee chest
When do hypercyanotic spells seen in TOF occur?
First year of life
When do hypercyanotic spells occur during the day in TOF?
Morning, preceded by feeding, crying, defectaion, or stressful procedures
Requires prompt assessment and treatment, seen in TOF
Hypercyanotic spells (blue spells or tet spells)
What can arise from chronic hypoxia?
Bacterial endocarditis AKA
Infection of the heart valves and inner lining of the heart
Often a consequence of bacteremia in the child with acquired or congenital heart anomalies
Primary organism causing IE
May follow an invasive procedure
Most common portal of entry for IE
UTI, cardiac surgery, tonsillectomy, bronchoscopy, esophageal stricture dilation,
bloodstream from indwelling catheters can cause
bacterial endocarditis (IE)
Prophylaxis in previous history of rheumatic fever without heart involvement...
Prophylaxis not recommended
Unexplained fever, low grade and intermittent are clinical maifestations of
Anorexia is a clical manifestation of
Malaise and weight loss are both clinical manifestations of
Petechia on oral mucuouss membrane is a clincial manifestation of
May see CHF, cardiac dysrhythmias, murmor (new or a change) as clinical manifestations of
How do you dx IE?
Clinical and lab findings. Most importnant, blood cultures and ECHO. Based on a high-index of suspicion (prosthetic valvles, hx of IE, complex cyanotic heart disease, surgically constructed arterial to pulmonary shutnts
Prevention of bacterial endocartditis in children with congenital heart disease
Primary drug used for prphylaxis in bacterial endocarditis
Alternative for children allergic to penicillin, used in prevention of bacterial endocarditis
Prophylactic treatment prior to procedures associated with
When to give prohylactic antibiotic therapy for BE before a procedure?
1 hour before
After blood cultures obtained for IE, begin antibiotics when?
How long to give antibiotidcs for IE?
4-6 weeks, HIGH dose IV
Blood cultures during treatement for IE?
Most freuqnely used antibiotic for IE
If endocartitis is fungal treat with
Occurs after infection with Group A Betal hemolytic strep pharyngitis
Acute rhumatic fever only follows a
Acute rhumatic fever invloves (3 main organs involved)
Cardiac valve damage (what kind) most significan complication of acute rheumatic fever?
Like huntintingon's associated with acute rheumatic fever
A late manifestation of acute rheumatic fever, and ther emay be no antecednet, evidencc eof recent group a strep pharyngitis.
Onset is graudual of this complication seen in acute rheumatic fever
Movements are transient and will disappear eventually
Chorea, seen in acute rhemaiutc fever
May be mistaken for clumsiness or absence seizures
Definitive dx of acute rhematic fever requires
2 major manifestations or
1 major and 2 minor
In order to dx, you must have supportive eveidnece of an antecedent of what?
Group A strep throat infection
Major manifestations of ARF dx
minor manifestaions of ARF for DX
Eleveated acute phase reactats
Prolonged PR interval on ECG
Supportive evidence of prvioews GA Strep infect
+ throat culture (not a rapid strep test)
Elevated or rising sptrep antibody titer
Pink rash on the trunk and extrememties seen in
Rash of face
More pronounced with heat
ARF is always seen with these manifestations
How long does it take for RF after infection of group a stre?
Most reliable test for RF?
ASO/ASLO titer (80% of children)
TX for RF?
PCN, or Emycin substitute
Primary anti-inflammatory agent for inflammation and fever and discomfrot in the joints
Important during acute febrile phase of RF?
Secondary prohylaxis and ARF
Oral penicillin BID or monthly IM pCN injections. Must have secondary prophylaxis for at least 10 years or well past adulthood.
Young woman with ARF should avoid
Education with ARF
Rise slow, avoid sudden position changes
Complaince, report SE and avoid alcohol
Beta blocker of choice in peds
Acute multi systemc vasculitis of unknown cause/therorized to be from infection
Inflamattion of blood vessels
20% of children will develop cardiac consequences
Fever 101-104 greater than 5 days
Desquamanation in hands and feet
Strawberry tongue, erythema of lips, cracked lips
Unilateral cervical lymphadenopathy
High dose IV gamma globulin in conjunction with salicyulate therapy is tx for
ASA given at 100mg/kd/day in 4 doses until fever subsides
ASA at antiplatete dose
When should you give aspirin to prevent GI upset?
ASA use and suspected chickenpox or flu
D/C, to persantine
IVIG is a
Contains cytokine, anditibodies of unclear clinical significance, perhaps nuetralizing
Containts natural antibiodies
During first 2 hours of administration of IVIG, frequent what?
vital signs. If adverse reaction noted, rash, fever, shaking, chills, d/s and call dr
If receiving IVIG how lon got defer live antibodies for immunizations?
I/O's in Kawasakis' why?
Assess for what in KD?
Administer what IVIG? in KD?
Hallmark of KD (TEST)
Provide what for the child with KD?
Educate pt's family regarding what with KD?
Hand feet peel, arthritis
Race and hypertension
African american's have hgiher incidence, younger age, more severe, and may result in early death
If no underlying disease, hypertension is then considered
primary or essential
2ndary HTN more common than primary in what age?
Infants HTN S/S
Irritability, head banging or rubbing, wake up at night screaming
Nonpharmacologic tx for htn
overall lifestyle ghanges are needed for tx of
2ndardy hypertension tx
Drug tx in hypertension
Propanolol most common, beta blocker, reduced heart workload.