Cardiac peds

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Sejune
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Cardiac peds
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2010-11-15 16:44:17
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Cardiac peds
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Cardiac peds
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  1. Child's CO based on
    pulse rate
  2. Amount of blood ejected per heart beat
    stroke volume
  3. Average stroke volume in children?
    140
  4. Degree of stretch of the cardiac muscle fibers at the end of diastole
    Preload
  5. The amount of resistance to resistance of blood from the ventricle-associated with sostole
    Afterload
  6. Force generated by contracting myocardium under any given condition
    contractility
  7. Increased contractilkity =
    Increased stroke volume
  8. The percentage of the end diastolic volume that is ejected with each stroke is called
    ejection farction
  9. What percent is a good ejection fraction?
    55%
  10. If contractility is increased than EF will
    increase
  11. Characterized bya weakened heart
    Systolic heart failure
  12. Typically left sided heart failure
    Systolic heart failure
  13. Still and noncompliant heart muscle
    Diastolic heart failure
  14. Inabiloity fo the heart to pump sufficient blood to meet needs of tissues for 02 and nutrients
    Heart failure
  15. Referred to as congestive heart failure
    Heart failure
  16. Most importnat lab when dx systolic heart failure?
    BNP
  17. BNP normal level
    0-100
  18. S/S of heart failure
    • Jugular vaein distention
    • Edema is a LATE sign
    • Bounding pulse
    • Tachycardia
    • Increased liver enzymes
    • Increased plateles
    • 0 change in WBC
    • Increased in concentrated urin
    • Increased creatinine and BUN
    • Increased C02 and lo2 02
  19. Anatomic abnormalities seen at birth
    Congenital heart disease
  20. Clinical consequences of congenital heart disease
    • Hypoxemia
    • Congestive Heart Failure
  21. Disease process or abnormaility that occurs after birth and can be seen in the normal heart or in the presense of heart defects
    Acquired cardiac disorders
  22. Results of acquired cardiac disorders
    • Infection
    • Autoimmune responses
    • Environmental factors
    • Familial tendencies
  23. Infection
    Acquired cardiac disorders
  24. Autoimmune responses
    Acquired cardiac disorders
  25. Environmental factors
    Acquired cardiac disorders
  26. Familial tendencies
    Acquired cardiac disorders
  27. Assessment/Insection of the child with cardiovascular alteraction
    • 1.) FTT
    • 2.) Cyanosis or pallor
    • 3.) Chest deformities
    • 4.) Unusual pulsations: Neck vein
    • 5.) Tachypnea, grunt (respiratory excursion)
    • 6.) Cyanotic bluish fingers (clubbing)
  28. FTT
    Seen in cardiac alterations in children
  29. Cynosis or pallor
    Seen in cardiac alterations in children
  30. Chest deformities
    Seen in cardiac alterations in children
  31. Unusual pulsations in children (not seen in infnats due to neck size)
    Seen in cardiac alterations in children
  32. Respiratory excursions: tachypnea, grunt
    Seen in cardiac alterations in children
  33. Clubbing of fingers
    Seen in cardiac alterations in children
  34. Palpation/percussion in cardiac disorders of children
    • Percuss chest for heart size, thrills
    • Palpapte: Hepatomegaly, spelenomegaly
    • Palpate pulses for rate, regularity and amplitude
  35. Charcter of heart sounds during pediatric alteractions in cardio
    Muffled, murmors
  36. How often to change electrodes on ECG?
    1-2 days
  37. One of the most frequently used dianostic tests for peds cardiac issues
    Echocardiography
  38. Uses high freqency sound waves
    echocardiography
  39. Must lie still during procedure and may require mild sedative
    Echocardiography
  40. Tachycardia clinical manifestation for
    Newborns/infants/Children/adolescents
  41. Gallop rhytem seen during manifestation of CHF
    Newborn/infants
  42. diminshed pulses...what age group for CHF?
    newborn/peds
  43. Diaphroesis seen in what age group for CHF?
    newborn/infants
  44. Cool, mottled extremeties seen in CHF of what age?
    Newborns/infants
  45. Pallor in CHF, wahat age?
    Newborns, infants, children, adolescents
  46. Edema, CHF, what age?
    All
  47. FTT in what age group for CHF
    newborn/infants
  48. tachypnea CHF, age?
    newborn, infants
  49. retractions, what age? CHF
    Newborrns, infants
  50. Wheezing, CHF, what age?
    All
  51. Rales or rhonchi, what age? CHF
    newborn, infants
  52. Hepeatomegaly, CHF, what age?
    All
  53. Low urine output, CHF, what age?
    ALL
  54. Dyspnea, CHF, what age?
    child, adolescent
  55. Orthopnea, CHF, what age?
    child, adolescent
  56. ascities, what age, CHF?
    Child, adolescent
  57. Poor weight gain? What age, CHF?
    Child, adolescent
  58. Exercise intolerance, CHF, what age?
    child, adolescent
  59. Most common cause of CHF in infants is
    Congenital heart disease
  60. Cause of cardiomyopathy?
    Acquired heart disease
  61. Endocarditis caused by
    Acquired heart disease
  62. Myocarditis, caused by
    Acquired heart disease
  63. Long term abnormal pressure load causes teh heart muscle to
    hypertrophy
  64. CHF is diagnosed based on
    clinical symptoms
  65. What reveals ventricular hypertorphy?
    ECG
  66. Goals of treating CHF
    • 1. Improve cardiac vuntion
    • 2 remove acculuated fluid and sodioum or decrease preload
    • 3 decrease cardiac demands
    • 4 improve tissue oxygenation
  67. What test to demonstrate cardiac enlargement?
    Chest x-ray
  68. test to determine if there is a pulmonary overcirculation or edema
    Chest xray
  69. Used to determine if congenital defects or cardiomyopathy are resent, can also assess heart size, hypertrophy and dilation
    Echocardiogram
  70. Purpose of CHF treatment
    Reduce volume overload, improve contractility, reducing afterload and decreasing cardiac work
  71. Primary treatment for infants that have CHF secondary to congenital defects
    Surgery
  72. Diuretic therapy and positive inotropes
    Treatments for CHF
  73. An example of a positive inotrope
    Digoxin
  74. Digoxin aka
    Lanoxin
  75. Not potassium sparing
    digoxin
  76. Infants that have CHF secondary to congenital defects, what is the primary treatment?
    Surgery
  77. what are positive inotropes?
    Meds directed at improving contractility
  78. Digoxin is a cardiac
    glyhcoside
  79. This is the first-line inotrope used in the infant or child
    Digoxin
  80. Benefits of digoxin
    • 1.) Increased cardiac output
    • 2.) Decreased heart size
    • 3.) Decreased venous pressure
    • 4.)) relief of edema
  81. Digoxin improvems the hearts ability to....
    contract
  82. Avoid giving digoxin with
    meals
  83. Give digoxin when feedings when?
    1 hour before or 2 hours after
  84. Give digoxin at regular
    intervals
  85. Check what before giving digoxin
    apical pulse for 1 minute
  86. Do not give digoxin if pulse below
    90-110
  87. If dose of digoxin missed
    DO NOT double up. If missed and 4 hours passeed, give regular dose at regular time. If less than 4 hours elapsed, give missed dose
  88. If on digoxin, decrease appetite, nausea, vomting, abdominal pain, diarrhea or visual changes occur, do what?
    Notify dr
  89. Child vomits after taking dose
    Do not repeat digoxin
  90. How is digoxin supplied
    0.05 mg/ml
  91. Infant dose of digoxin calculated in what?
    mcg
  92. Therapeutic dogix range
    .5-2
  93. Toxic level
    greater than 2
  94. Routes for digoxin
    PO and IV
  95. If on Digoxin what study should be performed?
    ECG
  96. ECG when on digoxin to monitor for what?
    P-R interval and reduced ventricular rate, and to detect seide effects such as dysrhtymias
  97. Do what prior to administration of digoxin
    Apical
  98. How often should a ECG be performed on digoxin
    ECG
  99. Primary side effect of digoxin
    Nausea and vomiting!!!!!!!!!!!
  100. Infants, pulse below what to hold digoxin
    90 - 110
  101. Young child hold dig if pulse less than
    • 70
    • 60 in adults
  102. A higher dose of what is an immediate warning of a dosage error with Dig?
    >.05mg
  103. Other than N/V what are other common signs of dig toxicity?
    anorexia, bradycardia (older children), tachycardia (younger children) , vision changes and heart block
  104. Possibly restict fluid when treating
    CHF
  105. S/E of lasix
    • Hyovolemia
    • Hypokalemia
    • Hyponatremia
    • Metabolic alkalosis
  106. Diuril, less frequently used than lasix, has common s/e of
    hypokalemia, acidosis
  107. Aldactone blocks action of?
    aldosterone
  108. potassium sparing diuretic
    • Aldactone
    • Do NOT administer potassium supplements!!!
  109. What for what when diong cardiac catheterization?
    allergies
  110. Labs to watch for when doing radiopaque catheter?
    BUN, createnine
  111. Typical reactions from caridac catheterization
    • 1.) Acute hemorrhage from entry site
    • 2.) low grade fever
    • 3.) Nausea
    • 4.) Vomiting
    • 5.) Loss of pulse in the catheterized extremeity (usually transient)
    • 6.) transient dysrhythmias
  112. Asses and mark what prior to cardiac catheterization
    pedal puses
  113. Prior to cardiac catheterization note the baseline what?
    oxygen saturation
  114. Sedation fr cardiac catheterization (food)
    NOP 4-6 hours prior
  115. A major cause of death, other than prematurity in the first yera of life
    Congenital heart disease
  116. Most common heart anomaly in congenital heart diease
    VSD, ventricular septal defect
  117. Factors conmtributing to congenital heart disease
    • Diabetes
    • Alcohol
    • Environmental toxins
    • Infections
    • chromosomal abnormalities (DOWNS)
  118. Left to right shunt
    Septal defect
  119. Right to left shunt
    Mixing of oxygenated and deoxygenated blood withing the heart chambers.
  120. Not much cyanosis seen in which shunt direction?
    Left to right
  121. Abnormal opening between the atria
    Atrial septal defect (ASD)
  122. Defects related to increased pulmonary blood flow
    • ASD
    • VSD
    • PDA
  123. Patient may be asymptomatic
    ASD
  124. Could develop CHF
    ASD
  125. Characteristic murmor see in
    ASD
  126. Surgically repaired defect related to increased pulmonary blood flow
    ASD
  127. Very favorable prognosis in what defect related to increased pulmonary blood flow?
    ASD
  128. Abmnormal opening between right and left ventricles
    VSD
  129. CHF is common in this defect related to increased pulmonary blood flow
    VSD
  130. Risk for bacterial endocarditis with this defect related to increased pulmonary blood flow
    (TEST QUESTION)
    VSD
  131. At risk for pulmonary vascular disease with what defect related to increased pulmonary blood flow
    VSD
  132. Prognosis is dependent on location of the defect and number of defects with this defect related to increased pulmonary blood flow
    VSD
  133. Failure of ductus arteriosis to close within first weeks of life
    Patent Ductus Arteriossus (PDA)
  134. May be asymptomatic or amy show CHF with this defect related to increased pulmonary blood flow
    PDA
  135. Characterisitic machinerly like murmur heard with which defect related to increased pulmonary blood flow
    PDA
  136. Bounding pulses are associated with which defect related to increased pulmonary blood flow?
    PDA
  137. TX for PDA are
    Meds, surgerya nd coidl occlusion
  138. What med is used to treat defects related to increased pulmonary blood flow?
    • Digoxin
    • Lasix
  139. For classic defects seen in Tetralogy of Fallot
    • 1.) Ventricular septal defect
    • 2.) Pulmonic stenosis
    • 3.) Overriding aorta
    • 4.) Right ventricular hypertorphy
  140. Clinical maifestation of Tetraology of Fallot seen in infants
    • Acutely cyanotic at birth
    • or
    • May have mild cyanosis that will progress over 1st year of life
    • Characteristic murmor
    • Anoxic spells during crying or after feeding
  141. Acute episodes of cyanosis and hypoxia seen during TOF Tetraology of Fallot
    Blue spells or tet spells
  142. Hypoxia is seen in impaired cellular processes such as
    • Renal perfusion
    • Crackels
    • Edema
    • Pale skin
    • Ascities
  143. Most charctereistic of childnre with tetralogy of Fallot !!!!!!!!!!!!!!!!!! TEST QUSTION
    Squatting
  144. Squatting see in
    toddlers/older children
  145. Unconsciouss attempt to releive chronic hypoxia during exercise
    Squatting
  146. If a child is in a hypercyanotic spell put them in what position?
    Raise HOB, knee chest
  147. When do hypercyanotic spells seen in TOF occur?
    First year of life
  148. When do hypercyanotic spells occur during the day in TOF?
    Morning, preceded by feeding, crying, defectaion, or stressful procedures
  149. Requires prompt assessment and treatment, seen in TOF
    Hypercyanotic spells (blue spells or tet spells)
  150. What can arise from chronic hypoxia?
    Neurologic complications
  151. Bacterial endocarditis AKA
    Infective endocarditis
  152. Infection of the heart valves and inner lining of the heart
    IE
  153. Often a consequence of bacteremia in the child with acquired or congenital heart anomalies
    IE
  154. Primary organism causing IE
    A. Streptococci
  155. May follow an invasive procedure
    IE
  156. Most common portal of entry for IE
    Oral
  157. UTI, cardiac surgery, tonsillectomy, bronchoscopy, esophageal stricture dilation,
    bloodstream from indwelling catheters can cause
    bacterial endocarditis (IE)
  158. Prophylaxis in previous history of rheumatic fever without heart involvement...
    Prophylaxis not recommended
  159. Unexplained fever, low grade and intermittent are clinical maifestations of
    IE
  160. Anorexia is a clical manifestation of
    IE
  161. Malaise and weight loss are both clinical manifestations of
    IE
  162. Petechia on oral mucuouss membrane is a clincial manifestation of
    IE
  163. May see CHF, cardiac dysrhythmias, murmor (new or a change) as clinical manifestations of
    IE
  164. 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
  165. Prevention of bacterial endocartditis in children with congenital heart disease
    antibiotics
  166. Primary drug used for prphylaxis in bacterial endocarditis
    amoxicillin
  167. Alternative for children allergic to penicillin, used in prevention of bacterial endocarditis
    Clindamycin
  168. Prophylactic treatment prior to procedures associated with
    BE
  169. When to give prohylactic antibiotic therapy for BE before a procedure?
    1 hour before
  170. After blood cultures obtained for IE, begin antibiotics when?
    immmediatley
  171. How long to give antibiotidcs for IE?
    4-6 weeks, HIGH dose IV
  172. Blood cultures during treatement for IE?
    Periodically
  173. Most freuqnely used antibiotic for IE
    PCN
  174. If endocartitis is fungal treat with
    Amphotericin B
  175. Occurs after infection with Group A Betal hemolytic strep pharyngitis
    Rhematic Fever
  176. Acute rhumatic fever only follows a
    throat infection
  177. Acute rhumatic fever invloves (3 main organs involved)
    • Joints
    • CNS
    • Heart
  178. Cardiac valve damage (what kind) most significan complication of acute rheumatic fever?
    Mitral
  179. Syndeham's choriea
    Like huntintingon's associated with acute rheumatic fever
  180. A late manifestation of acute rheumatic fever, and ther emay be no antecednet, evidencc eof recent group a strep pharyngitis.
    Chorea
  181. Onset is graudual of this complication seen in acute rheumatic fever
    Chorea
  182. Movements are transient and will disappear eventually
    Chorea, seen in acute rhemaiutc fever
  183. May be mistaken for clumsiness or absence seizures
    Chorea
  184. Definitive dx of acute rhematic fever requires
    • 2 major manifestations or
    • 1 major and 2 minor
  185. In order to dx, you must have supportive eveidnece of an antecedent of what?
    Group A strep throat infection
  186. Major manifestations of ARF dx
    • Carditis
    • polyarthritis
    • Chorea
    • Erythema marginatum
    • Subcutaneus nodules
  187. minor manifestaions of ARF for DX
    • Arthralgia
    • Fever
    • Eleveated acute phase reactats
    • ESR
    • CRP
    • Prolonged PR interval on ECG
  188. Supportive evidence of prvioews GA Strep infect
    • + throat culture (not a rapid strep test)
    • Elevated or rising sptrep antibody titer
  189. Pink rash on the trunk and extrememties seen in
    ARF
  190. Rash of face
    NOT ARF
  191. More pronounced with heat
    ARF
  192. ARF is always seen with these manifestations
    • Carditis
    • Polyarthritis
  193. How long does it take for RF after infection of group a stre?
    2-6 weeks!
  194. Most reliable test for RF?
    ASO/ASLO titer (80% of children)
  195. TX for RF?
    PCN, or Emycin substitute
  196. Primary anti-inflammatory agent for inflammation and fever and discomfrot in the joints
    Aspirin
  197. Important during acute febrile phase of RF?
    bed rest
  198. 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.
  199. Young woman with ARF should avoid
    oral contraceptives
  200. Education with ARF
    • Rise slow, avoid sudden position changes
    • Complaince, report SE and avoid alcohol
  201. Beta blocker of choice in peds
    propanolol
  202. Acute multi systemc vasculitis of unknown cause/therorized to be from infection
    Kawasaki
  203. Inflamattion of blood vessels
    Kawasaki
  204. 20% of children will develop cardiac consequences
    Kawasaki
  205. Fever 101-104 greater than 5 days
    Kawasakis
  206. Desquamanation in hands and feet
    Kawasakis
  207. Strawberry tongue, erythema of lips, cracked lips
    kawasaki
  208. Unilateral cervical lymphadenopathy
    Kawasaki
  209. conjunctival injection
    Kawasaki
  210. High dose IV gamma globulin in conjunction with salicyulate therapy is tx for
    kawasaki
  211. ASA given at 100mg/kd/day in 4 doses until fever subsides
    Kawasaki
  212. ASA at antiplatete dose
    Kawasaki
  213. When should you give aspirin to prevent GI upset?
    With meals
  214. ASA use and suspected chickenpox or flu
    D/C, to persantine
  215. IVIG is a
    blood product
  216. Contains cytokine, anditibodies of unclear clinical significance, perhaps nuetralizing
    IVIG
  217. Containts natural antibiodies
    IVIG
  218. 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
  219. If receiving IVIG how lon got defer live antibodies for immunizations?
    11 mo
  220. I/O's in Kawasakis' why?
    CHF commonality
  221. Assess for what in KD?
    CHF
  222. Administer what IVIG? in KD?
    Gamma Globulin
  223. Hallmark of KD (TEST)
    irritability
  224. Provide what for the child with KD?
    comfort
  225. Educate pt's family regarding what with KD?
    Hand feet peel, arthritis
  226. Race and hypertension
    African american's have hgiher incidence, younger age, more severe, and may result in early death
  227. If no underlying disease, hypertension is then considered
    primary or essential
  228. 2ndary HTN more common than primary in what age?
    <6
  229. S/S HTN
    • Headache
    • Dizzy
    • Vision issues
    • seizures
  230. Infants HTN S/S
    Irritability, head banging or rubbing, wake up at night screaming
  231. Nonpharmacologic tx for htn
    • weight reduction
    • diet intervention
    • exercise
  232. overall lifestyle ghanges are needed for tx of
    hypertension
  233. 2ndardy hypertension tx
    uddnerlying cause
  234. Drug tx in hypertension
    • used cautiously
    • Propanolol most common, beta blocker, reduced heart workload.

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