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the heart is either rotated or displaced to the right or is a complete mirror image
Dextrocardia
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Dextrocardia with the stomach placed to the right & liver to the left
Situs inversus
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Acts as reservoir for blood returning to heart from veins
Atria
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collection point for blood returning from systemic circulation for reoxygenatins in the lungs
right atrium
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receives freshly oxygenated blood from lungs via pulmonary veins
left atrium
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pumps unoxygenated blood to the lungs from pulmonary arteries
right ventricle
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pumps oxygenated blood to the systemic circulation via the aorta
left ventricle
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pumps blood to the lungs & thru out the body
ventricles
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blood tight wall that separates left heart from right heart
cardiac septum
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has 3 cusps/flaps; separates RA from RV
tricuspid valve
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has 2 cusps/flaps; separates LA from LV
biscupsid valve
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separates right ventricle from pulmonary arter
pulmonic valve
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separates left ventricle from aorta
aortic valve
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carries oxygenated blood out of left venticle to body
aorta
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carries unoxygenated blod from upper body to right atrium
superior vena cava
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carries unoxygenated blood from lower body to right atrium
inferior vena cava
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carries unoxygenated blood from RV to lungs
pulmonary artery
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returns oxygenated blood from lungs to LA
pulmonary veins
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atrial depolarization causing atrial contraction
P wave
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PR interval
initial stimulation of atria to initial stimulation of ventricles
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QRS complex
ventricular depolarization
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Ventricular repolarization; ventricles return to a resting state
ST segment and T wave
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carries blood through the lungs where it is reoxygenated
Pulmonary circulation
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carries blood from heart to the body and returns to the heart
systemic circulation
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occurs when the heart can no longer meet the metabolic demands of the body at normal physiologic venous pressures; most frequently occurs due to increased volume load or increased pressure load
CHF
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The causes of right sided heart failure includes: (3)
RV-end diastolic pressure rises; increased CVP; systemic venous engorgement
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Causes of left sided heart failure (4)
LV end-diastolic pressure rises; increased pressure in LA; increased pressure in pulmonary veins; pulmonary congeston/edema
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Compensatory mechanisms for CHF (3)
increase in heart size (hypertrophy), increase in heart muscle, increase in contractility of ventricles
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S/S of impaired myocardial function in children (9)
tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine output, altered LOC
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S/S of systemic venous congenstion in children (5)
Edema, edema with weight gain, ascites, hepatomegaly, neck vein distention
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Goals for a child with CHF: (4)
imrpove cardiac function; remove accumulated fluid/sodium; decrease cardiac demand; improve tissue oxygenation
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improves contractility, increases force of contraction, decreases rate of contractions, increases renal perfusion
Digoxin
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inhibits normal function of renin-angiotensin system of the kidney; causes vasodilation
ACE inhibitors
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used with chronic CHF; decreases HR and BP; causes vasodilation; side effects are dizziness, headache, hypotension
Beta blocker (Carvedilol)
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Nursing considerations for giving digoxin
Check apical pulse (infant 90 to 110); hold medication if below parameter; check drug levels (should be 0.8 to 2 mcg/l)
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S/S of toxicity of digoxin
bradycardia, nausea/vomiting, anorexia
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Diuretics decrease:
Preload
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What is the drug of choice for CHF?
Lasix; causes exretion of CL and K
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Side effects of Lasix
N/V; diarrhea, ototoxicity, hypokalemia (which causes cramps)
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at birth, the ductus arteriousus/foramen ovale usually closes when?
within 24-48 hours
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2 types of cardiac defects:
anatomic and acquired
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If a mother drinks, had rebulla in first 7 weeks of pregnancy, had CMV, toxoplasmosis, or other viral illnessess, the fetus is at risk for:
Congenital heart disease
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clincial manifestations of atrial septal defect (3)
may be asymptomatic; murmur; at risk for atrial dysrhytmias
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Treatment for atrial septal defect
Surgical patch closure before school age
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caused by an abnormal connection between 2 sides of the heart
increased pulmonary blood flow defects
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left to right shutn; S/S include CHF, murmur, right ventricular hypertrophy, eisenmenger syndrome
ventricular septal defect
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Clinical manifestations of patent ductus arteriosus (5)
may be asymptomatic early; CHF; washing machine-like murmer; widened pulse pressure; bounding pulses
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most common cardiac defect assoicated with in Down's syndrome; S/S include CHF, murmur, cyanosis with crying
Atrioventricular canal
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When blood exiting the heart is restricted by an anatomic narrowing (stenosis)
Obstructive defects
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increased pressure proximal to defects and decreased pressure distal to defect; S/S include decreased circulation in lower extremities, CHF with rapid deterioration, occurs in older children, disparity of BP between upper/lower extremities
Coarctation of aorta
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S/S of aortic stenosis includes: (5)
exercise intolerance, chest pain when standing, faint pulses, tachycardia, hypotension, poor feeding
-
narrowing of pulmonic valve or entrance to PA
pulmonic stenosis
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S/S of pulmonic stenosis (4)
May be asymptomatic, cyanosis, murmur, cardiomegaly
-
obstruction of pulmonary blood flow and an anatomic defect b/w right and left sides of heart
decreased pulmonary blood flow defects
-
has 4 defects (VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy)
Tertralogy of Fallot
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S/S of Tertralogy of Fallot (4)
cyanosis, murmur, hypercyanotic or "tet" spells, anoxic episodes
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no communication between right atrium/right ventricle; mixing of blood
Tricuspid atresia
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Clincial manifestations of tricuspid artesia in the newborn (3)
cyanosis, tachycardia, dyspnea
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Clinical manifestations of tricuspid artesia in the older child
chronic hypoxemia with clubbing
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S/S of transposition of great vessels (3)
severe cyanosis; CHF with mild cyanosis; cardiomegaly within few weeks of birth
-
Pulmonary veins abnormally correct to the RA or veins draining to RA instead of LA
TAPVC
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Single vessel that overrides both ventricles; S/S includes CHF, cyanosis, poor growth, activity intolerance, murmur
Truncus arteriosus
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under development of left side of heart; S/S include mild cyanosis, CHF
hypoplastic left heart
-
arterial oxygen tension that is less than normal
Hypoxemia
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decreased tissue oxygenation
Hypoxia
-
S/S of hypoxemia
Polycythemia, clubbing, squatting (reduces venous return from the legs ind increases systemic vascular resistance), poor weight gain, dyspnea on exertion, poor exercise tolerance, increased risk for bacterial endocarditis
-
if PaO2 is > 150, it is a ? disease; less than 100, it is a ? disease
pulmonary; cardiac
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maintains patent ductus arteriousus; used to treat hypoxemia R/T CHD; causes vasodilation and smooth muscle relaxation
Prostaglandin E
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What to do during hypercyanotic spells (4)
knee-chest position, 100 percent FiO2, MSO4, IV fluid replacement
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Palliative surgical procedure to create communication b/w R or L subclavian and the pulmonary artery
Modified Blalock-Taussig shunt
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compression of heart by blood and other effusions in the pericardial sac; S/S include increased/equalizing RA and LA filling pressures; narrowing pulse pressure, tachycardia, dyspnea, apprehension, suddenly no test tube drainage
Cardiac tamponade
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S/S of pneumothorax (5)
decreased breath sounds; sudden dyspnea; tachycardia; cyanosis; restlessness
-
s/s of pleural effusion (5)
increased RR, vomiting, decreased breath sounds, irritability, decreased oxygen sats
-
Occurs in immediate postop period, can also occur day 7 to 21 post op; S/S include fever, pericardial friction rub, pericardial, pleural effusion
Postperiocardiotomy syndrome
-
Treat postpericardiotomy syndrome with: (4)
rest, salicylate, NSAIDs, steroids
-
Inflammatory disease occurs after streptococcal pharyngitis; affects joints, brain, serous surfaces, heart
Rheumatic fever
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Most common complication of RF, damage to valves as result of RF
Rheumatic heart disease
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S/S of rheumatic fever (6)
mitral regurtiation, tachycardia out of proportion to fever; CHF; cardiomegaly; pericardial effusions (muffled heart sounds); progressive valvular damage
-
causes edema, inflammation, effusions; reversible, favors large jionts; usually accompanies acute febrile period
Polyarthritis
-
transitory, nonpuritic rash found on trunk/proximal portion of extremities
erythema marginatum
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small, nontender; persists indefinitely after onset of disease but no resulting damage; found in clusters over bony prominences
Subcutaneous nodules
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Involves CNS symptoms including irregular movements of the extremities, involuntary facial grimaces, speech disturbance, muscle weakness; aggravated by anxiety/relieved by rest
St. Vitus Dance or Sydenham Chorea
-
Penicillin G Im X 1; penicillin V X 10 days; sulfa (oral) x 10 days; erythromycin if allergic to above (oral) X 10 days
prevention of RHD and treatment
-
acute systemic vasculities with coronary arteries being the most susceptible to damage/ most cases under 5
Kawaski disease
-
Leading cause of heart disease in children in US
Kawaski disease
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Manifestations of Heart failure (7)
Dyspnea, orthopnea, fatigue, weakness, confusion, fluid retention/edema, arrythmias
-
Route of blood to the heart: Vena cava to ? to tricuspid valve to ? to pulmonic valve to ? to lungs to ? to LA to ? to LV to ? to aorta
RA, RV, pulmonary arter, pulmonary veins, mitral valve, aortic valve
-
period during which chambers of heart relax; electrical diastole is the resting phase of electrical cardiac cycle
Diastole (filling phase)
-
period during which chambers of heart contracts; begins as soon as ventricles fill with blood
Systole
-
Failure of right ventricle to move unoxygenated blood from venous system into pulmonary circulation; eventual back up into systemic venous circulation
Right sided heart failure
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Failure of left ventricle to move oxygenated blood from pulmonary circulation into arterial circulation; eventual backup of blood into lungs
Left sided heart failure
-
What is the difference in right sided vs. left sided HF?
Right sided backups into the systemic venous circulation; left sided by lungs
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