Exam #2 3600
Clinical Presentation
-Patients may have poor feeding, poor weight gain, cyanosis, tachycardia & tachypnea.
Heart Murmur
May or may not be present at birth.
Echocardiography
An ECHO will identify cardiac structures, blood flow and pressure gradients. Think of it as taking pictures and video inside of the heart.
ANATOMY OF THE HEART Pulmonary artery Pulmonary veir
Left atrium
Pulmonary valve
Right atrium
Mitral valve
Tricuspid valve
Aortic valve
Right ventricle Inferior vena cava
Left ventricle
Septum
Modules
Not all congenital heart defects are curable. Some congenital heart defects require several palliative open heart surgeries in order to maximize life expectancy; these defects are not "fixed". These patients will never have normal blood flow. For example, hypoplastic left heart syndrome (HLHSfl is a defect that cannot be fixed but can be palliated.
The goal in caring for infants and children with congenital heart disease is to balance pulmonary and systemic blood flow.
Modules
If an infant is born with a congenital defect but has adequate blood flow to both the lungs and heart, it is better for the patient to grow and gain weight before open heart surgery.
Open heart surgery in the neonate (< 30 days oldfl carries the highest risk of complications and death.
Not all infants and children with congenital heart disease will have oxygen saturations >tt2%. There are some defects where having a high saturation is actually a bad thing.
Increase Pulmonary Blood flow
A hole or connection between the right and left side of the heart. Blood will flow from the left side of the heart to the right side of the heart because the pressure is higher on the left side. Remember blood flow from HIGH to LOW pressure. Defects causing increased pulmonary blood low include:
Atrial Septal Defect (ASDfl, Ventricular Septal Defect (VSDfl and Patent Ductus Arteriosus (PDAfl.
Random notes from modules
-The lungs do not like too much blood flow - too much blood flow causes pulmonary over circulation and will cause respiratory distress.
- Patients with severe obstructive defects may show signs of decreased cardiac output and/or cardiovascular collapse. The signs and symptoms of heart failure include tachycardia, prolonged capillary refill, mottled or pale extremities, cool to cold extremities, weak pulses, diaphoresis, fatigue/weakness, restlessness and hypotension.
Definition of terms:
Cardiac output: Amount of blood discharged per minute from left or right ventricle
Stroke volume: Amount of blood ejected by left ventricle with each heartbeat
Preload: Equivalent to venous blood return to atria from body and end diastolic volume of heart
Afterload: Aortic impedance or wall stress
Contractility: Force exerted at ejection, taking into account end diastolic volume and wall stress
Expected Pediatric Lab Values
Lab values
Infant
RBCs=3.5-5.5 million u/L
Plalets:150,00-ft00,00 mm^3
Hemoglobin:1-6 yr=tt.5-1ft g/dl
Hematocrit:1-6 yr. =30-ft0%
Children
RBCs:ft.5-5.5 million u/L
Plalets: 150,000-ft00,000/mm3
Hemoglobin: 6-18 years 10-15.5 g/dL
Hematocrit: 6-18 yr: 32-ftft%
Heart Failure -Inability of the heart to adequately supply blood to meet the body's needs
-CHF is characterized by the inability of the cardiac muscle to