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Discuss S&S of CHF
1. Impaired myocardial function
increased HR at rest
decreased CO, perfusion, cap refill

2. Pulmonary congestion
adverse lungsounds
tachypnea

3. Systemic venous congestion
Describe manifestation of CHF in infants
1. Poor weight gain
-feeding inolerance
2. Activity intolerance
- feeding intolerance
- decreased play
3. Developmental dela
- gross motor
- psychosocial
- cognitive (brain)
How do u decrease cardiac demand and increase tissue oxygenation in CHF infants?
Decrease Cardiac Demand
- warm environment
- treat infections quickly

Increase tissue perfusion
- decrease WOB
- rest
Medications for pediatric CHF
Digoxin PO 
- take apical HR before giving digoxin

Diuretics - Furosemide (lasix)
Nutritional interventions for pediatric CHF
Increased calories
decrease work of feeding
limit length of feeding
rest
NG tube
Congenital Defects by Blood Flow Pattern Classification
Acyanotic: ASD, VSD, PDA
Cyanotic: Tetralogy of fallot, tricuspid atresia
Obstructive: Coarctation of Aorta, Aortic or Pulmonic stenosis
Mixed blood flow: transpotision of great arteries/vessles, hypoplastic L-Heart syndrome
What is PDA?
Patent Ductus Arteriosis
Blood recirculated to lungs
increased work on Left Side

Manifestation of PDA?
Manifested by...
  • asymptomatic or CHF
  • machinery type murmur
  • widened pulse pressure
  • bounding pulses
  • risk for bacterial endocarditis 
What is PDA treatment?
Indomethicin: for premature babies to close PDA

Surgical ligation

Prognosis: good
What is VSD?
Ventricular Septal Defect
opening between left and right ventricle
Left to Right shunt
- many times closes on its own
Manifestation of VSD
  • characteristic murmur
  • right sided CHF is common
  • risk for bacterial endocarditis 
Treatment for VSD
Palliative pulmonary banding
- decrease pulmonary blood flow

Surgical repair with suture or patch

Nonsurgical closure using cardiac cath
Prognosis: Good
What is TOF?
VSD, Pulmonic stenosis, Rt. ventricular hypertrophy, overriding aorta

equal pressure in ventricles

Cyanotic
Management of TOF
Palliative shunt: Blalock-Taussig shunt
- until big enough to repair 

Surgical repair: close VSD, correct stenosis, pericardial patch (enlarge RV)
Manifestation of TOF
Characteristic murmur
TET spells: acute cyanosis /hypoxia 
- Infants: knees to chest (decrease venous return)
Poor growth
Clubbing
Risk for emboli, LOC, sudden death
What is Coarctation of the Aorta?
localized narrowing of the Aorta
- less bloodf low to LE
- back log of blood

4 extremity BP taken 
Manifestation of Coarctation
UE: High BP and bounding pulses in UE

LE: Weak or absent femoral pulses, cool LE, low BP
Treatment for Coarctatoin
Surgical repair (before age 2)
Nonsurgical - balloon angioplasty

prognosis: good
What is Transposition of the Great Vessels
Malformation where 2 separate, closed circulation loops. 
- not compatible with life
- immediate correction
Treatment for TOGV?
Prostaglandin E to keep Ductus Arteriosis Open
- allow mixing blood
- create a VSD (left/right ventricle)
Surgical: arterial switch in first weeks of life
Prognosis: <2% mortality
What is Hypoplastic Left Heart Syndrome?
Under-developed Left Ventricle
not compatible with life

may not seem symptomatic baby until ductus arteriosis closes
Treatment for Hypoplastic Left Heart Syndrome
Keep PDA open
or create ASD (atrial)

Heart Transplant

mortality high
What are acquired cardiovascular disorders
- Endocarditis
- Rheumatic fever
- Kawasaki Diease
What is Bacterial Endocarditis
Infection of valves and innerlining of heart

Portal of entry:
- Oral 
- UTI (post catheter)
- Blood (longterm IV catheters)
Treatment for bacterial endocarditis
High doses of IV antibioics for 2-8 weeks

Prevent in susceptible patients (cardiac patients)
What is Rheumatic Heart Disease (fever)
inflammatory disease post strep throat

Carditis: usually in mitral valve causing mitral regurg
- may lead to CHF (may require valve repair/replacement )
What is Kawasaki Disease?
Acute systemic vasculitis
resolves in 6-8 weeks

Without treatment, 25-50% children have cardiac sequela
- leading to MI
Treatment of Kawasaki Disease
High doses of IV Immunoglobulin

Prognosis: great if treated
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