Final notes

• Acyanotic lesion is L to R shunting
• Cyanotic lesion is R to L shunting
• Atrial septal defects is when the foramen ovals does not close after birth and leads to a heart murmur and enlarged PA
• Patent ductus arteriosus is when pathway between descending aorta and PA fails to close so too much blood enters the lungs
• Ventricular septal defect is when there is a small opening in the wall separating the ventricles
• Atrioventricular defect is when the endocardial cushions do not form properly, common in T21
• Coarctation of aorta is a narrowed aorta leading to obstruction of LV outflow = HTN in UE and normal BP in LE
• Tetraology of fallot: lowers O2 throughout the body

  • pulmonary stenosis
  • ventricular septal defect
  • Overriding aorta
  • RV hypertrophy
• Hypoplastic L heart syndrome

  • most serious
  • Underdeveloped LV
  • Poor feeding, cyanosis, organ failure
• Transposition of great arteries

  • aortic artery arises from RV and PA from LV
• HCM is the most common cause of sudden cardiac death in kids
• heart begins to develop around the 4th week in utero
• Lungs develop around the 4th week of gestation
• Surfactant forms int he terminal saccular period
• Bronchoscopy is for direct visualization of the bronchial tree
• Ventilation perfusion scan is for evaluating the circulation of airflow and blood flow in the lungs
• Perfusion scan is when radioactive albumin is injected into the bloodstream and the perfusion of the heart is measured
• Ventilation scan is when the patient breathes in radioactive gas and measure airflow in the lungs
• Postural drainage

  • segmental bronchi should be perpendicular to the floor
  • 5-10 min
• 4 phases of cardiac rehab

  1. hospital base
  2. supervised and insurance based
  3. out of pocket
  4. in a gym
• Qualifications of Cardiac Rehab

  • NSTEMI/STEMI
  • PTCA
  • Valve replacement
  • CABG
  • CHF
• Compression garments 20-30
• PAD

  • pain (intermittent claudication)
  • pallor
  • pulses decreased or absent
  • paresthesia
  • paresis (muscle atrophy)
  • Trophic changes, dry, shiny skin, hair loss
• Intermittent Claudication is a sign of ischemia

  • production of lactic acid
  • relieved with rest
  • no greater than a 3
• Intermittent claudication exercise

  • walking 30 minutes, 3+ times per week for 6 months
• Virchow's triad for VTE

  • hypercoagulability
  • venous stasis
  • Endothelial injury
• LVAD

  • helps pump blood from L ventricle to the rest of the body
• Pulsatile is for systolic and diastolic phase

  nonpulsatile blood moves via centrifugal force (can go home with)
• For LVAD placement

  • NYHA level IV
  • chronic dependence on inotropic agents
  • LVEF <25%
• Patients do not have a pulse in non-pulsatile pumps
• Suckdown sound is an emergency for LVAD wires because it decreases CO with activity

  • place pt in supine with LE elevated for venous return
• For LVAD MAP should be 60-80
• In a heart transplant the heart is denervated so resting HR will sit higher so warm up and cool down are important
• VV can be mobilized
• Allocation criteria for heart transplants are now a 6-teired system
• Tension pneumothorax

  • mediastinum shifts away
• Atelectasis the mediastinum shifts to the affected side
• Decreased FEV1 = COPD
• S2 is the end of ventricular systole
• Hyperresonance sound = hyper inflated lung