Ch 46 Acquired Heart Disease

Ch 46 Acquired Heart Disease


Ch 46 Acquired Heart Disease
Acquired heart disease covers all of the conditions that were not present at birth. Children with CHD can develop acquired heart
disease. Infective endocarditis is an inflammation
that happens from infection of the cardiac valve and endocardium. It is typically caused from a bacteria but
can be viral or fungal in nature. The manifestations vary depending on what
organism is the cause but common ones include anorexia, nausea, fatigue, arthralgia, chest
pain, petechiae, and neurological impairment. Diagnostic evaluation is done by blood cultures
to detect the causative agent and they will do an ECHO. Other lab tests that can help with diagnosis
is a CBC, ESR, ECG and rheumatoid factor. Prevention is the most important therapeutic
intervention . Children at risk need optimal dental care. Therapeutic management if they have infective
endocarditis would be high doses of appropriate antibiotics IV for 2-8 weeks (may go home
with home care to continue them). Prophylaxis for 1 hour before procedures (IV)
or may use PO in some cases. Nsg care mgmt. includes educating on s/s of
endocarditis and the need for prophylaxis antibiotics before invasive procedures or
dental work. It is changing and now they are using this
only for very high risk. At least that is the recommendations but not
all providers change. Identifying dysrhythmias in childhood is important. They must be quickly identified as life threatening
or non life threatening. In tachydysrhythmias and bradydysrhythmias
, cardiac output is diminished. They will have low cardiac output which results
in poor organ perfusion. Many times the early symptoms are subtle but
as the disease progresses, they become more noticeable. The infant and toddler will show poor feeding,
irritability, lethargy, pal poor peripheral perfusion, decreased urine output, and HF. In older children they can experience palpitations,
dizziness, syncope and exercise intolerance. Diagnostic evaluation is a 12 lead ECG. Therapeutic management include meds, ablation,
cardioversion and pacemakers. Two dysrhythmias due to a fast rate include
supraventricular tachycardia and ventricular tachycardia. Treatment measures vary but they must slow
down the heart rate. Dysrhythmias due to a slow rate include bradydysrhythmias
and absent rhythms. Surgery is typically needed for bradydysrhythmias
and CPR and medical management is needed for an absent rhythm. Epinephrine is the drug of choice. Rheumatic fever: Inflammatory disease occurring
after group A β-hemolytic streptococcal pharyngitis (GABHS)
Infrequently seen in the United States; big problem in developing countries
Self-limiting Affects joints, skin, brain, serous surfaces,
and heart Major manifestations include carditis, polyarthritis,
Chorea, Erythema marginatum, and subcutaneous nodules. Minor manifestations include: fever, arthralgia,
elevated ESR or positive C-reactive protein, Prolonged P-R interval and supporting evidence
of preceding streptococcal infection Diagnosed by Jones criteria (presence of two
major manifestations or one major manifestation and two minor manifestations)
Therapeutic management includes prevention of GABHS- think infection control. Instruct on importance of finishing all antibiotics,
having a recheck if ordered, educate on the spread of the disease. PCN is the drug of choice is not allergy. If allergy-sulfa or erythromycin. If treatment is not effective, they can repeat. Kawasaki disease An acute systemic vasculitis
of unknown cause In 75% of cases, the child is younger than
5 years of age Three phases
Acute phase: Sudden high fever, unresponsive to antipyretics and antibiotics
Subacute phase: Lasts from the end of fever through the end of all Kawasaki Disease clinical
signs Convalescent phase: Clinical signs have resolved,
but laboratory values have not returned to normal; ends when normal values have returned
(6 to 8 weeks) Clinical manifestations include:
Child must have fever for more than 5 days along with four of five clinical criteria*
(diagnosis may be made on day 4 by an experienced clinician if child has all the clinical criteria):
1. Changes in the extremities: In the acute phase
edema, erythema of the palms and soles; in the subacute phase, periungual desquamation
(peeling) of the hands and feet 2. Bilateral conjunctival injection (inflammation)
without exudation 3. Changes in the oral mucous membranes, such
as erythema of the lips, oropharyngeal reddening; or “strawberry tongue” (large papillae
are exposed) 4. Polymorphous rash
5. Cervical lymphadenopathy
Acute phase, symptoms may come and go. Child is usually pretty irritable. Subacute- during this phase the child is highest
risk for coronary artery aneurysms. Echocardiogram is used to monitor. Treatment includes
Intravenous immunoglobulin (IVIG) Acetylsalicylic acid (ASA) 80 to 100 mg/kg/day
for anti inflammatory and then 3 to 5 mg/kg/day antiplatelet
Low dose ASA is continued until the platelet count has returned to normal which can be
6-8 weeks. If coronary abnormalities develop, ASA therapy
will be continued indefinitely. You should be familiar with hypertension so
I will just touch on what you would need to know for the pediatric population. Many times there are no clinical manifestations
of hypertension but if the blood pressure rises they can have dizziness, headache, epistaxis
and visual disturbances. Diagnostic evaluation includes obtaining history
and physical exam which would include blood pressure checks. Therapeutic management includes weight reduction
which should be healthy lifestyle changes and no a diet. Physical conditioning which should include
30-60 minutes of aerobic exercise several times a week, relaxation techniques and possible
some pharmacologic treatment. Identify kids at risk and treat early. It is recommended all kids get a cholesterol
screening between age 9 and 11. Treatment is lifestyle modification, Restrict
intake of cholesterol and fats Increase intake of whole grains, fruits, and
vegetables Exercise for 60 minutes a day 5 days a week
Stop smoking and avoid secondhand smoke If there is no response to diet changes and
medications Colestipol (Colestid)
Cholestyramine (Questran)

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