Lecture 8 - The Child with Problems Related to Production & Circulation of Blood
atrial septal defect; ventricular septal defect
"A whole in the filling chambers of the heart" is __________; "A whole in the pumping chambers of the heart" is _______
- oxygen - prostaglandins - maturity
3 factors that impact the closure of the patent ductus arterious
Indomethacin (a PgE inhibitor)
A common method of making the PDA close is my giving this medication
Kawasaki Disease
Acute systemic vasculitis (inflammation of the blood vessels) that has an unknown etiology
systemic
After birth (systemic/pulmonary) vascular resistance is higher
Digiband
Antidote to digoxin
left-right (high pressure LA to lower pressure RA)
Atrial septal defect creates what type of shunt?
pulmonary (the collapsed fetal lungs causes greater pressures in the right side of the heart and pulmonary artery)
Before birth (systemic/pulmonary) vascular resistance is higher
Clotting abnormalities (stroke or infracations)
Biggest risk factor of the for the defects that have a decrease in plumonary blood flow and cause Compensatory polycythemia
cardiac output
Blood ejected out heart in 1 min
lowest; right
Blood will go thru the path where the pressure is the ______, after birth, pressure on the _____ side is decreased
yes
Can you have a congenital heart disease and an acquired heart disease at the same time?
- Dilation of coronary arteries (ectasia) - Coronary artery aneurysms (giant aneurysms >8 mm)
Cardiac complications that can occur if Kawasaki Disease is not treated and left to resolve on its on
Coarctation of Aorta
Cardiac defect that is localized narrowing near the insertion of the dutus arteriosus
aortic stenosis
Cardiac defect that is the narrowing or stricture of the aortic valve causing resistance to blow flow from the left ventricle
Hypoplastic Left Heart Syndrome (HLHS)
Cardiac defect where the left ventricle and the aorta is to small
1. coracartion of the aorta 2. aortic stenosis 3. pulmonary stenosis 4. valvular aortic stenosis
Cardiac defects that are obstructive
1. TOF 2. tricuspid atresia 3. plumonarry atresia
Cardiac defects that cause an decrease in pulmonary blood flow
1. atrial septal defect 2. ventricular septal defect 3. patent ductus aterious 4. atrioventricular canal
Cardiac defects that cause an increase in pulmonary blood flow
1. transposition of great arieres 2. total anomalous plumonary envous return 3. truncus arterios 4. hypoplastic left heart syndrome
Cardiac defects that have mixed blood flow
- decrease LV function - predcardial effusion - mitral regurgitation
Cardiac manifestations of Kawasaki disease
Polycythemia/ Cerebrovascular accident/ Endocarditis
Children with defects that decrease the pulmonary blood flow are at an increase risk for these three things
Central venous pressure
Circulating BV or Preload is easiest to assess using this device
BP discrepancies Pulse discrepancies
Classic symptoms of Coarctation of Aorta in a younger child
mild
Classification of hemophilia that is when you have bleeding with severe trauma or surgery
moderate
Classification of hemophilia that is when you have bleeding with trauma
serve
Classification of hemophilia that is when you have bleeding without trauma
- hemarthrosis (bleeding in joints) - Ecchymosis - Epistaxis - bleeding after procedures
Clinical manifestations of hemophilla
- HEART FAILURE in later decades of life - murmur
Common clinical manifestations of Atrial septal defect
- HEART FAILURE - increase workload of the left side of the heart - increase pulmonary congestion - possible hypertrophy of the RV - machinery like murmur
Common clinical manifestations of Patent Ductus Arteriosus
- O2 stats in the 50-90% range - dusky or mottled skin - cyanotic - Difficulty breathing and eating at same time - Chronic - clubbing of fingers and toes
Common clinical manifestations of defects that cause a decrease in pulmonary blood flow
- HEART FAILURE - increase pulmonary vas resistance - hypertrophy of the RV and RA
Common clinical manifestations of ventricular septal defect
arrhythmia
Common complication following an arterial switch surgery
cardiac tamponade
Complication that can occur after cardiac surgery where the heart is compressed by blood vessles and other clots in the pericardial sack
increase
Conditions that make it more difficult for the heart to pump blood forward into circulation (increase/decrease) the after load
- pulmonary congestion - pink with feeding difficulties - tachycardia - tachypena - murmus - shortness of breath
Congestive heart failure symptoms that will occur in a child that has a cardiac defect that increases the pulmonary blood flow
cephalosprins or macrolides
Drug that can be used to eradicate the Rheumatic fever primary infection in PCN sensitive childern
Sildenafil (Viagra)
Drug that will prevent plumonary hypertension
o Oxygen poor blood leaves the heart to enter the heart lung machine o Heart lung machine pumps and adds oxygen to the blood before it returns to the body o Oxygen rich blood returns to the body, skipping the heart and lungs o A perfussionist operates the bypass machine.
Elements of an open heart surgery
Infection, autoimmune response, disease process, environmental factors, and familial tendencies
Factors that can influence acquired heart disease
increases; greater
For preload If the amount of blood delivered to the heart _______, then the myocardial fibers lengthen, and a ______ amount of blood is pumped out of the heart
Prevent excessive crying Quiet games and activities Elevate HOB Optimal nutrtion For infant, feed slowly; <30 min Is pt well hydrated Optimize nutrition
General care for the child who just had heart surgery includes....
4;8
Heart and components begin to develop by __ weeks and complete by __ weeks gestation
check the pulses; cap refill; LOC; urine output
How can you assess for Cardiac output/tissue perfusion
fluid status by looking at input and output of the patient
How can you assess preload?
- ECG - listening to apical pulse for 1 min
How do you monitor for arrhythmia after a cardiac surgery?
blood that comes into the left atrium will be shunted back into the right atrium
How is blood flow changed with Atrial septal defect?
the blood in the aorta is shunted/ recirculated back into the pulmonary artery (lower pressure system now)
How is blood flow changed with Patent Ductus Arteriosus?
blood flows from the high pressure LV to the lower pressure RV
How is blood flow changed with ventriculrar septal defect?
- severe cyanosis appears soon after birth and does not improve with oxygenation - depressed function
How would a child with miminal to no communication between the circulations with TGA present at at birth
give ABC (ace inhibitors, beta blockers, calcium channel blockers)
If after load is to high, what can you do to decrease it?
give ionotrope (will increase the ton of the vasculature so the heart has something to pump against)
If the after load is to low, what can you do to increase it?
increase iV fluids to increase the circulating volume therefore increasing the preload
If you have a low preload, what could you do?
AV bundle or purkinje fibers
If you have ventricular septal defect you could permanently or temporarily damage the ____
o Balloon septostomy (for communication between atrium) o Prostaglandin E1 is started at 0.1 mg/kg/min (keeps ductus open)
Immediate intervention at birth until surgical intervention can be arranged when teh child has Tricuspid Atresia
o Remove pressure dressing day after catheterization and apply band aid o Change band aid q day for next 2 days o Keep site clean and dry; not tub baths (dislodge clot) o Observe site for swelling, drainage, bleeding, leg for coolness, of infection o avoid a lot of excerise by may attend school
Impoartnt teaching that needs to be done with parents of a child who just had a cardiac cath
o Vs q 15 minutes x 1 hr then q 30 x 1 hr o Apical pulse for 1 minute o Assess site for redness or bleeding; check under buttocks o Pulse distal to site may be weak for first few hours, but extremity should be warm
Important assessments that need to be done AFTER a cardiac cath
- height - allergy to iodine - look for s/s of infection - assessment of pedal pulse - basline o2 level
Important assessments that need to be done BEFORE a cardiac cath
keep pt. hydrated, on aspirin, and watch the polycythemia levels
Important considerations for Shunts
lower
In sickle cell that rate of production of blood cells is (higher/lower) than the rate of distruction
acyanotic; CHF
Increased Pulmonary Blood Flow Clinical Manifestations include (cyanotic/acyanotic) and symptoms of ...
• If increased pulmonary BF, restrict it with PA band - temporary repair. • Need to put it on right - loose enough to allow growth, but not too loose or it can cause HF
Indications & problems with plumonary atery banding
Initial survival depends on PDA remaining open until some surgical intervention can be performed
Initial survival with TGA depends on what?
erythrocyte and c-reactive protein
Lab value that is high in the convalescent phase of Kawasaki Disease
Hypertension in upper extremities Dizziness, headache, fainting or epistaxis Decreased or absent pulses in lower extremities Leg cramps during exercise Rib notching on CXR
Later symptoms of Coarctation of Aorta in a older child
abrupt fever that is unresponsive to antibiotics and antipyertics
Main symptom of the acute phase in Kawasaki Disease
carditis; Non-tender Subcutaneous nodules; polyarthritis of large joints; rash; chorea
Major criteria to meet Rheumatic fever
Vivien T. Thomas
Major player in the development and success of BT shunts Film-Something the Lord Made
digoxin
Medication that can be given to increase the contractility of the heart
morphine, diaudid, or other opioids
Medication that should be given during a sickle cell crisis
DEMEROL
Medication that should not be given during a sickle cell crisis
Prostaglandin E1
Medication that will be given after birth for a infant with TGA that wil keep the ductus open
- screening children for sore throats that may be caused by A Strep - Complete antibiotics for 10 days
Methods to prevent rheumatic fever
fever; arthralgia (pain in joints)
Minor criteria to meet Rheumatic fever
Transposition of the Great Arteries (TGA) Hypoplastic Left Heart Syndrome (HLHS) Truncus Arteriosus
Mixed cardiac defects
- bradycardia - nasuea - vomiting (unreleated to feedings) - anorexia
Most common signs of digoxin toxicity
potential for MI
Most serious complication of having Kawasaki Disease
120; 40 days
Normal RBC life time and a sickle RBC lifetime
1. unoxygenated blood enters the LA from the SVC and IVC 2. passes through the tricuspid valve into the RV 3. passes through the pulmonic vlave into the plum artery 4. plum aretry to plum vein 5. plum vein into LA 6. passes through the mitrial valve into the LV 7. passes through the aotric vlave into the aorta
Normal pathway for blood flow in the heart
low
Obstructive cardiac defects will exhibit symptoms of (high/low) cardaic output
plumonary artery banding to decrease plumonary blood flow
Palliative treatment for ventricular septal defect
increase
Patent Ductus Arteriosus results in an (increase/decrease) in pulmonary blood flow
left to right (high pressure aorta to low pressure plum artery)
Patent Ductus Arteriosus creates what type of shunt?
prostaglandins; ductus arterious
Patients that are born with TOF are placed on ________ so that the ______ can be kept open
Poor feeding Tachypnea/tachycardia Failure to thrive/activity intolerance Developmental delays Prenatal history Family history of cardiac disease
Pediatric indicators of cardiac dysfunction
malaria (have a survival advantage)
People with sickle cell or are carriers of sickle cel are more resistant to this disease
left; right
Pressure on the ___ side of heart is greater than that on the ____
after load
Resistance against which the ventricles must pump against when ejecting blood
increase
Rheumatic fever will have an (increase/decrease) in C-reactive protein
- narrowing in pulse pressure - pulses parodoxus - immediate stop in chest tube drainage - LA and Ra pressure equalizing - dyspena - tacycardia
S/S of cardiac tamponade
increase; increase
Shunts will (increase/decrease) pulmonary blood flow and (increase/decrease) oxygen sats
preload (its the circulating blood volume returning to the heart)
Stretch of sarcomeres during diastole
Diminished pulses Poor color Poor capillary refill Decrease urinary output Decrease BF flow to GI tract CHF with pulmonary edema
Symptoms of Obstructive defects that are all from a low CO
- No manifestation seen except altered laboratory findings. - Resolution in about 6-8 weeks from onset
Symptoms of the Convalescent phase in Kawasaki Disease
- high fever that is not responsive to medication - bitlateral conjuntivis without drainage - strawberry tounge - edema - EXTERME irritability - Periungual desquamation (peeling of skin) - Arthritis - non blistering rash
Symptoms of the acute phase in Kawasaki Disease
- resolution of fever - gradual subsiding manifestations - Peeling of skin around the nails, on the palms
Symptoms of the subacute phase in Kawasaki Disease
false (only valvular function and flow of blood)
T/F Echos can pressure the measure within the heart
false (Duration 6-8 weeks, self-limiting but without treatment 25% will have cardiac sequel)
T/F Kawasaki Disease is not self limiting
true
T/F More than one defect can either compound problems or cancel out problems (to some degree)
false (palliative)
T/F Shunts and Atrial septostomy are curative for TOF
true
T/F Ventricular Septal Defect is commonly assocaited with other defects in teh heart happening at once
hypoxia
Term for a reduction in tissue oxygenation
hypoexmia
Term for when the arterial oxygenation is below normal and is identified by a low SaO2 stat (50-90%)
Hypercyanotic or Tet Spells
The acute episodes of cynosis and hpoxia that occurs in TOF
ventricular septal defect (VSD)
The cardiac defect that is due to the failure of the wall between the LV and the RV to form
atrial septal defect
The cardiac defect that is due to the opening between the LA and the RA that is present during fetal life not closing
Patent Ductus Arteriosus
The cardiac defect that is due to the opening between the pulmonary artery and the aorta that is present during fetal life not closing
Transposition of the Great Arteries (TGA)
The cardiac defect that is when the pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle
Tricuspid Atresia
The cardiac defect that is when the valve that lies between the RA and RV fails to develop
Pulmonary Atresia
The cardiac defect that is when the valve that lies between the RV and pulmonary artery fails to develop
Tetralogy of Fallot Triscuspid Atresia Pulmonary Atresia
The conditions that cause an DECREASE in pulmonary blood flow
Patent Ductus Arteriosus (PDA) Atrial Septal Defect (ASD) Ventricular Septal Defect (VSD) Atrioventricular Canal (AV Canal)
The conditions that cause an INCREASE in pulmonary blood flow
ductus arteriosus
The connection between the pulmonary artery and aorta during fetal circulation
foramen ovale
The connection between the right atrium and the left atrium during fetal circulation
unsaturated; saturated
The content of O2 on RBC entering into the right side of the heart is _______; the content of O2 on the RBCs that come from the pulmonary veins into the LA is ______
1. ventricular septal defect 2. right ventricle hypertrophy 3. overriding aorta 4. pulmonic stenosis
The defects that are included in Tetralogy of Fallot
Down Syndrome (Trisomy 21)
The disorder that Atrioventricular Canal is most common in
penicillin
The drug of choice to be used in order to eradicate the Rheumatic fever primary infection
contractility
The efficiency of myocardial fiber shortening or the ability of the cardiac muscle to act as an efficient pump
Blood goes from the right side to the left side because of the stenosis on the pulmonic valve
The element in TOF that is the reason right-left shunts are possible
systemic and pulmonary resistance (a higher resistance= a higher afterload)
The factor that primarily determines the after load of the heart
Increase the circumference of the aorta so that they can get blood flow to the lower body
The goal of the surgery that is preformed for coraction of the aorta
Infant- <90-110 bpm Older children- <70 bpm Adults- <60 bpm
The heart rates that digoxin should not be given
Myeloid tissue (bone marrow) Lymphatic system (fluid and structures)
The hematopoietic organs
- increases the risk for CVA and vital organ infarction - need to make sure that they have good perfusion
The main concern during a Vaso-occlusive crisis
Compensatory polycythemia
The most characteristics finding in a person who has a cardiac defect that results in a decrease in pulmonary blood flow
mitral valve
The most common valve to be affected by Rheumatic Fever
Coarctation of the aorta Aortic Stenosis Pulmonary Stenosis
The obstructive cardiac defects
ductus venous
The part of fetal circulation that will take oxygenated blood and materials from the umbilical vein to the Inferior vena cava in order for the blood to reach the RA
p wave
The part of the ECG that represents that spread of impulse over the atria
p-r interval
The part of the ECG that represents the time between atrial depolarization and the beginning of ventricular depolarization
QRS complex
The part of the ECG that represents ventricular depolarization
t wave
The part of the ECG that represents ventricular repolarization
SA node
The part of the conduction system of the heart that is normally the pacemaker and initiates an impulse and causes atrial depolarization
AV node
The part of the conduction system that is the major pathway of transmission between atria and ventricles
atrial septum
The part of the heart that divides the left and right atriums
ventricular septum
The part of the heart that divides the left and right ventricles
o Partial or complete replacement of normal Hgb with abnormal hemoglobin S (HgbS) o When deoxygenation occurs, hemoglobin in the RBCs takes on an elongated ("sickle") shape o Sickled cells are rigid and cause clumping of the RBCs (obstruct capillary blood flow) o Microscopic obstructions lead to engorgement and tissue ischemia
The pathophysiology behind sickle cell
mediterranean and african american
The populations that sickle cell occurs most in
would squat to counteract the cyanosis. This increases their systemic vascular resistance to balance the shifting of blood
The position that the children having a Hypercyanotic or Tet Spell would resume and the reason
Blalock-Taussig; provides blood flow to the pulmonary arteries from the left or right subclavian artery via a tube graft
The preferred shunt that is used for TOF and what is uses
cyanosis
The presences of deoxygenated hemoglobin
if the shunt clots you can have sudden death
The risks associated with shunts
Arterial Switch
The surgery of choice for TGA
preload; after load; contractility
The three determinants of cardiac output
1. Lasix 2. Digoxin 3. Captopril/Enalapril
The three drugs that will be given to enhance cardiac output
Norwood Bidirectional Glenn Shunt Modified Fontan
The three procdeuers that will occur for a child that has Hypoplastic Left Heart Syndrome (HLHS)
1. tricuspid: between RA and RV 2. mitral: between LA and LV
The two AV values and their locations
1. pulmonary: RV and pulmonary artery 2. aortic: LV and aorta
The two semilunar valves and their locations
echocardiogram
The type of procedure that involves the use of ultra-high-frequency sound waves to produce an image of the hearts structure
Cardiac Shunts
The type of surgical procedure that is needed to correct the decrease pulmonary blood flow in TOF
preload
The volume of blood returning to the heart OR the circulating blood volume
- infection - exposure to extreme temperatures (mostly cold) - dehydration, acidosis, hypoxia - Stress - high altitudes
Things that can cause the decrease in oxygen in skicle cell anemia
IVIG and aspirin
Treatment for Kawasaki Disease
hypoxemia; heart failure
Two broad categories for the clinical consequences of congenital heart defects
obstructive; increase pulmonary blood flow
Two categories of heart defects that will cause the child to be acynatic
mixed blood flow; and decrease pulmonary blood flow
Two categories of heart defects that will cause the child to be cyanotic
Rheumatic Fever
Type of acquired heart disease that is an inflammatory disease that occurs after Group A beta-hemolytic streptococcus
Atrioventricular Canal
Type of cardiac defect that is when there is a incomplete fusion of the endocardial cushions
neutral thermal environment
Type of environment that the child should be in after surgery
acquired heart disease
Type of heart disease in which there is a disease processes or abnormalities that occur after birth that affects the cardiac function
congenital heart disease
Type of heart disease where there is an abnormal anatomical defect present at birth that result in abnormal cardiac function
hemophilia A
Type of hemophilia that is a deficiency of factor VII and is 80% of cases
hemophilia B
Type of hemophilia that is caused by a deficiency in factor IX
Cardiac Catherization
Type of procedure that uses INVASIVE radiopaque cathers paced in a pherpherial blood vessle and advanced into the heart to measure pressures and oxygen levels in the chambers as well has ph levels and flow of the blood
o Cath lab - percutaneous place patch to close defect (small ASDs) o Surgically a patch or pericardium use to close the hole - with bypass machine (moderate-large ASDs)
Type of procedures used for Atrial septal defect closure
left-right shunt (increase plumonary blood flow)
Type of shunt that will have symptoms of congestive heart failure
right-left shunt (decrease pulmonary blood flow)
Type of shunt that will have symptoms of cyanosis
vein; artery
Umbilical (artery/vein) contain oxygenated blood; while umbilical (artery/vein) contain unoxygenated blood
left-right
Ventricular septal defect creates what type of shunt?
to prevent backflow of blood
What are the main job of teh valves in the heart?
emboli; seizures; LOC; sudden death
What can Hypercyanotic or Tet Spells put the child at risk for?
Fully saturated systemic blood mixes with desaturated pulmonary blood which causes a relative desaturation of the systemic blood
What can happen to the oxygen content in a mixed/combined cardiac defect?
birth when umbilical cord is clamped and lungs expand
What causes the hemodynamics of the fetal vascular system undergoes major changes to transition to post natal circulation?
- a low ASD - a high VSD
What does Atrioventricular Canal consist of?
a large central AV valve that allows blood flow from all 4 chambers of the heart
What does Atrioventricular Canal create in the heart?
proximal to the defect (upper extremities and head) will have an increase in BP and distal to the defect will have a decrease in BP (body and lower extremities)
What does Coarctation of Aorta do to the blood pressure?
and anastomosing the main pulmonary artery to the proximal aorta (just above the aortic valve) and anastomosing the ascending aorta to the proximal pulmonary artery
What does the Arterial Switch do?
irreversible pulmonary hypertension
What happens if the defect that is causing an increase in pulmonary blood flow is never resolved?
blood pressure (central line or SWAN can get direct pressure inside of the heart)
What is after load measured by/ with?
overwhelming pneumonia due to the inability of the spleen to filter
What is chest syndrome that occurs in sickle cell patients?
usually inferred from assessment for tissue perfusion (warm, cap refill, ect) and urine output
What is contractility measured by?
the sickled cells slow or stop the flow of blood though small BV and cause infarction/ tissue damage
What is the Vaso-occlusive crisis expericed in Sickle cell?
decrease afterload
What is the effect of giving Captopril/Enalapril?
increase contracility; decrease heart rate
What is the effect of giving Digoxin?
decrease preload
What is the effect of giving Lasix?
Large tissue infarctions occur and damaged tissues/organs have impaired function
What is the outcome of a vasoocculive crisis?
coils or ducts are placed by a catheter to occlude the PDA
What is the percutaneous treatment for PDA?
sickled cells become fragile and easily hemolyzed or sequestered in the spleen causing pooling of blood and infarction of splenic vessels
What is the splenic sequestration that occurs in sickle cell?
a thoracotomy to ligate and stop communication between systems with a clip and tie
What is the surgical treatment for PDA?
brain; lungs are essentially nonfunctional
What organ does the majority of oxygenated fetal blood go to? Why?
Apical pulse for one minute (radial pulse may have a pulse deficit with decreased CO)
What should always be assessed before giving digoxin?
circular blood flow
What type of circulation is with Transposition of the Great Arteries (TGA) ?
autosomal recessive
What type of disorder is sickle cell anemia?
- low levels of factor VIII or IX - prolonged PTT - normal platelets - normal PT - normal fibrinogen
What will lab work for a person with hemophilia show?
if the plum resistance was lower than the systemic
What would give Tetralogy of Fallot a left-right shunt?
if the plum resistance was higher than the systemic
What would give Tetralogy of Fallot a right- left shunt?
with crying or feeding
When does Hypercyanotic or Tet Spells occur?
in toddlers; late winter and early spring
When is the peak of Kawasaki Disease?
when plumonary artey pressure begins to rise to high
When will you start to clinically see a person show signs of having a Atrial septal defect?
through the formaen ovele into the LA; so that the better oxygenated blood from the placenta will go to directly to the LA and LV reaching the brain and upper extermites
Where is the high pressure of the blood coming from the ductus venous into the IVC and RA going to go? Why?
through the tricuspid valve into the RV; then the majoirty is shunted through the dutus arteious
Where is the low pressure of blood coming back from the head and upper extremities though the SVC and RA going to go? Why?
ventricular; the pressure differences between the RV and LV are much higher than the RA and LA so more blood flow is diverted to the pumonary circulation
Which type of septal defect commonly presents earlier in life? Why?
- Gives info about oxygen saturation of blood within the chambers and great vessels - pressure changes within these structures - measures CO and SV - Anatomic abnormalities such as septal defects or obstruction to flow
Why are caths used to dignois cardiac conditions?
certain defects can be seen through cardiac silhouettes
Why are chest x rays used to dignois cardiac conditions?
when the child oxygen requirements exceed the blood supply
Why do Hypercyanotic or Tet Spells occur?
chronic hypoxemia
Why do children with a decrease in pulmonary blood flow have chronic clubbing?
You don't have enough cells going to the lungs to get oxygenated so this is why the oxygen is not helpful
Why do defects that cause a decrease in blood flow to the lungs not respond to oxygen therapy?
the body is always starving from oxygen it will increase the rbc production
Why do defects that have a decrease in plumonary blood flow cause Compensatory polycythemia?
pulmonary vasuature changes occur after several decades if the defect is not repaired because of the low pressure difference in the RA and LA
Why is it common for people with ASD to be asymptomatic?
Mobility leads to injuries from falls and accidents
Why is it likely that hemophilia will not manifest until 6 months of age?
lungs expand and take over oxygenation which has a vasodilating effect on the pulmonary beds dropping the pressure
Why is there a fall in pulmonary vascular resistance after birth?
low pressure placenta is removed; the heart will take over pumping blood to the body
Why is there a rise in systemic vascular resistance after birth?
yes (have enough blood cells that are getting to systemic circulation)
Will Patent Ductus Arteriosus (PDA) Atrial Septal Defect (ASD) Ventricular Septal Defect (VSD) Atrioventricular Canal (AV Canal) be responsive to oxygen treatment?
no
Will Tetralogy of Fallot Triscuspid Atresia Pulmonary Atresia Respond to oxygen treatment?
Atrial septostomy
a procedure where a small hole is made in the wall between the left and right atria of the heart.
bacterial infections
leading cause of death in young children with sickle cell disease
