심장부분 (과 사실 neuro부분)이 약한부분이라 이번기회에 한번 정리하자!싶어서 정리하는 cardiovascular disease. 생각보다 헷갈리는 포인트가 많았는데, 정리하면서 훨씬 이해할수있고 명확해지길..!

이번 파트 핵심은 혈류 방향(좌→우 vs 우→좌)과 cyanosis유무 여부로 구분하기가 핵심인것같았고, 그외에 acuired heart disease와 cardiac procedures도 학습하기!

Cyanotic Heart Disease: Tetralogy of Fallot​, Transposition of the Great Vessels, Tricuspid Atresia, Truncus Arteriosus

Acyanotic Heart Disease: Atrial/Ventricular Septal Defect, Patent Ductus Arteriosus, Coarctation of the Aorta

Acquired Heart Disease: Kawasaki Disease, Rhematic Heart Disease

Cardiac procedure: Catherization

1. Cyanotic Heart Disease - TOF (Right to left blood flow shunt) ***Nclex가 사랑하는 주제라고 강조해주셨다!

산소 부족 혈액이 전신으로: cyanosis

4 Defects in this condition: "PROV"

• Pulmonary stenosis

• Right ventricular hypertrophy

• Overriding aorta

• Ventricular Septal Defect (VSD)

SOB: Cyanosis, Fainting, lound systolic murmur, poor weight gain, clubbing nails, TET spells (Hypercyanotic Hypoxia, Tachypnea) with knee to chest/squatting (child) & oxygenation

Complications: Polycythemia → "hydration" → Report Hgb > 22g/dL

2. Acyanotic Heart Disease:

1) Atrial Septal Defect & Ventricular Septal Defect

- Abnormal opening between the atrium (ASD) or ventricles (VSD)

- Murmur expected; Grunting during feeding (VSD)

- Decreased CO

- Can be asymptomatic or may develop HF

S/S

1. Decreased CO: Activity intolerance, weak peripheral pulses, feeding difficulties, hypotension, oliguria, pale/cool extrimities

2. Heart Failure*: weight gain, puffiness (esp. periorbital edema), pale/cool extremities, decreased # of diapers & decreased feeding

- small openings may close by themselves

- large openings leads to surgery

2) Patent Ductus Arteriosus (PDA)

• opening/shunt between the aorta and pulmonary artery that was supposed to close within the 1st weeks of life (usually closes shortly after birth)

S/S: Machine-like murmur, widened pulse pressure & bounding pulses, s/s of decreased CO, pulmonary congestion

Medication: Idomethacin - to close a patent ductus in premature infants & some newborns & Prostaglandine E - to keep the PDA open until surgery happens

3) Coarctation of the Aorta

• Narrowed section of the aorta

S/S

- headache, BP & pulse difference between upper & lower extremities

• high BP & bounding pulses to upper

• cool, low BP & diminished pulses to lower body

Complications - Stroke, HF

Treatment: Prostaglandin, Digoxin, Balloon angioplasty & stents

3. Acquired Heart Disease:

1) Kawasaki Disease: systemic inflammation of arterial walls & cause - unknown

Symptoms

• Abrupt onset of fever > 5 days (unresponsive to antibiotics)

• Bilateral conjunctivitis (nonpurulent)

• Red cracked lips

• Erythematous (Strawberry) tongue

• Edema and erythema of hands and feet with peeling skin

• Cervical Lymphadenopathy임파선염

• Irritability

Complication

• Coronary artery aneurysm

Treatment: IVIG, high dose Aspirin (monitor for s/s of Reye's syndrome)

2) Rheumatic Heart Disease

• Inflammation autoimmune disease that affects heart, tissues & joints

• One of the causes: Pertially treated or untreated strep throat (by group A streptococccus, GAS)

• Fever 38.2–38.9 °C (100.8–102.0 °F)

• Carditis: Inflammation of the heart muscle – chest pain

• Polyarthritis: Migrating inflammation of the large joints, usually starting in the legs and migrating upwards

• Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons

• Erythema marginatum: Reddish ring-shaped rash

• Central Nervous System: Sydenham's chorea, involuntary jerky movements

Complications

• Rheumatic Heart Disease (damages heart valves)

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Kawasaki vs Rheumatic disease 구분하는게 헷갈리는 부분인데, 특히 학교시험에서 헷갈려서 정답이 kawasaki인데 rheumatic disease로 선택해서 틀렸다ㅠㅠ

특히 문제에서 “fever + rash + irritability” 같이 나오면 계속 헷갈렸다...

왜냐면 둘다 inflammation + cardiac complication이있고, rash가 나오면 카와사키인가?하다가도 Rheumatic도 rash (erythema marginatum) 있으니까 구분이 어려웠다ㅠㅠ 두 질병은 확실하게 구분하자면, 원인 + 침범 부위에 집중하는게 중요한거 같다!

• Kawasaki Disease

• 원인: unknown

• 핵심: coronary artery

• 특징: strawberry tongue, conjunctivitis, 손발 peeling

• Rheumatic Heart Disease

• 원인: Group A strep infection 이후

• 핵심: mitral valve

• 특징: migratory arthritis, chorea

그럼으로 문제에서 문제에서

strep infection나오면 무조건 Rheumatic을 선택하고, strawberry tongue + conjunctivitis는 Kawasaki!

이 문제도 헷갈렸던게, 처음에 고른답이 B였는데 (물론 신중하게 읽지않아서 그런게크지만..) 아기가 힘들면 창백해지는 거 아닌가?”라고 생각했다

• pale = 혈류 감소 / 빈혈 느낌

• cyanosis = 산소 부족

산소 부족 문제” → cyanosis가 핵심이기에 "blue" 나오면 무조건 TOF!

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이번주도 시험공부하면서 드림널스를 통해서 같은주제를 한번 더 복습하고 자세하게 설명해주시고 문제를 풀어보면서 확실하게 이해할 수 있어서 좋았던것같다!!!

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