Congenital Heart Defects
Congenital defects that cause:
Increased pulmonary blood flow
Obstructive Defects
Decreased Pulmonary Blood Flow
Mixed Blood Flow
Increased: ASD, VSD, PDA, AV Canal Defect
Obstructive: Coarctation of the Aorta, Aortic Stenosis, Pulmonic Stenosis
Decreased: Tetralogy of Fallot , Tricuspid Atresia
Mixed: Transposition of the Great Arteries, Hypoplastic left heart syndrome
ALL Congenital Heart Defects increase risk of _______________?
The following are causes of ________:
•Blood is not totally sterile
•Localized infection in body, Bacteria is carried by bloodstream to heart
•Bacteria attack lining of heart valves
•Risk/benefit of prophylaxis (abx)
Bacterial Endocarditis
What is the difference between a fetal heart and a newborn heart?
The foramen ovale and ductus arteriosus are open in a fetal heart and both are closed in a newborn heart.
Repair:
•Surgical patch (open heart surgery) or transcatheter closure
Atrial Septal Defect
▪Get accurate height - determines correct catheter selection
▪Allergy status
▪Assess and mark pedal pulses prior to procedure for baseline
▪Baseline O2 Sat
▪Parent & patient education based on developmental stage
▪Medical play to understand procedure
▪May reschedule for bad diaper rash
Pre-Procedure Cardiac Catheterization Care
Hole in between the left and right atria
L-R Shunt
Usually tolerated well
Leads to RA/RV enlargement
HF risk (rare)
May be asymptomatic
Can close spontaneously
Atrial Septal Defect (ASD)
•Systemic inflammatory connective tissue disorder after initial pharyngitis with some strains of group A beta-hemolytic streptococci
Acute Rheumatic Fever
What is the normal cardiac physiology (flow of the heart)?
Right Atrium - Tricuspid Valve - Right Ventricle - Pulmonary Valve - Pulmonary Artery - Pulmonary Vein - Left Atrium - Mitral Valve - Left Ventricle - Aortic Valve - Aorta - Circulation
Treatment
●Indomethacin (prostaglandin inhibitor) may help close it in premature infants
Surgery - with ligation, coils, occluders, etc.
Patent Ductus Arteriosus (PDA)
▪Circulation checks
▪Pedal pulses equal? (pulse on cath side may be weaker x few hours)
▪Coolness or blanching – sign of obstruction
▪Frequent VS
▪Count HR for full minute
▪BP – check for hypotension
▪Check dressing for bleeding or hematoma
▪If bleeding occurs – apply continuous pressure 1 inch above puncture site
▪Adequate fluid intake – either po or IV
▪For infants – check glucose frequently
▪Child on bedrest for 4-6 hours post venous cath/ 6-8 hours post arterial cath
▪No tub baths for 3 days
Post Procedure Cardiac Catheterization Care
Usually closes within wks of birth
Blood flow from aorta into pulmonary artery
L-R Shunt
Increased workload on left side of heart
Increased pulmonary vascular congestion
Can be asymptomatic
S&S of HF
Patent Ductus Arteriosis
____________Causes changes in:
•heart (myocarditis, valvulitis or endocarditis)
•joints (polyarthritis)
•brain (chorea – involuntary muscle twitching)
•skin tissues (subcutaneous nodules; rash)
Acute Rheumatic Fever
What is included in a physical assessment for cardiac function? (list at least 1 or more from each of the following categories: Maternal pregnancy, Family Hx, Infant, Child/Teen)
Maternal pregnancy hx: Substance use/abuse, diabetes mellitis, lupus, low birth weight, IUGR
Family Hx of cardiac or genetic problems
Infant: Poor feeding, fatigue, tachypnea, sweating, slow/poor weight gain
Child/ Teen: Exercise intolerance, edema, respiratory problems, chest pain, palpitations, syncope, HA
▪Surgical treatment
▪Palliative – pulm. Artery banding
▪Complete repair – patch and reconstruct valves
Atrioventricular Canal Defect (AV Canal Defect)
The following are clinical manifestations of ___________________?
-Impaired Myocardial Function
-Pulmonary Venous Congestion
-Systemic venous congestion
-Decreased Cardiac Output
Congestive Heart Failure
As ductus arteriosus closes infant becomes hypoxic and cyanotic
R to L shunt
Acute episodes of cyanosis and hypoxia called "blue" or "tet spells"
Should be treated within 1st year
Tetralogy of Fallot
Subacute: starts with resolution of fever: cardiac damage, thrombocytosis, hypercoagulability, Desquamation/peeling of skin on toes/fingertips, hands and feet. Arthritis, irritability.
Stage 2 of Kawasaki Disease
What would you include in a VS & Physical Exam of cardiac function?
Tachy/Brady- Cardia
Tachypnea & BS - Wheezing, crackles, grunting
Murmur
Pulses
Cyanosis, Pallor, Clubbing
Nutritional Status
●Treatment – should be done by 2 yrs. old, no cardiopulmonary bypass needed
●Percutaneous balloon angioplasty - transcatheter
●Resection of narrow portion or enlargement with graft
●Stents placed in older adolescents
Coarctation of The Aorta
The following are treatment options for _________________?
•Infant in knee chest position
•Calm, comforting approach
•100% O2 via face mask
•Morphine SQ or IV
•IV fluid replacement/expansion
Repeat morphine
Hyper-cyanotic Spells
Symptoms are progressive
Increased pressure to the head and upper extremities
Hypertension in arms, bounding pulses
Dizziness, Headaches, Fainting, Aneurysms, Stoke
S&S of Heart Failure
Decreased pressure to body & lower extremities
Decreased BP & Weak Pulses in lower extremities
Should be treated by 2 yrs old
Coarctation of the aorta
The following describes which acquired heart defect?
Babies under 1 yr and children older than 5 yrs – highest risk of coronary artery sequelae
Leading cause of acquired heart disease
Kawasaki Disease
Poor feeder, Tachypnea, Tachycardia, Wheezes, Grunting, Diminished Breath, Murmurs, Cyanosis, Pallor, Clubbing, Activity Intolerance, Developmental Delays, Prenatal & Family History of Cardiac Disease, Asymmetrical Pulses, BP Changes
Pediatric Indicators of Cardiac Dysfunction
•Tx:
•Prostaglandins to open ductus arteriosus
•Cardiac catheterization balloon to create an ASD (temporary; repair in stages)
Transposition of the Greater Arteries
The following are nursing therapeutic managements for ______________?
▪Improve cardiac function (Administer Digoxin)
▪Reduce afterload – angiotensin-converting enzyme (ACE) inhibitors
▪Decrease Cardiac Demands
▪Improve Tissue Oxygenation
▪Minimize Fluid Overload (administer diuretics)
Chronic Heart Failure (CHF)