7.4 Acyanotic Conditions

Question 1

Heart Defect Classifications

Answer 1

Cyanotic

(Decreased Blood Flow Pulmonary Disorders)
- Tetralogy of Fallot

(Mixed Blood Flow Disorders)
- Transposition of Great Vessels
- Truncus Arteriosus
- Hypoplastic Left Heart Syndrome

Acyanotic

(Increased Pulmonary Blood Flow)
- Atrial/Septic Defect
- Ventral/Septal Defects
- Patent Ductus Arteriosus

(Obstruction Disorders)
- Aortic Stenosis
- Coarctation of the Aorta
- Pulmonary Stenosis

Question 2

Atrial/Septic Defect (ASD)

Answer 2

• Acyanotic (NO BLUE)
• Foramen Ovale between left and right atrium does not close after birth
• Oxygenated blood from the left side of the heart goes to the right side because there is less pressure. The right side must compensate for increased volume.
• Not as likely to cause HF because there is not as much pressure between the right atrium and the right ventricle.
• Usually asymptomatic
• Heart sounds are split
• You may be able to hear a murmur near the tricuspid valve (upper left sternal border)
• The right atrium and right ventricle may be enlarged due to increased workload.

Treatment
- Patch
- Open repair

Question 3

Ventral Septal Defect (VSD)

Answer 3

• Acyanotic (NO BLUE)
• Opening between the ventricles
• Left ventricle pushes blood to the right ventricle.
• This increases volume on the right side ventricle which causes right side of the heart to work harder because it must push more blood through pulmonary resistance to the lungs. This makes it more susceptible to HF.
• These may close on their own in the 1st year of life

Treatment
- Sutures
- Patches

Question 4

Patent Ductus Arteriosus

Answer 4

• Ductus arteriosus does not close
• Allows blood to flow from higher pressure aorta to lower pressure pulmonary artery which causes a left to right shunt causing blood to need to re-circulate to the lungs. This causes pulmonary congestion or more workload for the right side of the heart. This also causes increased workload of the left side of the heart with the extra blood volume.

Symptoms
- Classic Machine-like Murmur
- Can show signs of HF
- Turbulent blood flow from aorta to pulmonary artery

Treatment
- Medication (indomethacin)
- Surgery

Question 5

Coarctation of the Aorta

Answer 5

• Narrowed aorta
• This constriction occurs where the ductus arteriosus used to be
• Due to this constriction not enough blood is being pumped out to the periphery. You see increased amount of blood flow to upper extremities but decreased blood flow to lower extremities

Symptoms
- Blood pressure is higher in upper extremities than lower extremities
- Murmur during systole
- Left ventricular wall thickens due to workload increasing to pump blood to the periphery

Treatment
- Surgery
- Balloon

Question 6

Aortic Stenosis

Answer 6

• Narrow opening of the aortic valve causing increased amount of workload on the left ventricle which can lead to left sided HF

Symptoms
- Poor feeding
- Decrease cardiac output
- Murmur
- Left ventricular hypertrophy

Treatment
- Surgery
- Balloon

Question 7

Pulmonary Stenosis

Answer 7

• Narrow opening that causes increased workload on right ventricle which can lead to right sided heart failure

S/S
- Poor feeding
- Decreased Cardiac Output
- Murmur
- Right ventricle hypertrophy

Treatment
- Surgery
- Balloon

Question 8

Summary

Answer 8

ASD - Abnormal opening between the atria allowing blood to flow from left atrium to right atrium

VSD - Abnormal opening between the ventricles allowing blood to flow from left ventricle to right ventricle

PDA - Failure of ductus arteriosus to close within the first few weeks of life causing blood to go from aorta to pulmonary artery

Coarctation - Localized narrowing near insertion site of ductus arteriosus (aorta)