Acyanotic Heart Defects Flashcards
arterial septal defect (ASD)
a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart.
clinical manifestations of ASD
may be asymptomatic
heart murmur
CHF
children with ASD are at an increased risk of
increased risk of dysrhythmias with pulmonary vascular obstructive disease and emboli later in life
treatment of ASD
mild defects may close spontaneously
open heart
dacron patch closure
may be closed using devices (septal occluder) during heart cath
Ventricular septal defect
septum fails to completely form between the right and left ventricles, pinpoint to total absence
clinical manifestations of ventricular septal defect
CHF; mod to severe, cyanosis characteristic murmur right ventricular hypertrophy FTT fatigue recurrent respiratory infections
therapeutic management of ventricular septal defects
pulmonary artery banding
may close spontaneous by age 3
interventional heart cath with septal occluder or surgical correction with a patch and repair of AV valve tissue
increased pulmonary blood flow defects
ASD
Ventricular septal defects
Patent ductus arteriosus (PDA)
patent ductus arteriosus (PDA)
fetal structure fails to close, blood is shunted from the aorta to the pulmonary artery
clinical manifestations for PDA
machine like murmur
can be asymptomatic
CHF
treatment of PDA
indomethacin (prostaglandin E inhibitor)
interventional heart cath with coil
LT thoracotomy or VATS
what is a VATS
video assisted thoroscopic surgery
3 small incisions on LT side of chest to place a clip on on the ductus
what causes obstructive lesions
blood exiting the heart meets an area of anatomic narrowing, causing obstruction to blood flow
where does the obstructive lesions form?
near the valve as in aortic and pulmonic stenosis
consequences of obstructive lesions
either shunting ( LT to right) or back-up of blood on the right side
increased pulmonary congestion
signs of CHF
coarctation of aorta
localized narrowing of aorta near the insertion of the ductus arteriosus, resulting in increased pressure proximal to the defect ( head and upper extremities’) and decreased pressure distal to the defect (body & lower extremities)
what are the two locations of coarctation of the aorta
preductal- between subclavian artery before the ductus arteriosus
postductal- collateral circulation develops during fetal life (distal to the ductus arteriosus)
clinical consequences of coarctation of the aorta
L-R shunting, increased pulmonary blood flow leading to CHF
increased blood flow to head and upper extremities
decreased blood flow to trunk and lower extremities
therapeutic management of coarctation of aorta
prostaglandin E to maintain PDA
Balloon angioplasty
surgery within the first 2 years
obstructive blood flow defects
coarctation of aorta
aortic stenosis
pulmonic stenosis
aortic stenosis
narrowing or stricture of aortic valve causing resistance to blood flow out of left ventricle
results in decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion.
serious effects of aortic stenosis
obstruction tends to be progressive
sudden episodes of myocardial ischemia, or low cardiac output, can result in SUDDEN DEATH. Only defect where ACTIVITY IS LIMITED.
surgical repair rarely results in a normal valve.
clinical manifestations of aortic stenosis in infants
faint pulses hypotension tachycardia poor feeding decreased cardiac output
clinical manifestations of aortic stenosis in children
exercise intolerance, chest pain, and dizziness when standing for long periods
treatment of aortic stenosis
balloon dilation or
surgery; aortic valvotomy or replacement .
Mortality high in NB low for older kids
what is restricted in kids with aortic stenosis?
activity level
children are not on bedrest, but activity level is restricted (can watch movies instead of going outside, play legos instead of riding a bike, take elevator instead of stairs)
NO STRENUOUS ACTIVITY
pulmonic stenosis
narrowing at the entrance to the pulmonary artery
pulmonary atresia
extreme form of pulmonic stenosis, total fusion resulting in no blood flow to the lungs
clinical manifestations of pulmonic stenosis
may be asympotmatic
some have mild cyanosis, CHF or murmur
treatment of pulmonic stenosis
balloon angioplasty
surgery
acyanotic defects in summary
shunting from LT to RT
increased pulmonary vascular congestion
monitor for signs of CHF
tachypnea, diaphoresis, eating problems, edema, rales, crackles
