ATI 20 - Congenital heart Disease - DECR PULMO BF Flashcards
***3 types of decr pulmo BF
1 pulmo stenosis
2 tetralogy of fallot
3 pulmo/tricuspid atresia
stenosis
narrowing
- obstructs blood flow
- can be above or below valve
PULMONARY STENOSIS
**pathophysiology
obstructs BF into pulmo artery
>incr preload
»leads to RIGHT VENT HYPERTROPHY
PULMONARY STENOSIS
**clinical manifestations
- *mild stenosis = asymptomatic**
- dyspnea, fatigue on exertn
- systlc ejectn mrmr
- cyanosis
- cardiomegaly
incr in severity of pulmo stenosis
- louder + longer murmur
- cyanosis is worse
PULMONARY STENOSIS
**clinical therapy
- *balloon dilatn of valve**
- surgicl valvotomy - when baloon is not indicated
PULMONARY STENOSIS
prognosis
newborns w critical PS = mortality rt 10%
- usually doesnt incr in severity
- lifelong infective endocarditis prophylaxis is needed
preferred tx for PULMONARY STENOSIS
balloon dilation of valve
-performed during catherization
**TETRALOGY OF FALLOT **
4 defects involved
1 stenosis of pulmo outflow tract or valve
2 right ventrcl hypertrophy
3 ventricl septal defect
4 overriding aorta
overriding aorta + ventrclr septal defect
allow unoxygenated blood to pass into systemic circulation
***How is severity determine din TETRALOGY OF FALLOT
***degree of pulmo stenosis
**toddlers w uncorrected TETRALOGY OF FALLOT instinctively…
squat
- assume knee-chest position
- incr systemic vascular resistance
- incr pulmo blood flow
TETRALOGY OF FALLOT
clinical manifestations
newbornds: hypoxic + cyanotic as ductus arteriosus closes
older infants/toddlers: tachypnea + cyanosis
-polycythemia, hypoxic spells, metab acidosis, poor growth, clubbing, + exercise intolerance
-systolc murmur heard in pulmonic area
-thrill inpulmo area
TETRALOGY OF FALLOT
clinical therapy*
- *most have corrective surgery by 1-2 yr unless a hypercyanotic spell occurs earlier
- symptomatic kids have correctv surgery after 3-4 mo age
- *may need palliative modified BLALOCK-TAUSSIG SHUNT while waiting
**priority nursing mgmt if TETRALOGY OF FALLOT is experiencing cyanosis
KNEE CHEST POSITION
- then O2
- calm kid
- give morphine
TETRALOGY OF FALLOT
**prognosis
-not all are cured, most have improved quality of life
- *valve replacement 10-20 yr after corrective surgery
- —if pulmo regurg worsens
- *ventricular arrythmias may happen years after surgery and can cause sudden death!!! wtf
**atresia
absent or abnormal narrowing
no valve
**patent foramen ovale
allows blood flow fr RA to LA
**patent ductus arteriosus
allows blood flor to pulmo artery
**Pulmonary Atresia
no valve/opening to allow blood to flow from RV to pulmo artery
**Tricuspid Atresia
no valve or opening to allow blood to flow fr RA to RV
Pulmonary or Tricuspid Atresia
**clinical manifestations
severe cyanosis present at birth
- poor feedng, growth delay
- CHF, pulmo edema, hepatomegaly
- tachypnea, acidosis, hypoxic spells, clubbing
- cont mrmr in pulmo area
- single s2
**medication to keep atresia open
prostaglandin E
- given immediately to maintain PDA
- opposite of ibuprofen which is a prostaglandin inhibitor
Pulmonary or Tricuspid Atresia
clinical therapy
- PGE (immediately to maintain PDA)
- tx CHF
- balloon atrial septostomy
- surgery in 3 stages
Pulmonary or Tricuspid Atresia
**surgery in 3 stages
1 shunt placement
2 glenn procedure
3 fontan procedure
**in pulmo/tricuspic atresia, the RV becomes…
hypoplastic
