Congenital Heart Disease Flashcards
Congenital Heart Disease
Most common congenital anomaly
A major cause of death in 1st year of life
Can be structural and/or conductive
Etiology:
- 90% unknown
- multifactorial inheritance
- risk factors - maternal, family history
- associated with chromosomal abnormalities, syndromes or congenital defects in other body systems
- Gene mapping research
Increased Pulmonary Blood Flow (3)
Atrial septal defects
Ventricular septal defects
Patent Ductus arteriosus
Obstruction to systemic blood flow (3)
Coarctation of the Aorta
Aortic stenosis
Hypoplastic Left Heart Syndrome
Decreased Pulmonary Blood Flow (2)
Tetralogy of Fallot
Pulmonic Stenosis
Mixed blood flow
Transposition of the Great Arteries
Truncus Arteriosus
Hemodynamic Classification: Increased pulmonary blood flow
- Left-to-right shunt
- Cause HF
Hemodynamic Classification: Decreased pulmonary blood flow
Right-to-left shunt if septal defect present
Cause cyanosis
Hemodynamic Classification: Obstruction to systemic blood flow
Increased pressure load on left ventricle -> decreased CO (shock)
Signs of poor CO; HF (cyanosis on right side)
Hemodynamic Classification: Mixed blood flow
Saturated & desaturated blood mix within heart or great arteries -> variable clinical picture
Cyanosis & HF
Defects with Increased Pulmonary Blood Flow
Left-to-right shunt: connection of left & right sides of heart (septal defect), or of great arteries (PDA)
S&S of HF: increased blood volume on right side increases pulmonary blood flow at expense of systemic blood flow
Defects that obstruct systemic blood flow
Blood exiting heart mets area of anatomic narrowing (stenosis) causing obstruction to blood flow
- increase pressure in ventricle & great artery before obstruction
- Decreased pressure in area beyond obstruction
Defects with Decreased Pulmonary Blood Flow
Obstruction of pulmonary blood flow & anatomic defect (ASD or VSD)
Right to left shunt
Hypoxemic & usually cyanotic
Hypercyanotic Spells (Tet spells): Clinical Manifestations
- increased rate & depth of respiration
- increased cyanosis
- Increased heart rate
- Pallor & poor tissue perfusion
- Agitation or irritability -> may lead to limpness or seizures
Hypercyanotic Spells: Treatment
- Knee-chest position (decreases venous return, shunting blood to vital organs, reduces cardiac workload)
- calm, comforting approach
- administer 100% oxygen
- give SC or IV morphine
- begin IV fluid replacement & volume expansion, prn
- Repeat morphine administration
Mixed Defects
Survival in post-natal period depends on mixing of blood from pulmonary & systemic circulations within the heart chambers
Pulmonary congestion
Decreased CO
Clinically - some degree of desaturation (cyanosis may not be visible) & HF