CONGENITAL HEART DISEASES Flashcards
defect in the heart or great
vessels or persistence of a fetal
structure after birth
congenital heart disease
classification - increased blood flow, obstruction to blood flow from vesicles
acyanotic
classification - decreased pulmonary blood flow, mixed blood flow
cyanotic
left or right sided failure?
hepatosplenomegaly
jugular vein distention
edema
weight gain
oliguria
right sided
left or right sided failure?
cough
cyanosis
grunting
retraction
crackles
head bobbing
left sided
defects with increased pulmonary blood flow
atrial septal defect
ventricular septal defect
patent ductus arteriosus
atrioventricular canal defect
most common CHD result from a connection between the left and right side of the heart (septal defect) or between the great arteries (patent ductus arteriosus) that allows blood to flow between the left and the right side of the heart
increased pulmonary blood flow
clinical manifestations of increased pulmo blood flow
- increased HR, RR, metab
- poor suck
- diaphoresis
- poor weight gain
- CHF
- respi infections
- Abnormal opening between the
atria, allowing blood from the
higher pressure left atrium to
flow into lower pressure right
atrium - Right atrial and ventricular
enlargement occurs
atrial septal defect
ASD heart sound
early to midsystolic murmur at the 2nd/3rd left intercostal
types of ASD
opening is at the lower end of the septum
ASD 1 - ostium primum
types of ASD
opening is near the center of the septum
ASD 2 - ostium secundum
types of ASD
opening is near the junction of the superior vena cava and the right atrium
ASD 3 - sinus venosus defect
surgical management of ASD
- large defect - sutures / patch graft
- small defect - no intervention
- cardiac catheterization (umbrella)
- Abnormal opening between the right and left ventricles
- Many close spontaneously during
the 1st year of life in children with small or moderate defects
ventricular septal defect
VSD heart sound
midsystolic murmur at 2nd ICS left sternal border
true or false - in VSD, s/sx of HF and decreased cardiac output are present
true
management for ASD and VSD
- low sodium
- fluid restriction
- activity as tolerated
medication for ASD and VSD
- digoxin
- diuretics
- antibiotics
- analgesics
- vasopressor
surgical management VSD
___ to normalize pressures and flow distal to the band and prevent pulmonary vascular disease
pulmonary artery banding
- Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first
weeks of life. - Widened pulse pressure and bounding pulses are present
patent ductus arteriosus
PDA heart sound
continuous, harsh, machinery-like
murmur at left upper sternal border
PDA WOF?
crackles (sign of complication; left sided HF)
medical management PDA
- prostaglandin E1 (alprostadil)
- indomethacin IV
- oxygen
surgical management PDA
- surgical ligation (TOC!)
- newborns - balloon atrial septostomy
If PDA is not treated, the child’s life span is shortened because ___ and ___ develop
pulmonary hypertension and pulmonary vascular obstructive disease
- a combination of defects in the atrial and ventricular septa and portions of tricuspid and mitral valves
atrioventricular canal defect
other name for atrioventricular canal defect
endocardial cushion defect
AVCD (wow gawa gawa) heart sounds
A holosystolic (heard the entire phase of systole) murmur is loudest at the left lower sternal border
management for AVCD
- surgery
- palliative pulmo artery banding
- patches over septal defects
- prophylaxis for infective endocarditis
obstruction to blood flow from ventricles types of defects
coarctation of aorta
aortic stenosis
pulmonic stenosis
▪An anatomic stenosis of the aorta causes obstruction to blood
flow and results in a pressure load on the left ventricle and
decreased cardiac output
obstructed systemic blood flow
where the location of the narrowing in obstructed systemic blood flow?
near the valve of the obstructive defect
clinical manifestations of obstructed systemic blood flow
- diminished pulse
- delayed capillary refill
- decreased UO
- leg cramps
- cold feet
- decreased blood in GI
- Localized narrowing near the insertion of the ductus arteriosus
- Blood pressure is higher in upper extremities than the lower
extremities
*Headache, dizziness, fainting, epistaxis due to hypertension
coarctation of the aorta
coarctation of the aorta heart sounds
Systolic heart murmur at interscapular area on the left
surgical management of coarctation of the aorta
- balloon angioplasty
- end to end anastomosis
- reconstruct aorta with flap of left subclavian
true or false - in surgical mgmt of coarctation of the aorta cardiopulmonary bypass incision is used
false - thoracotomy incision
- Narrowing of the aortic valve
- causing resistance to blood
flow from the LV into the
aorta, resulting in
decreased CO, left
ventricular hypertrophy,
pulmonary vascular
resistance
aortic stenosis
aortic stenosis heart sounds
systolic heart murmur @ the right 2nd ICS
surgical management of aortic stenosis
- dilation of narrowed valve
- aortic valvotomy
- valve replacement
Narrowing at the entrance to the
pulmonary artery (pulmonary
valve)
pulmonic stenosis
pulmonic stenosis heart sounds
A loud systolic ejection murmur
with a widely split S2 and thrill
Newborns with severe narrowing (pulmonic stenosis) are ___
cyanotic
surgical management of pulmonic stenosis
- dilation by balloon valvuloplasty
- transventricular valvotomy
- pulmonary valvotomy
mgmt of obstructed systemic blood flow
- PGE1
- digoxin
- antibiotic
- antihypertensives
- oxygen
- fluid restriction
- low sodium
- limited activity
decreased pulmonary blood flow types of defects
tetralogy of fallot
tricuspid atresia
*Defects that obstruct the pulmonary blood flow result in little or no blood reaching the lungs to get oxygenated.
* Right-sided pressures exceed those on the left, resulting in
right-to-left shunting
decreased pulmonary blood flow
4 defects of TOF
VSD
pulmonary stenosis
overriding of aorta
right ventricular hypertrophy
clinical manifestations of TOF
- tet spell
- cyanosis
- squatting
- clubbing
- dyspnea
- growth retardation
- prominent inferior sternum
TOF heart sounds
Cardiac thrill at the left sternal
border and an obvious right
ventricular impulse
what to do if hypercyanotic spell occurs?
- knee chest
- 100% oxygen
- morphine sulfate
- IV fluid replacement
treatment for TOF
- prevent complications
- cyanotic spells: knee-chest, O2, morphine
- beta-adrenergic blockers
- prophylactic antibiotics
surgical management for TOF
- blalock-taussig - join the subclavian and pulmonary artery
- relieve pulmo stenosis
- close VSD
- the absence of communication
between the right ventricle and
the pulmonary artery
pulmonary/tricuspid atresia
medical and surgical mgmt for PTA
- alprostadil
- subclavian-pulmonary shunt
- fontal procedure (restructure right side of heart)
mixed blood flow types of defects
transposition of great arteries
total anomalous venous return
truncus arteriosus
hypoplastic left heart syndrome
*involve a combination of defects that make the newborn
dependent upon mixing pulmonary and systemic circulations for
survival during postnatal period
* mixing of oxygen-saturated and desaturated blood results in a
general desaturated systemic blood flow and cyanosis
mixed defects
___ occurs because of increased pulmonary
blood flow and obstruction of systemic flow.
pulmonary congestion
- The pulmonary artery
leaves the left ventricle
and the aorta exits from
the right ventricle - No communication exists
between the systemic and
pulmonary circulation
transposition of great arteries
- The defect is a failure of the pulmonary veins to join the left atrium
- The defect results in mixed blood being returned to the right atrium
and shunted from the right to the left through an ASD
total anomalous pulmonary venous return
total anomalous pulmo venous return - The right side of the heart ___, whereas the left side of the heart may remain small
hypertrophies
clinical manifestations of total anomalous pulmonary venous return
- cyanosis
- respi infections
- precordial bulge is palpated
- injection murmur and gallop in the pulmonic area
___ may occur with feedings as the filled esophagus compresses the common pulmonary vein
increased cyanosis
mgmt of total anomalous pulmonary venous return
- prostaglandin E1
- treat hypoxemia and chf
- balloon atrial septostomy
prognosis of total anomalous pulmonary venous return
survivors have lived more than 2- years after correction
- Failure of the normal septation
and division of the embryonic
bulbar trunk into the pulmonary
artery and the aorta, resulting in
a single vessel that overrides
both ventricles - Blood from both ventricles mixes
in the common great artery,
causing desaturation and
hypoxemia
truncus arteriosus
mgmt for truncus arteriosus
- rastelli procedure (close vsd, make passage to pulmo arteries)
- digoxin and diuretics
prognosis for truncus arteriosus
- truncal valve stenosis and regurgitation
- child should not participate in competitive sports
Underdevelopment of the
left side of the heart
occurs, resulting in
hypoplastic left ventricle
and aortic atresia
hypoplastic left heart syndrome
clinical manifestations of hypoplastic left heart syndrome
- cyanosis
- progressive deterioration
- decreased cardiac output - cardiovascular collapse
treatment for hypoplastic left heart syndrome
- prostaglandin E
- ventilator
- digoxin diuretics
- surgery
- heart transplant
- norwood
what to monitor before giving digoxin
pulse rate - do not give if below 100 bpm
Give digoxin at regular intervals; usually every ___ hours
12
Do not mix the digoxin with food or other fluids; Administer ___ before or ___ after feeding
1 hour before
2 hours after
true or false - digoxin If the child vomits, do not give a 2nd dose
true
