pediatric cardiac issues Flashcards
What are the two broad classifications of congenital heart defects?
- Acyanotic (increased pulmonary blood flow)
- Cyanotic (decreased delivery of oxygenated blood to body)
what is the major complication that occurs with acyanotic heart defects?
- congestive heart failure
- as a child with an acyanotic defect grows, they may become cyanotic
what are some acyanotic heart defects?
- patent ductus arteriosis
- atrial septal defect
- ventricular septal defect
what is patent ductus arteriosis?
- where the ductus arteriosis remains open (should normally close around 14 hours after birth)
- occurs more commonly in premature infants (less than 28 weeks)
- can be present with other heart defects
- makes up 5-10% of congenital heart defects
- occurs in 1/2000 term infants
what is an atrial septal defect?
- where a hole is present between right and left atria
- this may be because foramen ovale doesn’t close
- some ASDs will close spontaneously
- can sometimes be identified by noting a pulse deficit
what is a ventricular septal defect?
- an opening between the two ventricles
- the most common of all defect
- only 15% large enough to cause CHF
- creates pulmonary vascular resistance and treatment depends on size and how much resistance
how are acyanotic lesions managed?
- digoxin
- diuretics (to prevent pulmonary congestion)
- oxygen
- elevation of head of bed (also prevents pulmonary congestion)
- surgery
what are cyanotic defects?
- heart defects that result in decreased oxygen delivery to body
- may be because of circulating unoxygenated blood or decreased volume of flow
What is Tetralogy of Fallot?
- a cyanotic heart defect with four features:
1) ventricular septal defect
2) pulmonary stenosis
3) overriding aorta
4) right ventricular hypertrophy 2ndary to stenosis - results in mixing of oxygenated and deoxygenated blood flowing to body
what is a TET spell?
a spell of extreme hypoxemia
-caused by too much blood mixing and not enough oxygen reaching the body
what positions may a child experiencing a TET spell take and why?
crouching or the fetal position
-raises the systemic vascular resistance and forces more blood to heart and lungs
How is tetralogy of fallot treated?
- beta blockers
- morphine (slows respiration rate)
- prostaglandin E1 (if closure of PDA is life threatening prostaglandin keeps open)
- surgery ideally by 4-6 months old
- adequate hydration
- supplemental oxygen
- antibiotics prophylactically to prevent endocarditis
how and why does the ductus arteriosis normally close?
-the cutting of the umbilical cord, oxygen exposure and decrease in prostaglandin normally closes this just after birth
what are the four defects that define tetralogy of fallot?
1) pulmonary stenosis (narrowing of pulmonary valve)
2) right ventricular hypertrophy (this usually occurs because of the increased work of pumping into narrow and thickened pulmonary valve)
3) over-riding aorta (gets blood from right and left ventricle because it over-rides to right side)
4) ventricle septal defect
what are symptoms of tetralogy of fallot?
- child may squat when experiencing a tet spell to increase systemic resistance making it harder for blood to go into aorta and therefore more goes to lungs
- lower spO2
- cyanosis
- shortness of breath
- rapid respiration rate
- clubbing of fingers and toes
- poor weight gain
its tetralogy of fallot a cyanotic or acyanotic defect?
cyanotic as the over-riding aorta collects deoxygenated blood from the right ventricle, the VSD most often shunts right to left because of the right ventricular hypertrophy and there is less circulation through lungs because of the pulmonary stenosis
what is congestive heart failure?
- occurs when heart muscle is unable to pump enough to meet up with body’s demands
- ventricles can’t pump sufficiently to body and so blood and other fluids back up into lungs, abdomen, liver, and lower body
- fluid builds up around heart contributing to inefficiency of pumping
what is a symptom of a tet spell?
-becoming blue as a result of not enough oxygen reaching body
why may prostaglandin be given for cyanotic heart conditions?
to keep ductus arteriosus open until other defects can be repaired. this opening in the aorta allows for more blood to circulate past lungs
how soon after birth is the ductus arteriosus normally closed?
14 hours