Peds Cardiac Flashcards
Cardiac Defects that Increase Pulmonary Blood Flow
Patho
- Ventricular Septal Defect (VSD)
- Atrial Septal Defect (ASD)
- Patent Ductus Arteriosus (PDA)
- Atrioventricular Canal Defect
Blood is shunted from the higher pressure left side to the lower pressure right side, causing a large amount of blood to move through the heart to the lungs
Cardiac Defects that Decrease Pulmonary Blood Flow
Patho
- Tetralogy of Fallot (TOF)
- Tricuspid Atresia
- Pulmonary Stenosis
- Right Ventricular Hypertrophy
- Overriding Aorta
Blood shunts from the higher pressure right side of heart to lower pressure left side through a structural defect. Deoxygenated blood mixes with oxygenated blood, causing deoxygenated blood to enter systemic circulation.
Cardiac Defects that cause Obstructed Blood Flow
- Coarctation of the Aorta
- Aortic Stenosis
- Pulmonary Stenosis
All involve narrowing of a vessel, which interferes with the ability of the blood to flow freely through the vessel
Cardiac Defects that cause Mixed Blood Flow
- Transposition of the Great Arteries (TGA)
- Truncus Arteriosus
- Hypoplastic Left Heart Syndrome (HLHS)
Mixing of well-oxygenated blood with poorly oxygenated blood, resulting in systemic blood containing a lower oxygen content and decreased cardiac output
Consequences of CHD
Increased Flow
- Increased Pulmonary Flow: “Hole in the heart”; small, usually closes on its own; very common
- Increase flow to pulmonary system -> heart failure
Obstructive Flow
- Obstruction on left side -> heart failure
- Obstruction on right side -> cyanosis
- Weak pulses
- Cool hands and feet
Decreased Flow
- Decreased pulmonary blood flow -> cyanosis, Low O2 sats
- Cyanosis depends on size of defect
- O2 sats can be as low as 50%
Mixed Flow
- Hypoxemia (with or without cyanosis): cyanosis depends on how big the hole is
- Heart failure: depends on amount of fluid overload
Ventricular Septal Defect
Patho
Blood Flow
S/S
Risk for:
Diagnostics
- Most common cardiac defect; “hole in the heart”
- Hole between right and left ventricle
- Blood flow: From LV to RV; higher to lower pressure
- Usually will heal on its own
S/S: - If small defect, may be asymptomatic (because L-R shunting is minimal due to increased pulmonary resistance at birth)
- Easily tired
- Poor feeding (worried about weight gain)
- Frequent pulmonary infections
- SOB, tachypnea, and loud, harsh murmur
- Lethargy with difficulty eating
- If the baby is not eating or growing well, they need surgery
Risk for - Aortic valve regurgitation
- Infective endocarditis
Diagnostics - ECHO
- Chest X-Ray
- MRI if needed (radiation is a last resort)
Ventricular Septal Defect
Treatment
Surgical
Cardiac catheterization lab
- Septal occluding device is inserted that blocks the defect with a permanent implant
- Not recommended for pt with coagulation concerns or active bacterial infections
Open Heart Surgery:
- Pericardial Patch vs. Suturing
- Usually babies are not operated on until 6 months of age or it is based on weight (2000 grams)
- Complications: Dysrhythmias
Non-Surgical
Vitals:
- HR
Lab work:
- Electrolytes (CMP), Digoxin
Lasix (furosemide):
- Diuretic, gets fluid off lungs
- Weight based dose
- Take at home everyday
Digoxin
- Increases force of contractility
- Decreases HR; assess heart rate before giving (within 1 hour before giving)
- If less than 90 bpm, do NOT give Digoxin
- Digoxin Toxicity S/S: dysrhythmias, profusely vomiting (fluids, monitor electrolytes), anorexia
- On a monitor
- Check digoxin levels routinely
Preventative measures for heart failure, help the baby feed and grow so they do not need surgery
Tetralogy of Fallot (TOF)
Patho
Risk Factors
3rd most common defect
Involves 4 abnormalities in the structure of the heart. Typically:
1) VSD (hole between ventricles)
2) Narrowing of pulmonary artery
3) Overriding aorta that shifts where blood is exiting the heart
4) Right ventricular hypertrophy (thickening of the wall)
Pulmonary stenosis impedes blood flow to the lungs, causing RV hypertrophy = increased RV pressure. Forces deoxygenated blood through the VSD to the LV. The overriding aorta receives blood from both the right and left ventricles.
Risk Factors:
- Higher likelihood to occur with some chromosomal disorders: Downs and DIGeorge
Clinical Presentation of Tetralogy of Falot
Management of exacerbation
Clinical Presentation: amount of cyanosis depends on size of defect
- Irritable
- Cyanotic with feeding and crying
- Poor growth
- Clubbing of the fingertips
- “Tet” spells: Hyper cyanotic spell (acute episode of cyanosis and hypoxia): occurs when oxygen requirements exceed blood supply, usually during crying or after feeding or throwing a tantrum (because they are holding their breath)
- Severe cyanosis at birth is rare, related to the presence of PDA (it is still open, closes up quickly after birth, and that is when cyanosis is seen)
- Some infants may be acutely cyanotic at birth if pulmonary stenosis severe
Management of Spell
- Knee to chest
- Bending to squat
- Fetal position
- Medications (if the first two things do not work): Morphine and Oxygen
- Nursing Implications for Care: cluster care to decrease irritability; oxygen reduces pulmonary vasoconstriction
Clinical Presentation of Tetralogy of Falot
Management of exacerbation
Clinical Presentation: amount of cyanosis depends on size of defect
- Irritable
- Cyanotic with feeding and crying
- Poor growth
- Clubbing of the fingertips
- “Tet” spells: Hyper cyanotic spell (acute episode of cyanosis and hypoxia): occurs when oxygen requirements exceed blood supply, usually during crying or after feeding or throwing a tantrum (because they are holding their breath)
- Severe cyanosis at birth is rare, related to the presence of PDA (it is still open, closes up quickly after birth, and that is when cyanosis is seen)
- Some infants may be acutely cyanotic at birth if pulmonary stenosis severe
Management of Spell
- Knee to chest
- Bending to squat
- Fetal position
- Medications (if the first two things do not work): Morphine and Oxygen
- Nursing Implications for Care: cluster care to decrease irritability; oxygen reduces pulmonary vasoconstriction
Tetralogy of Falot
Treatment
- Palliative shunt:
- Infant cannot undergo primary repair, typically due to PS
- Blalock Taussig Shunt (BTS): provides blood flow to pulmonary arteries from left or right subclavian artery via a tube graft - Complete repair:
- Usually, first year of life
- Involves closure of VSD with a patch
- Right ventricular outflow tract: the obstructed pathway between the right ventricle and the pulmonary artery is opened and enlarged with a patch. If the pulmonary valve is small, it may be opened as well.
- Widen the narrowed pulmonary blood vessels. The pulmonary valve is widened or replaced, and the passage from the right ventricle to the pulmonary artery is enlarged. These procedures improve blood flow to the lungs. This allows the blood to get enough oxygen to meet the body’s needs. - Fixing these two defects resolves problems caused by the other two defects. When the right ventricle no longer has to work so hard to pump blood to the lungs, it will return to a normal thickness. Fixing the VSD means that only oxygen-rich blood will flow out of the left ventricle into the aorta.
Coarctation of the Aorta
Patho and Blood Flow
A narrowing of the Aorta typically at or near the site of the ductus arteriosus. OUTSIDE the heart
- Pressure in the ventricle and in the great artery before the obstruction is increased; pressure in area beyond obstruction is decreased. = KINK IN WATER HOSE
- Hemodynamically there is a pressure load on the ventricle and decrease cardiac output.
- Narrowing of the Aorta between the upper body and the lower extremities**
- BLOOD FLOW: Blood flow is impeded at the coarctation, causing increased pressure proximally (LV) and decreased pressure distally.
- Decrease blood flow to trunk and lower extremities; increased blood flow to brain and upper extremities (2+ bounding pulses)
Coarctation of the Aorta
Clinical Presentation
Diagnostics
Treatment
Clinical Presentation
- Asymptomatic
- BP higher in upper extremities
- Weak or absent femoral pulses (same with pedal pulses)
Diagnostics:
- CXR
- ECHO
- Cardiac Cath (“E” sign)
Treatment
- Non-surgical Treatment: Balloon angioplasty, Stent placement
- Surgical Treatment: Resect portion of Aorta
Aortic Stenosis
Patho
Clinical Manifestations
Aortic Valve INSIDE heart; restricted blood flow out of the heart -> fluid overload of the heart
Thick walls of the heart
Clinical presentation
- Chest pain
- Fatigue
- SOB
- Syncope
- Systolic Ejection Murmur
Aortic Stenosis
Diagnostics
Treatment
Diagnostics
- ECHO, CXR
- Echo shows high areas of turbulence surrounding the valve
- Cardiomegaly on CXR - ventricle wall is big
- Can see electrophysiology changes on EKG (inverted T waves)
Treatment
- Balloon valvuloplasty, Valve replacement
