THE CHILD WITH CONGENITAL HEART PROBLEM Flashcards
Weaker pulses or lower blood pressure in the lower extremities may indicate
coarctation of the aorta (COA)
Bounding pulses can indicate
patent ductus arteriosus (PDA) or aortic insufficiency.
to define silhouette of the heart.
Heart size, shape, pulmonary markings, and cardiomegaly.
Chest x-ray
n invasive test to diagnose or treat cardiac defects.
Visualizes heart and vessels.
Measures oxygen saturation of chambers.
Measures intra-cardiac pressures.
Cardiac Catheterization
Watch for signs of toxicity to the dye used during the procedure
Increased temperature Urticaria Wheezing Edema Dyspnea Headache
Pre-cardiac Catheterization
Assess vital signs with blood pressure Hemoglobin and hematocrit Pedal pulses Observe NPO Hold digoxin IV if child is polycythemic
ressures on the left side of the heart are normally higher than the pressures in the right side of the heart.
Left to Right Shunt
Clinical Manifestations of
Left to Right Shunt
infant is not cyanotic.
Tachycardia due to pushing increased blood volume.
Cardiomegaly due to increased workload of the heart.
Deoxygenated blood from the right side shunts to the left side
Right to Left Shunts
Clinical Manifestations Right to Left Shunts
Hypoxemia = the result of decreased tissue oxygenation.
Polycythemia = increased red blood cell production due to the body’s attempt to compensate for the hypoxemia.
Increase viscosity of the blood = heart has to pump harder.
Treatment of Heart Failure
Digoxin Therapy
Digoxin increases the force of the myocardial contraction.
Bradycardia Arrhythmia Nausea, vomiting, anorexia Dizziness, headache Weakness and fatigue signs for?
Signs of Digoxin Toxicity
Interventions for Heart Failure
Fluid restriction
Diuretics – Lasix (potassium wasting) or Aldactone (potassium sparing)
Bed rest
Oxygen
One of the most common benign defects
Ductus normally closes within hours of birth
Connection between the pulmonary artery (low pressure) and aorta (high pressure)
Patent Ductus Arteriosus
Diagnosis of Patent Ductus Arteriosus
Chest x-ray – enlarged heart and dilated pulmonary artery
Echo-cardiogram
Treatment of Patent Ductus Arteriosus
- Indomethocin given po – constricts the muscle in the wall of the PDA and promotes closure
- Cardiac Catheterization – coil is placed in the open duct and acts like a plug
- Closed heart surgery – small incision made between ribs on left hand side and PDA is ligated o
Blood in left atrium flows into right atrium
Pulmonary hypertension
Reduced blood volume in systemic circulation
Atrial Septal Defect
Treatment For Atrial Septal Defect
Surgical closure of the atrial septal defect
Opening in the ventricular septum
Left-to-right shunt
Right ventricular hypertrophy
Deficient systemic blood flow
Ventricular Septal Defect
Diagnosis of Ventricular Septal Defect
heart murmur
Electrocardiogram – to see if there is a strain on the heart
Chest x-ray – size of heart
Echocardiogram – shows size of the hole and size of heart chambers
Treatment of VSD
CHF:
Digoxin if additional force needed to squeeze the heart
FTT (Failure to thrive) o
Congenital narrowing of the descending aorta
80% have aortic-valve anomalies
Difference in BP in arms and legs (severe obstruction)
Coarctation of Aorta
Treatment of Coarctation of Aorta
Prostaglandin
when a baby’s heart does not form correctly as the baby grows and develops in the mother’s womb during pregnancy.
Tetralogy of Fallot (TOF)
Tetralogy of Fallot (TOF)
first described by
Étienne-Louis Fallot in 1888
Tetralogy of Fallot (TOF)
Four Components
VSD
Pulmonary stenosis
Overriding of the aorta
Hypertrophy of right ventricle
has two rather than three leaflets. Leaflets are thickened or fused.
Obstruction of blood flow from left ventricle
Mild symptoms: dizziness, syncope, angina, fatigue
Aortic Stenosis
Diagnosis of Aortic Stenosis
Heart murmur
Electrocardiogram
Echocardiogram
Exercise stress test
Treatment of Aortic Stenosis
Cardiac catheterization
Surgical valvotomy
Life threatening shock develops when the ductus arteriosis closes
Low oxygen saturations – will not increase with oxygen administration
Pulses will be weak in all extremities
HYPOSTATIC LEFT HEART SYNDROME(HLH)
TREATMENT FOR HYPOSTATIC LEFT HEART SYNDROME(HLH)
Norwood – right ventricle becomes the systemic ventricle pumping blood to the body
Glenn – done at 3-6 months
Fontan – done at 2 -3 years of age
Infection of endocardial surface of the heart
History of CHD, Kawasaki Disease, Rheumatic Fever, or prosthetic valves are more susceptible to infection
Bacterial Endocarditis
Acute-self limiting disease
Generalized vasculitis
Peak incidence 6 months to 2 years
More common in males and Japanese
Kawasaki Disease
