Pediatric Cardiac Disorders

Fetal Circulation

Main Blood Flow

Placenta Umbilical Vein Liver Ductus Venosus Inferior Vena Cava

Vena Cava Right Atrium Foramen Ovale Left Atrium Left Ventricle

Aorta Body

Fetal Circulation

Secondary Route:

Right Atrium

Right Ventricle

Pulmonary Artery

Ductus Arteriosus

(so does not go to lungs)

Aorta

Body

Fetal Circulation

Third route of blood flow

Right Atrium

Right Ventricle

Pulmonary Artery

Lungs (needs to perfuse the

lungs and upper body with

oxygen)

Left Atrium

Left Ventricle

Aorta

Body

Transition from Fetal Circulation to Pulmonary circulation

The umbilical arteries and vein and the ductus venosus become non-functional

Decreased pulmonary vascular resistance and increased pulmonary blood flow

Increase in pressure of the left atrium, decrease pressure in right atrium, causing closure of foramen ovale.

Pulmonary resistance is less than systematic resistance so there is left-to-right shunting resulting in closure of the ductus arteriosus.

Congestive Heart Failure

Congestive heart failure

The inability of the myocardium to circulate enough oxygenated blood to meet the demands of the body.

When the heart fails, cardiac output is diminished. Heart rate, preload, contractitility, and afterload are affected.

Peripheral tissue is not adequately perfused.

Congestion in lungs and periphery develops.

Signs and Symptoms

1. Tires easily during feeding

2. Periorbital edema, weight gain

3. Rales and rhonchi

4. Dyspnea, orthopnea, tachypnea

5. Diaphoretic / sweating

6. Tachycardia

7. Failure to gain weight

Treatment of Congestive Heart Failure Medication Therapy

Digitalis – increases contractility and decreases heart rate.

ACE-inhibitors - arterial vasodilator / afterload reducing agent

Diuretics - enhance renal secretion of sodium and water by reducing circulating blood volume and decreasing preload.

Beta Blocker - increases contractility

Treatment of Congestive Heart Failure

Diet – low sodium, small frequent feedings

(be sure you can pick the right foods for a low NA diet.

Nursing care:

Measure intake and output – weighing diapers

Observe for changes in peripheral edema and circulation

If ascites present – take serial abdominal measurements to monitor changes.

Skin care

Turning schedule

Congenital Cardiac Anomalies

Defects that increase pulmonary blood flow

Patent Ductus Arterious

Atrial septal defects

Ventricle septal defects

Atrial Septal Defect

1. Oxygenated blood is shunted from left to right side of the heart via defect

2. A larger volume of blood than normal must be handled by the right side of the heart hypertrophy

3. Extra blood then passes through the pulmonary artery into the lungs, causing higher pressure than normal in the blood vessels in the lungs congestive heart failure

Treatment

Medical Management

Medications – digoxin

Cardiac Catheterizaton - Amplatzer septal occluder

Open-heart Surgery

Cardiac Catheterization

Pre-care:

History and Physical

Lab work – EKG, ECHO cardiogram, CBC

NPO

Preprocedural teaching

Post Care:

Monitor vital signs

Monitor extremity distal to the catheter instertion,

Keep leg immobilized

Vital signs

Check for bleeding at insertion site

Measure I&O

Treatment

Device Closure – Amplatzer septal occluder

During cardiac catheterization the occluder is placed in the Defect

Ventricle Septal Defect

1. Oxygenated blood is shunted from left to right side of the heart via defect

2. A larger volume of blood than normal must be handled by the right side of the heart hypertrophy

3. Extra blood then passes through the pulmonary artery into the lungs, causing higher pressure than normal in the blood vessels in the lungs congestive heart failure

Treatment

Surgical repair with a patch inserted

Patent Ductus Arteriosus

1. Blood shunts from aorta (left) to the pulmonary artery (right)

2. Returns to the lungs causing increase pressure in the lung

3. Congestive heart failure

Treatment for PDA

Medical Mangement

Medication

Indomethacin - inhibits prostaglandin's which help keep the ductus arteriosus open

Surgery Ligate the

ductus arteriosus

Treatment for PDA

Cardiac Catheterization

Insert coil – tiny fibers

occlude the ductus

arteriosus when a

thrombus forms in

the mass of fabric and

wire

Pulmonic stenosis Tetralogy of fallot

Transposition of the great arteries Truncus arteriosus

Defects with decrease blood flow and mixed defects

Pulmonic Stenosis

Narrowing of entrance that

decreases blood flow

Treatment:

Medications – Prostaglandins to keep the PDA open

Cardiac Catheterization

Baloon Valvuloplasty

Surgery

Valvotomy

Tetralogy of Fallot

Four defects are:

1. 2.

3.

4.

Signs and Symptoms

1. Failure to thrive

2. Squatting

3. Lack of energy

4. Infections

5. Polycythemia

6. Clubbing of fingers

7. Cerebral absess

8. Cardiomegaly

Treatment

Surgical interventions

Blalock – Taussig or Potts procedure – increases blood flow to the lungs.

Open heart surgery

Transposition of Great Vessels

Aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle - which is not

compatible with survival unless there is a large defect present in ventricular or atrial septum.

artery

aorta

Truncus arteriosus

A single arterial trunk arises from both ventricles that supplies the systemic, pulmonary, and coronary circulations. A vsd and a single, defective, valve also exist.

Entire systemic circulation supplied from common trunk.

Defects obstructing Systemic blood flow

• Aortic stenosis • Coarctation of the Aorta

Coarctation of the Aorta

1. Narrowing of Aorta causing obstruction of left ventricular blood flow

2. Left ventricular hypertrophy

Signs and Symptoms

1. B/P in upper extremities

2. B/P in lower extremities

3. Radial pulses full/bounding and femoral or popliteal pulses weak or absent

4. Leg pains, fatigue

5. Nose bleeds

Treatment

Goals of management are to improve ventricular function and restore blood flow to the lower body.

Medical management with Medication

A continuous intravenous medication, prostaglandin (PGE-1), is used to open the ductus arteriosus (and maintain it in an open state) allowing blood flow to areas beyond the coarctation.

Baloon Valvoplasty

Surgery for Coarctation of Aorta

1. Resect

narrow

area 2. Anastomosis

Acquired Cardiac Diseases

RHEUMATIC FEVER

A systemic inflammatory (collagen) disease of connective tissue that usually follows a group A

beta-hemolytic streptococcus infection.

This disorder causes changes in the entire heart (especially the valves), joints, brain, and skin

tissues.

Rheumatic Fever

Assessment

Jones Criteria

Major

Minor

Treatment

Antibiotic Therapy

Aspirin

Subacute Bacterial Endocarditis / Ineffective Endocarditis:

Microorganisms grow on the endocardium, forming vegetations,

deposits of fibrin, and platelet thrombi. The lesion may invade adjacent tissues

such as aortic and mitral valves.

Subacute Bacterial Endocarditis / Ineffective Endocarditis:

Assessment

Diagnosis – blood cultures

Treatment

Antibiotics

Patient teaching – take antibiotics prior to surgery, dental work, etc.

Kawasaki Disease

Multisystem vasculitis – inflammation of blood vessels in the body especially the coronary arteries with antigen-antibody

complexes.

Kawasaki Disease Signs and Symptoms / Treatment

Three Phases of clinical manifestations:

Acute

Subacute

Convalesant

Treatment

Aspirin

Gamma Globulin

Nursing Care