Congenital Heart Disease

Emad Al Khatib, RN,MSN,CNS

1. Classification of Congenital Heart Disease.

2. A cyanotic Heart Disease a. Increase pulmonary blood flow b. Obstruction of blood flow 3. Cyanotic Heart disease a. Decrease pulmonary blood flow b. Mixed blood flow .

A Cyanotic Heart DefectMove blood from arterial …to…venous system

A Cyanotic

Increased in pulmonary blood flow1. ASD2. VSD3. AVC4. PDA

Obstruction of blood flow form ventricle

1. Pulmonary stenosis2. Aortic stenosis

3.Coarctation of the Aorta

Defect with increased pulmonary blood flow

1. VSD (ventricular septal defect )

2. ASD (Atrial septal defect )

3. AVC (Atrioventricular canal defect )

4. PDA ( patent ductus arteriosus)

VSD (ventricular septal defect )

VSD …30% of CHD

85% spontaneous closed

*Assessment . (4 to 8 week of age ) fatigue…murmur…thrill may be palpable..

Echo .ECG, MRI ,(RT ventricle hypertrophy )

Treatment …

cardiac catheterization .. Surgery

ASD (blood flow from left to right atrium)

Tow type ..1. Ostium primum ( lower end of the septum )2. Ostium secundum( center of the septum )

**Assessment ...systolic murmur enlarged RT side of the heart ..increased in pulmonary

circulation…Echo.**Management …cath repaired, or open heart surgery

(1 to 3 years) **Complication ..arrhythmias …emboli

AVC ( Atrioventricular Canal Defect)

Low a trial septal defect continuous with high ventricular defect and distortion of the mitral and tricuspid valve

**Assessment …Echo …surgical is important some time need new valve

**Treatment …after surgery give antibiotic and anticoagulant

Closed observation to the jaundice

PDA ( Patent Ductus Arteriosus) it’s failed to closed at birth ,blood will shunt

from the aorta to the pulmonary artery. Complete closure occurs…3 month More common in girls than boys

**Assessment ….direct after cardiac catheterization

**Treatment…in infant give IV or OR indomethacin(3time \12hr or 24hr)

to lead to closed the ductus

Side effect…

1.reduce glomerular filtration rate.

2.Impaired plat aggregation

3.Demention GI&CNS blood flow

Treatment…

Cath at age of (6m to 1y) or surgical intervention by Thoraoctomy

If not treatment …

1. CHF

2. Infected Endocardities

Obstruction of blood flow form ventricle

1.Pulmonary stenosis

2.Aortic stenosis

3.Coarctation of the Aorta

pulmonary stenosis 10%

Narrowing in pulmonary valve Assessment like RT side heart failure

Systolic murmur…thrill ECG …Echo ( RT side hypertrophy ) Treatment

Balloon angioplasty

Aortic stenosis

7% of total cases of CHD Increased pressure in the LF side of the heart

(LV hypertrophy) Assessment… murmur ,thrill ,high BP, high

HR. Treatment..- Beta-blocker or ca channel blocker to

decreased hypertrophy - Balloon valvoplasty

Coarctation of the Aorta 6%

in boys more than in girls** assessment high BP in upper body part in the arm

20mmhg more than leg, headache, vertigo, epistaxis.

Treatment Digoxin & diuretic Surgical at the age of 2yrs

Cyanotic Heart Defect

Cyanotic

Decreased pulmonary blood flow

Mixed blood flow

mixed blood flow

1. Transposition of the great Arteries

2. Total pulmonary venous return

3. Truncus Arteriosus

4. Hypo plastic left Heart Syndrome

Transposition of the great Arteries In boys more than girls

*assessment …cyanotic from birth, murmur may or not ,Echo, cath.

*Treatment.

PGE to keep PDA opining

Surgical at 1week to 3months

Total Pulmonary venous return 2%Pulmonary vein return to the right atrium or the

superior vena cava instead of the left atrium

* Treatment

Give PGE, cath, and surgical treatment

Truncus Arteriosus 1%

One major artery or (trunk) arises from the LF & RT ventricle in place of a separate Aorta & Pulmonary Artery

with VSD. Assessment … Cyanosis Treatment … surgical at school age

Hypo plastic left Heart Syndrome*assessment of HLHS

Infants may appear healthy at birth, but signs of HLHS soon become apparent after the ductus arteriosus closes. These signs include the following:

Cyanosis (a blue skin, lips, fingernails and other areas of the body as a result of the lack of oxygen-rich blood to the body)

1.Heart murmur

2.Enlargement of the heart (as seen in an echocardiogram)

3.Noticeably troubled breathing

4.Apparent weakness

5.Inability to feed normally

6.Cold extremities

Defect with Decreased pulmonary blood flow

1. Tricuspid Artesia

2. Tetrology of Fallot

Tricuspid Artesia

Tricuspid valve closed no blood from RA to RV

*if foramen ovale and PDA still open will maintain good O2 blood so you have to give PGE IV.

If not sever cyanosis ,tachycardia , dyspnea * Treatment Surgically

Tetrology of Fallot 10%

1.pulmonary stenosis

2.VSD *usually large*

3.dextra position (overriding of the Aorta )

4.hypertrophy of the right ventricle.