1
Q
Most common congenital heart anomaly?
A
Ventricular Septal Defect
2
Q
causes of CHD in children?
A
- Maternal or environmental
- chromosomal/genetic
- multifactorial
3
Q
Ductus arteriosus closes?
A
functional 24-72 hours; permanent 2-3 weeks
4
Q
Evaluation of Cardiovascular function - what to ask about?
A
- Family history of CHD, sudden death
- Mother’s pregnancy (any exposures, illnesses?)
- Infant’s feeding pattern
- Profuse sweating, fatigue, tachypnea, irritability,
reflux, always hungry - Child’s feeding pattern (Picky or slow eater)
- History of frequent URIs, respiratory difficulties
- Exercise intolerance, fatigue
- General appearance
- Activity, Mood, Nutritional status, Edema
- Poor weight gain
- Skin (cyanosis, diaphoresis)
- Fingernails (clubbing, cyanosis)
5
Q
Classification of cardiac lesions in CHD?
A
- Lesions with increased pulmonary blood flow (left to right shunts)
- Lesions with decreased pulmonary blood flow (right to left shunts)
- Obstructive lesions (Obstruction of blood flow out of the heart)
- Lesions with mixed blood flow
6
Q
Increased Pulmonary Blood Flow Defects and what happens?
A
have an abnormal connection between the two sides of heart - either the septum or the great vessels which leads to an Increased blood volume on the right side of the heart, increased pulmonary blood flow and decreased systemic blood flow
7
Q
Increased Pulmonary Blood Flow Defect General characteristics?
A
- Acyanotic I- ncreased pulmonary vascularity - Poor weight gain - Heart failure frequent - Late permanent pulmonary vascular changes can occur
8
Q
Increased Pulmonary Blood Flow Defect examples
A
- VSD (ventricular septal defect)
- ASD (atrial septal defect)
- PDA (patent ductus arteriosus)
9
Q
Ventricular Septal Defect (VSD) Clinical signs?
A
- May be asymptomatic initially
- CHF
- Failur To Thrive (FTT)
- Frequent URIs
- Fatigue, poor feeding
10
Q
most common VSD location?
A
midseptal defect below aortic valve
11
Q
Diagnostics for VSD?
A
- Systolic murmur heard at left sternal border
- ECG, chest x-ray, echo, cardiac cath
12
Q
Treatment for VSD?
A
- Small VSDs may close spontaneously - 1st 2 years of life
- Medical : tx of CHF, SBE prophylaxis
- Surgical: palliative; corrective
13
Q
Surgical Treatments for VSD - Palliative?
A
- Pulmonary Artery (PA) Band
- band Narrows the pulmonary artery, thereby decreases blood flow to the lungs & decreases CHF. Child will eventually outgrow PA Band & require corrective surgery
14
Q
Surgical Treatments for VSD - Corrective?
A
- Closure of VSD with patch
- Complications of corrective surgery include: conduction problems (possibility of complete heart block), residual VSD, plus complications related to open heart surgery
15
Q
Most common location for an Atrial Septal Defect?
A
midseptum near foramen ovale
16
Q
Symptom of ASD?
A
- often asymptomatic
- As child gets older, may see activity intolerance & dyspnea (shortness of breath)
17
Q
Diagnostics of ASD?
A
- If L to R shunt is large, will have a diastolic murmur
- ECG, chest-x-ray, echo
18
Q
Treatment for ASD?
A
- Medical: Bacterial endocarditis (BE) prophylaxis
- Repair (via cardiac cath or surgery)
19
Q
Why repair an ASD?
A
to prevent activity intolerance & dyspnea (shortness of breath) as child gets older
20
Q
Persistent patency of normal fetal structure, connection between the left pulmonary artery and the descending aorta?
A
Patent Ductus Arteriosus (PDA)
21
Q
Patent Ductus Arteriosus (PDA) normally closes after birth due to _______?
A
- increased arterial O2 sats & decreased prostaglandins when no placenta
22
Q
What happens if the PDA stays open and why?
A
- If stays open, direction of flow changes after birth
- because of increased pressure & resistance in the aorta, causing increased blood to the pulmonary arterial and flow to the lungs
23
Q
Clinical signs of PDA if small?
A
- If small, may be asymptomatic
24
Q
Clinical signs of PDA if large?
A
- signs/sx of CHF.
- more apparent with anything that puts increased stress on heart.
25
Diagnostics of PDA?
- Classic “machinery” type murmur
| - ECG, chest x-ray, echo
26
Tx of PDA?
- May close spontaneously
- Medical: Indomethicin (prostaglandin inhibitor)
- Via cardiac catheterization
- Amplatzer duct occluder
- Surgical: ligation or division
27
Indomethicin mechanism of action?
prostaglandin inhibitor, used to treat pain
28
General characteristics or S/S of Decreased Pulmonary Blood Flow Defects
- cyanosis (varying degrees)
- decreased pulmonary vascularity
- heart failure rare
- hypoxemia
- polycythemia
- clubbing
- paroxysmal hypercyanotic spells (40%)
29
Examples of Decreased Pulmonary Blood Flow Defects?
- Tetralogy of Fallot
| - Tricuspid atresia
30
Four defects associated with the Tetralogy of Fallot (TOF)?
- Ventricular septal defect (VSD)
- Pulmonary stenosis (right ventricular outflow obstruction)
- Right ventricular hypertrophy
- Overriding aorta (dextroposition of the aorta)
31
Which defect associated with the Tetralogy of Fallot causes the other 3?
overriding aorta
32
Clinical signs of TOF
- Cyanosis, clubbing
| - Paroxysmal hypercyanotic spells (a.k.a. TET spells)
33
Tx of Paroxysmal hypercyanotic spells?
Morphine and O2
34
Diagnostics for TOF?
- Harsh systolic murmur at lower left sternal border
- ECG, chest x-ray, echo
- CBC - polycythemia
35
TET position?
Squatting increases peripheral vascular resistance (PVR) and thus decreases the magnitude of the right-to-left shunt across the ventricular septal defect (VSD)
36
Preoperative management of TOF?
- prevent dehydrations
| - NO AIR IN IV LINES
37
Tx of TOF?
- Blalock-Taussig shunt (palliative if child too small for repair, lots of TET spells)
- Open heart surgery
- VSD closure
- Correct pulmonic stenosis
38
Procedure where a small shunt is placed between the pulmonary artery and aorta which lets blood move from aorta to lungs?
Blalock - Taussig shunt
- done for TOF if pt is to small for a full repair.
- may have decreased or absent pulse in affected arm - - NO BP in that arm
39
Examples of Obstructive Defects?
- Coarctation of the aorta
- Aortic stenosis
- Pulmonic stenosis
40
Anatomic narrowing/stenosis of aorta?
Coarctation of the aorta
41
Coarctation of the aorta causes what to happens?
Increased pressure in left ventricle causing decreased cardiac output with significant decrease in blood flow to abdomen and legs
42
Clinical signs of a Coarctation of the aorta?
- Blood pressure higher in arms than in legs
- High pulse pressure in carotid & radial pulses
- Low pulse pressure in femoral & pedal pulses
- Warm upper body, cool lower body
43
Diagnostics of a Coarctation of the aorta?
- usually no murmur
- Upper Extremity BP at least 20mm mmHg > Lower - Extremity BP
- Echo (confirmational test)
44
Treatment of a Coarctation of the aorta?
- Surgery - removal of stenotic area
- Balloon angioplasty
- BE prophylaxis
45
Complications of a Coarctation of the aorta?
- restenosis, residual hypertension, CV disease as adult
46
Examples of Mixed Defects?
- Transposition of the Great Vessels (TGV, TGA)
- Total anomalous pulmonary venous connection (TAPVC)
- Truncus arteriosus
- Hypoplastic heart syndrome (Left or Right)
47
Defect where the Aorta rises from right ventricle and Pulmonary artery rises from left ventricle?
Transposition of the Great Vessels (TVG)
48
Transposition of the Great Vessels results in?
have two separate and parallel circulations
49
Clinical signs of a Transposition of the Great Vessels?
- Cyanosis always present
| - Murmurs if other associated defects
50
Treatment of TGV?
- Continuous infusion of Prostaglandin E
- Create or keep atrial septal defect open with balloon septostomy
- Corrective surgery, usually as neonate
51
Diagnostics for a TGV?
ECG, CXR, exho
52
Defect where the left-sided cardiac structures are underdeveloped?
Hypoplastic Left Heart Syndrome (HLHS)
53
Postoperative Complications of HLHS surgical tx?
- CHF
- Dysrhythmias
- Decreased cardiac output syndrome
- Decreased peripheral perfusion
- Pulmonary changes
- Neurologic changes
- Postpericardiotomy syndrome
- Endocarditis (BE, SBE, IE)
54
Postpericardiotomy Syndrome Clinical manifestations?
- Fever, increased WBCs, pericardial friction rub, pericardial & pleural effusion
55
Postpericardiotomy Syndrome teaching?
- complication of tx for HLHS
- can occur immediately, or up to 7-21 days postop
- may require pericardiocentesis or pleurocentesis
56
CHF is usually seen in which children?
- most < 12 months old
| - primarily with left to right shunts and coarctation of the aorta
57
S/S of Impaired myocardial function in a child with CHF?
Tachycardia, fatigue, weakness, restlessness, pallor, cool extremities, decreased BP, gallop rhythm (3rd heart sound), decreased urine output, cardiomegaly
58
S/S of pulmonary congestion in a child with CHF?
Tachypnea, dyspnea, respiratory distress, exercise intolerance, poor feeding
59
S/S of Systemic venous congestion in a child with CHF?
Peripheral and periorbital edema, weight gain, ascites, hepatomegaly
60
Nursing Management of child with CHF?
- Decrease energy expenditure
- Provide adequate nutrition: high caloric formulas > 20 kcal./oz.
- Avoid fluid overload
- Administer meds to enhance cardiac function
- Digoxin and diuretics
61
Digoxin actions?
increases contractility and slows the HR
62
S/S of Digoxin toxicity?
nausea/vomiting, anorexia, listlessness, bradycardia, dysrhythmias
63
shunts oxygenated blood from the umbilical vein to inferior vena cava
Ductus venosus
64
shunts oxygenated blood from R. atrium to L. atrium
Foramen ovale
65
shunts blood from the pulmonary artery to the aorta
Ductus arteriosus
66
Do no give Digoxin if infant's HR is ?
< 100 BPM
67
shunts oxygenated blood from umbilical vein to inferior vena cava in fetus
Ductus venosus
68
shunts oxygenated blood from R. atrium to L. atrium in fetus
Foramen ovale
69
shunts blood from pulmonary artery to aorta in fetus
Ductus arteriosus
70
Ductus venosus
shunts oxygenated blood from umbilical vein to inferior vena cava in fetus
71
Foramen ovale
shunts oxygenated blood from R. atrium to L. atrium in fetus
72
Ductus arteriosus
shunts blood from pulmonary artery to aorta in fetus
73
A mother states that her baby turns blue while feeding or crying, what do you suspect?
TET spells caused by TOF
74
Patient has strong radial pulses, weak LE pulses and a BP > 20mmhg in UE when compare to LE, what do you suspect and what else would you look for?
Coarctation of the aorta, look for temp in upper body to be greater than lower body
75
CHF is most often seen in?
children with a left to right shunt and coarctation of the aorta
