Unti 28 Peds Cardiac Disorders Flashcards
In fetal circulation, how does the heart get oxygenated?
By the placenta
Regarding fetal circulation, what does the Foramen Ovale do?
Pumps blood from the Right to Left Atrium
Closes usually half an hour after birth due to pressure changes
Regarding fetal circulation, what does the Ductus arteriosus do?
Shunts blood from the pulmonary artery to the descending aorta
Could take up to 4 days to close
Describe Congenital Heart Defects and Acquired Heart Defects.
Congenital:
- Present at birth
- Family Hx/genetics
- Down syndrome carries higher risk
- High risk maternal factors such as Age > 40, diabetes, substance abuse, and rubella during pregnancy
Acquired:
- Technically heart failure
- Cardiomyopathy
- Infection
- Toxins
- Hypertension/hyperlipedemia
- Kawasaki Disease
What are the classifications of Congenital Heart Defects?
[Increased pulmonary blood flow]
-abnormal structure pushes more blood towards lungs, less blood to body. Heart works harder
[Decreased pulmonary blood flow]
-Abnormal structure pushes less blood to lungs, deoxygenated blood to body
[Obstructive]
-Narrowing stricture, heart works harder
[Mixed]
Briefly describe Increased Pulmonary Blood Flow.
- Left to right shunt where oxygenated blood re-enters the pulmonary circulation.
- R. Ventricle strain, dilation, hypertrophy because it is working harder
Name the defects with Increased pulmonary blood flow, state what each means, and what happens regarding all of them.
VSD (ventriculoseptal defect): abnormal opening in the ventricular septum (slight murmur)
ASD (atrioseptal defect): abnormal opening in the atrial septum (slight murmur)
PDA (patent ductus ateriosus): ductus ateriosus fails to close (you’ll hear machine like murmur)
In all of these:
- Blood is recirculated through the LUNGS
- Less blood is available to rest of the body
- Heart works harder
- May correct themselves, if not usually 1 Sx with excellent prognosis
If defects not treated, or worsens, then will result in heart failure and/or pulmonary hypertension
What is the most common congenital heart defect?
VSD - ventriculoseptal defect
classified as an increased pulmonary blood flow congenital heart defect
What is the obstructive congenital heart defect? Describe it. What will nurses look for? How is it fixed?
Coarctation of the aorta
- It is the narrowing of the aorta
- Decreased blood flow below defect
- Increased pressure above defect
- Femoral pulses weak or absene
- Radial pulses bounding
- Upper extremity hypertension
can be fixed with patch to aorta
Nurses will assess pulses, BP upper and lower
Describe the defects with Decreased Pulmonary blood flow and what you will see.
They are right-to-left shunts meaning deoxygenated blood enters systemic circulation.
- Results in “blue babies”
- Decreased pulmoecnary blood flow
- Central cyanosis
- Low O2 stats
What is the treatment for defects with decreased blood pulmonary blood flow?
Treatment often requires emergency treatment
Sx in several stages
Prognosis varies depending on extent of defect
Name the most common complex lesion and explain it.
[Tetralogy of Fallot] is the most common complex lesion and it has to due with FOUR problems of deoxygenated blood entering the oxygenated side at the same time.
FOUR heart defects
What is the medical management of Tetralogy of Fallot?
- Keep Ductus Arteriosus patent
with prostiglandins - Vasodilators, diuretics, digoxin, ACEI’s
- Activity/Rest balance to prevent fatigue
- Surgical management required
What are signs and symptoms of Tetralogy of Fallot?
- Hyper-cyanotic/blue called TET spells
- Choking spells with periods of dyspnea
-RELIEF with squatting or placing infant in knee to chest position to increase blood flow to lungs (specific to TOF)
- Clubbing (from chronic hypoxemia)
- Polycythemia (increased RBC from chronic hypoxemia)
What is the newborn cardiac screening?
Using pulse ox:
Pre and post ductal screening meaning:
the RIGHT HAND and whichever foot.
- Baby should be 25-48 hrs old
- O2 stat needs to be >95%
