Transcript CONGENITAL CARDIAC DEFECTS

Chapter 27
Christine Limann Dyer, RN, MSN CPN
 Umbilical
vein,
umbilical arteries
 Foramen ovale
 Ductus arteriosus
 Ductus venosus
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 Poor
feeding
 Tachypnea/tachycardia
 Failure to thrive/poor weight gain/activity
intolerance
 Developmental delays
 Prenatal history
 Family history of cardiac disease
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 Murmurs
= heart sounds that reflect flow of
blood within the heart



May occur in systole or diastole, or both
Can occur in a normal heart in periods of stress:
anemia, fever, or rapid growth
Can reflect abnormalities in heart or vessels
 “Innocent
murmurs” = normal cardiac anatomy
and cardiac function

Occur in up to 50% of all kids at some time
http://depts.washington.edu/physd
x/heart/demo.html
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 Chest
x-ray
 ECG
 Echocardiography
 Cardiac
catheterization

Nursing
Responsibilities

Post Catheterization: Monitor pressure dressing in the groin,
heart rate, respirations & blood
pressure
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 Signs

& Symptoms:
Inadequate cardiac output
 Nursing




Care:
Artificial shunt or pathway created shortly after birth
Prostaglandin (PGE1) given
Numerous surgical repairs (cardiac transplant)
Palliative care measures
 Transposition
of
great vessels
 Some complex
single-ventricle
defects
 ASD
 Pulmonary artery
stenosis
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DIAGNOSIS
INTERVENTION
Valvular pulmonic stenosis
Balloon dilation
Recurrent coarctation of aorta
Balloon dilation
Congenital mitral stenosis
Balloon dilation
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 Congenital

Anatomic → abnormal function
 Acquired

Disease process




Infection
Autoimmune response
Environmental factors
Familial tendencies
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 Maternal

Maternal drug use


or environmental = 1% to 2%
Fetal alcohol syndrome—50% have CHD
Maternal illness



Rubella in first 7 weeks of pregnancy → 50% risk of
defects including PDA and pulmonary branch stenosis
CMV, toxoplasmosis, other viral illnesses → cardiac
defects
IDMs (infant of diabetic mother) = 10% risk of CHD
(VSD, cardiomyopathy, TGA most common)
 Chromosomal/genetic
 Multifactorial
= 10% to 12%
= 85%
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 Incidence:




5 to 8 per 1000 live births
About 2 or 3 of these are symptomatic in first
year of life
Major cause of death in first year of life (after
prematurity)
Most common anomaly is VSD
28% of kids with CHD have another recognized
anomaly (trisomy 21, 13, 18, + + + )
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 Acyanotic

May become
cyanotic
 Cyanotic


May be pink
May develop CHF
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 Hemodynamic




characteristics
Increased pulmonary blood flow
Decreased pulmonary blood flow
Obstruction of blood flow out of the heart
Mixed blood flow
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 Abnormal
connection between two sides of
heart

Either the septum or the great vessels
 Increased
blood volume on right side of heart
 Increased pulmonary blood flow
 Decreased systemic blood flow
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 Atrial
septal defect
 Ventricular septal defect
 Patent ductus arteriosus
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 Coarctation
of the aorta
 Aortic stenosis
 Pulmonic stenosis
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 Tetralogy
of Fallot(T.O.F.)
 Tricuspid atresia
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Place in this
Position
During Tet spell
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 Transposition
of great vessels
 Total anomalous pulmonary venous
connection
 Hypoplastic heart syndrome


Right
Left
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 Impaired

myocardial function
Tachycardia; fatigue; weakness; restless,
pale, cool extremities; decreased BP;
decreased urine output
 Pulmonary
congestion
 Tachypnea, dyspnea, respiratory distress,
exercise intolerance, cyanosis
 Systemic venous congestion

Peripheral and periorbital edema, weight
gain, ascites, hepatomegaly, neck vein
distention
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 Signs
& Symptoms:
Vary with age fluid congestion
 Poor feeding & growth, irritability, shortness of
breath, excessive sweating

 Nursing


Care:
Positive inotropes (digoxin), diuretics (furosemide),
vasodilators (captopril)
Fluid restriction not often used (only in the worst
cases)
 Help
family adjust
to the disorder
 Educate family
 Help family cope
with effects of the
disorder
 Prepare child and
family for surgery
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 Open
heart
 Closed heart
procedures
 Staged procedures
 Prepare child and
family for
procedures
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 Monitor
vital signs and
A/V pressures
 Intra-arterial monitoring
of BP
 Intracardiac monitoring
 Respiratory needs
 Rest, comfort, and pain
management
 Fluid management
 Progression of activity
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 CHF
 Dysrhythmias
 Decreased
cardiac output syndrome
 Decreased peripheral perfusion
 Pulmonary changes
 Neurologic changes
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 Symptoms:
fever,  WBCs, pericardial
friction rub, pericardial and pleural effusion
 Occurs in immediate postoperative period
 Also can occur later (days 7 to 21 postop)
 Etiology unknown
 Theories of etiology


Viral infection, autoimmune response, reaction
to blood in pericardium
May require pericardiocentesis or pleurocentesis
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 Infectious
and inflammatory cardiac disorders
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 BE,
IE, or SBE
 Streptococci
 Staphylococci
 Fungal infections
 Prophylaxis: 1 hour
before procedures
(IV) or may use PO
in some cases
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
RF



Inflammatory disease occurs after group A
β-hemolytic streptococcal pharyngitis
Infrequently seen in U.S.; big problem in
Third World
Self-limiting

Affects joints, skin, brain, serous surfaces, and
heart
Carditis
 Polyarthritis
 Erythema marginatum
 Subcutaneous nodules


Rheumatic heart disease


Most common complication of RF
Damage to valves as result of RF
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 St.
Vitus dance (aka,
chorea) reflects CNS
involvement
 Definition: Chorea refers to
sudden, aimless movements
of extremities, involuntary
facial grimaces, speech
disturbances, emotional
lability and muscle
weakness

http://www.youtube.com/watch?v=
Worse with anxiety and
RnxqqW_nH0k
relieved by rest
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 Treatment
of streptococcal
tonsillitis/pharyngitis




Penicillin G—IM x 1
Penicillin V—oral x 10 days
Sulfa—oral x 10 days
Erythromycin (if allergic to above)—oral x 10 days
 Treatment

of recurrent RF
Same as above
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 IV
IgG
 ASA 80-100
mg/kg/day—fever
 Then 3-5
mg/kg/day—
antiplatelet
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 Primary
= no known cause
 Secondary = identifiable cause
 Pediatrics: HTN generally secondary to
structural abnormality or underlying
pathology



Renal disease
CV disease
Endocrine or neurologic disorders
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 Identify
kids at risk and treat early
 Treatment = dietary

 If


Restrict intake of cholesterol and fats
no response to diet → Rx
Colestipol (Colestid)
Cholestyramine (Questran)
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Contractibility of
myocardium is impaired
 Secondary
cardiomyopathy
 Dilated cardiomyopathy
 Hypertrophic
cardiomyopathy
 Restrictive
cardiomyopathy

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
Treatment


Correct underlying
cause if possible
Often treatment is
aimed at managing CHF
and dysrhythmias
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 Digoxin
 Diuretics
 Beta
blockers, calcium channel blockers
 Dobutamine
 Nitroprusside
 Amrinone
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 IV
IgG
 Digoxin (Lanoxin)
 ACE inhibitors
 ASA, NSAIDs
 Lasix
 Spironolactone (Aldactone)
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 Diagnostic




evaluation
ECG
Holter monitoring
Electrophysiologic cardiac catheter
Transesophageal recording
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
Signs & Symptoms:


SOB, chest pain, weakness, fatigue, dizziness, leg swelling & fainting
episodes
Nursing Care:
Prostacyclin (Flolan) dilates blood vessels & decreases pulmonary
vascular resistance
 Inhaled nitric oxide relaxes pulmonary (not systemic) vessels
 Sildenafil (Revatio) decreases pulmonary artery pressures
 Bosentan (Tracleer) blocks hormone that causes vasoconstriction

Signs & Symptoms:

A fainting spells (may experience a seizure)
Nursing Care:
Increase sodium & water intake
 Fludrocortisione (Florinef)
 Beta-blocker
 Monitor (frequency, severity & precipitating factors)

 Signs

& Symptoms:
fainting, palpitations, seizure or death
 Nursing




Care:
Beta-blockers
Pacemaker-defibrillator insertion
Left cardiac sympathetic denervation
Medication compliance
 The
nurse who can determine the baseline
rhythm and recognize changes will facilitate the
best outcome for a child with an arrhythmia
 Important questions:
Is the rhythm potentially fatal?
 Will it alter the cardiac output?

 Bradydysrhythmias


AV block
May use pacemaker
 Tachydysrhythmias


SVT most common tachydysrhythmia
Treatments
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 Orthotopic
transplant
 Heterotopic transplant
(piggyback)
 Organ donation issues
 Nursing considerations
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