1. Module 5 Pediatric Cardiac Disorders

2. 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     

3. Fetal Circulation Secondary Route: Right Atrium  Right Ventricle 
Pulmonary Artery 
Ductus Arteriosus 
(so does not go to lungs)
Aorta 
Body

4. 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     

5. 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.

6. Congestive Heart Failure

7. 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.

8. Etiology and Pathophysiology
Congenital defects – allow blood to flow from the left side of the heart to the right so that extra blood is pumped to the pulmonary system rather than through the aorta when the ventricle contracts.
Obstructive congenital defects – restricts the flow of blood so the heart hypertrophies to work harder to force blood through the narrowed structures. The hypertrophied muscle becomes ineffective.
Other defects which weaken the heart muscle.

9. Compensatory Mechanisms
Stimulation of the sympathetic nervous system which releases norepinephrine from the adrenals. This stimulates blood vessels to constrict and an increase in the heart rate.
Tachycardia increases venous return to the heart which stretches the myocardial fibers and increases preload. Only successful for short period of time.
Increased renin and ADH secretion caused by decrease renal perfusion. Resultant increase in Na and H2O retention to increase fluid to the heart and leading to edema

10. Signs and Symptoms Tires easily during feeding
Periorbital edema, weight gain
Rales and rhonchi
Dyspnea, orthopnea, tachypnea
Diaphoretic / sweating
Tachycardia
Failure to gain weight

11. 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

12. 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

13. Congenital Cardiac Anomalies

14. Defects that increase pulmonary blood flow
Patent Ductus Arterious
Atrial septal defects
Ventricle septal defects

15. Atrial Septal Defect
Oxygenated blood is shunted from left to right side of the heart via defect
A larger volume of blood than normal must be handled by the right side of the heart hypertrophy
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

16. Treatment Medical Management Cardiac Catheterizaton -
Medications – digoxin
Cardiac Catheterizaton -
Amplatzer septal occluder
Open-heart Surgery

17. 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

18. During cardiac catheterization the occluder is placed in the
Treatment
Device Closure – Amplatzer septal occluder
During cardiac catheterization the occluder is placed in the
Defect

19. Ventricle Septal Defect
Oxygenated blood is shunted from left to right side of the heart via defect
A larger volume of blood than normal must be handled by the right side of the heart hypertrophy
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

20. Treatment
Surgical repair with a patch inserted

21. Patent Ductus Arteriosus
Blood shunts from aorta (left) to the pulmonary artery (right)
Returns to the lungs causing increase pressure in the lung
Congestive heart failure

22. Treatment for PDA Medical Mangement Medication
Indomethacin - inhibits prostaglandin's which help keep the ductus arteriosus open
Surgery
Ligate the
ductus arteriosus

23. Treatment for PDA Cardiac Catheterization
Insert coil – tiny fibers occlude the ductus arteriosus when a thrombus forms in the mass of fabric and wire

24. Defects with decrease blood flow and mixed defects
Pulmonic stenosis Tetralogy of fallot Transposition of the great arteries Truncus arteriosus

25. Pulmonic Stenosis Narrowing of entrance that decreases blood flow
Treatment:
Medications – Prostaglandins to keep the PDA open
Cardiac Catheterization
Baloon Valvuloplasty
Surgery
Valvotomy

26. Tetralogy of Fallot
Four defects are: 1. 2. 3. 4.

27. Signs and Symptoms Failure to thrive Squatting Lack of energy
Infections
Polycythemia
Clubbing of fingers
Cerebral absess
Cardiomegaly

28. Treatment Surgical interventions
Blalock – Taussig or Potts procedure – increases blood flow to the lungs.
Open heart surgery

29. 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

30. 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.

31. Defects obstructing Systemic blood flow
Aortic stenosis
Coarctation of the Aorta

32. Coarctation of the Aorta
Narrowing of Aorta causing obstruction of left ventricular blood flow
Left ventricular hypertrophy
Signs and Symptoms
 B/P in upper extremities
B/P in lower extremities
Radial pulses full/bounding and femoral or popliteal pulses weak or absent
Leg pains, fatigue
Nose bleeds

33. 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

34. Surgery for Coarctation of Aorta
1. Resect
narrow
area
2. Anastomosis

35. Ask Yourself ?
Laboratory analysis on a child with Tetralogy of Fallot indicates a high RBC count. The polycythemia is a compensatory mechanism for:
a. Tissue oxygen need
b. Low iron level
C. Low blood pressure
d. Cardiomegaly

36. Acquired Cardiac Diseases

37. 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.

38. Rheumatic Fever Assessment Jones Criteria Major Minor Treatment
Antibiotic Therapy
Aspirin

39. 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.

40. Subacute Bacterial Endocarditis / Ineffective Endocarditis:
Assessment
Diagnosis – blood cultures
Treatment
Antibiotics
Patient teaching – take antibiotics prior to surgery, dental work, etc.

41. Kawasaki Disease
Multisystem vasculitis – inflammation of blood vessels in the body especially the coronary arteries with antigen-antibody complexes.

42. Kawasaki Disease Signs and Symptoms / Treatment
Three Phases of clinical manifestations:
Acute
Subacute
Convalesant
Treatment
Aspirin
Gamma Globulin
Nursing Care

43. Which phase of Kawasaki is this child exhibiting?
Kawasaki Disease
Which phase of Kawasaki is this child exhibiting?
Inflamed, Cracked, Peeling Lips
Strawberry tongue