CONGENITAL

HEART
DISORDERS
ACYANOTIC
HEART
DISEASES
ACYANOTIC HEART DISEASES
• Indicates the presence of defect that
permits the passage of blood from the left
side of the heart (higher pressure) to the
right side of the heart (lower pressure).
• There is shunting of oxygenated blood from
the left side of the heart back to the right
side of the heart.
• Oxygenated blood enters to the systemic
circulation, but since some oxygenated blood
goes back to the right side of the heart,
there is now less oxygenated blood being
delivered to the body
ACYANOTIC HEART DISEASES
• In an effort to compensate for the
diminished amount of oxygenated blood being
delivered to the body, the heart now pumps
harder than usual.
• Eventually, the left side of the heart will “get
tired” and so will not anymore work (heart
failure).
• The right side of the heart will be subjected
to pressure greater than normal. This
condition will lead to what is known as
CONGESTIVE HEART FAILURE.
ACYANOTIC HEART DISEASES
• Signs of Left-sided Heart Failure:
1. Feeding difficulty
2. Pallor
3. Dyspnea
4. Tachypnea
ACYANOTIC HEART DISEASES
• Signs of Right-sided Heart Failure:
1. Hepatomegaly
2. Anorexia
3. Dilated Neck Veins
4. Diaphoresis
5. Edema – late sign
 CONGESTIVE HEART FAILURE
• Nursing objectives in the care of patients
with CHF:
1. Improve myocardial contractility by giving
digitalis
• Pharmacologic action: increases the force of
contraction of the heart, thereby slowing
the heart rate
• Precaution: not given if the heart rate is
below the minimum for that particular age
• Signs of digitalis toxicity: nausea (earliest
sign), vomiting, anorexia, diarrhea, headache,
yellow or green halos around light, lethargy,
irritability, and arrythmias.
CONGESTIVE HEART FAILURE
2. Reduce cardiac workload by reducing
energy requirements
• Complete Bed Rest (CBR)
• Orthopneic position
• Small frequent feeding
• Minimal handling
CONGESTIVE HEART FAILURE
3. Remove accumulated fluid
• Diuretics
• Low sodium diet
• Intake and output
• Weigh daily
4. Improve tissue oxygenation by oxygen
administration
EXAMPLES OF
ACYANOTIC
HEART
DISEASES
ATRIAL
SEPTAL
DEFECT
 ATRIAL SEPTAL DEFECT
• DEFECT: there is an opening between the
right and left atria
• HEMODYNAMICS:
 ATRIAL SEPTAL DEFECT
• Signs and Symptoms:
1. Prone to respiratory tract infections
2. Dyspnea on mild exertion
3. Prolonged “dub”
VENTRICULAR
SEPTAL
DEFECT
VENTRICULAR SEPTAL DEFECT
• DEFECT: there is an opening between the
right and left ventricles
• HEMODYNAMICS:
• TYPES:
1. Low-septum = defect is small; may
spontaneously close; no treatment is
ordinarily given
2. High-septum = larger defect; does not close
spontaneously; a plastic patch to close the
defect is applied early to prevent pulmonary
HPN
VENTRICULAR SEPTAL DEFECT
• Signs and Symptoms:
1. Bradycardia
2. Slowing of growth pattern
3. Systolic ejection murmur or prolonged
“lub”
 PATENT
DUCTUS
ARTERIOSUS
PATENT DUCTUS ARTERIOSUS
• DEFECT: there is an opening between the
pulmonary artery and the aorta
• HEMODYNAMICS:
• SIGNS and SYMPTOMS:
1. Continuous machinery-like murmur at the
left intraventricular area – pathologic sign
of PDA
2. Prominent radial pulses in the newborn
3. Limited growth and physical activity
4. On ECG/CXR: Left ventricular enlargement
PATENT DUCTUS ARTERIOSUS
• MANAGEMENT:
1. Indomethacin
2. Rashkind-Dumbrella Technique
• PROGNOSIS: without surgery, life
expectancy is shortened because of a
common complication, BACTERIAL
ENDOCARDITIS (usually caused by
streptococcus viridans)
COARCTATION
OF THE
AORTA
COARCTATION OF THE AORTA
• DEFECT: there is narrowing along the
aorta
• HEMODYNAMICS:
• SIGNS and SYMPTOMS:
1. Absent femoral pulse – pathognomonic
sign
2. BP is higher in the upper extremities –
can cause headache & epistaxis, and
pulse in the upper extremities will be
rapid and bounding
COARCTATION OF THE AORTA
• Because of the lower BP in the lower
extremities:
1. leg pains on exertion
2. cold feet
3. muscle spasms
4. pulse is weak, delayed or even absent
• Myocardial hypertrophy – usual
response of the heart when it pumps
harder than usual
CYANOTIC
HEART
DISEASES
 CYANOTIC HEART DISEASES
• DEFECT: indicates abnormalities that
permits some of the systemic venous
return (unoxygenated blood) to bypass
the lungs and enter the general
circulation directly.
EXAMPLES OF
CYANOTIC
HEART
DISEASES
TRANSPOSITION
OF THE GREAT
VESSELS
 TRANSPOSITION OF THE
GREAT VESSELS
• DEFECT:
1. The aorta (which is supposed to arise
from the left side of the heart) is now on
the right side
2. Pulmonary artery (which is supposed to
arise from the right side of the heart) is
now on the left side
• HEMODYNAMICS:
 TRANSPOSITION OF THE
GREAT VESSELS
• MANAGEMENT:
1. Arterial-switch Procedure
2. Rashkind-Dumbrella technique
3. CBR ṡ BP
TETRALOGY
OF
FALLOT
 TETRALOGY OF FALLOT
• DEFECTS:
1. Pulmonary Stenosis
2. Ventricular Septal Defect (VSD)
3. Overriding of the Aorta
4. Right Ventricular Hypertrophy
 TETRALOGY OF FALLOT
• SIGNS and SYMPTOMS:
1. CYANOSIS –
 usually manifested when the child is 3-6
months old or is already active
 tends to appear exaggerated by exercise,
crying or straining
 On vigorous and persistent crying, cyanosis
becomes intense (blue baby)
 Severe dyspnea develops and the infant
faints because of cerebral hypoxia (hypoxic
episodes or “tet spells”
 TETRALOGY OF FALLOT
2. Clubbing of fingers and toes – due to
peripheral hypoxia which leads to a
compensatory shift of fluid from the
intracellular spaces, causing edema. Usually
observed at one year of age.
3. Growth retardation – the only symptom
common in both cyanotic and acyanotic heart
defects.
4. Exertional dyspnea relieved by squatting –
arterial saturation returns more rapidly to its
normal resting value during squatting (let child
stay in this position until he stands up all by
himself; he is trying to relieve his symptoms).
 TETRALOGY OF FALLOT
5. Polycythemia (increased Hgb & Hct) –
compensatory mechanism to deliver as
much oxygenated blood as possible to
the body. However, this predisposes the
child to cerebral thrombosis and brain
abscess, leading to CVA.
6. On ECG – right ventricular hypertrophy
7. On CXR – “boot-shaped” configuration
of the heart
 TETRALOGY OF FALLOT
• DIAGNOSIS:
1. Cardiac Catheterization – to Dx extent of
damage in the heart by determining flow
pattern of blood, oxygen saturation,
pressure in the cardiac chambers and
vessels, SV and CO.
• Information to be given to the child:
a. Leg will hurt for a short time near the
beginning of the procedure
b. Some pressure will be felt when the
catheter enters the heart
 TETRALOGY OF FALLOT
• Specific Measures:
a. Monitor vital signs
b. Check pedal and popliteal pulses every
30 minutes
c. Observe catheter insertion site for
bleeding
d. Provide foods & fluids as soon as
tolerated
e. Ambulatory privileges 24 hours after
 TETRALOGY OF FALLOT
• MANAGEMENT:
1. Adequate hydration – to prevent pulmonary
emboli, brain abscess, & cerebral thrombosis
2. Prevent recurrent infections –
3. Alleviate dyspnea by knee-chest position
4. Oxygen & morphine to provide rest & relieve
anxiety, as ordered
5. Do not allow child to cry for long periods of
time
 TETRALOGY OF FALLOT
6. Surgery – at about shoolage
• Palliative such as BLALOCK-TAUSSIG
procedure
• Corrective such as OPEN HEART
SURGERY – VSD & pulmonary stenosis
are corrected, using hypothermia &
heart-lung machine