Nursing care of the newborn with alteration in oxygenation due to cardiac and tissue perfusion.
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• Cardiac development occurs very early in fetal life
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• maternal factors (rubella, alcohol, diabetes mellitus)
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• Genetic factors (history of congenital heart disease)
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• Trisomy 21 (Down syndrome)
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• Presence of other congenital anomalies or syndrome.
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Opening in the atrial septum permitting free communication of blood between the 2 atria
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Ostium primum (ASD1) open at lower end of septum
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Ostium secundum (ASD2) open near the center septum
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Pathophysiology
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• Blood flows from left to right (oxy to deoxy) because of the stronger contraction of the left side of the heart, causing an increase volume in the right.
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• Right atrium enlarged, ventricular hypertrophy and increased pulmonary artery blood flow.
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Signs and symptoms
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•Dyspnea on exertion, fatigability, mild growth failure
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•Cyanosis does not occur unless CHF is present.
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Diagnosis
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•ECG with color flow doppler reveal enlarged right side of the heart
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• Cardiac catherization reveal separation in atrial septum
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Treatments
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•Surgical or catherization laboratory for ASD2
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•Surgery : sutured, completed with catheterization
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•Cardiopulmonary bypass : open heart surgery
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•Silastic or Dacron patch : sutured in place
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Complications
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• Infectious endocarditis and eventual heart failure
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• can cause emboli during pregnancy if not treated
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Narrowing at above or below the aortic valve.
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Supravalvular
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ascending aorta. least common
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Valvular
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most common
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Subvalvular
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subaortic. left outflow tract.
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Signs & Symptoms
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•Mild: exercise intolerance, easy fatigability, asymp.
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•Moderate: Chest pain, dyspnea, diziness & syncope
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•Severe: weak pulses, left failure, hypotension, tachy and activity intolerance chest pain and sudden death.
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Treatment
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•Balloon valvuloplasty as the standard treatment
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•Mild: activity should not be restricted
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•Mod-severe: no competitive sports
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•Cardiac catheterization: Balloon dilation
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•Surgical valvotomy: if closed procedure doesn't work. done to older pts. when severe calcium deposits further obstruct the valve.
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•Beta blocker or calcium channel blocker
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•Antibiotic prophylaxis against endocarditis
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Increased pulmonary blood flow
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• Atrial septal defect
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• Ventricular septal defect
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• Patent ductus arteriosus
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• Atrioventricular canal
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Obstruction to blood flow from ventricles
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• Coarction of the aorta
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• Aortic stenosis
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• Pulmonic stenosis
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Echocardiogram
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Cardiac Catheterization
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Electrocardiogram
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Chest X-ray
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Echocardiography
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MRI
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Abnormal opening in ventricular septum, allows free communication between R & L ventricles
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Small to moderate VSD: 3-6 mm, asymptomatic
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Moderate to large VSD: symptomatic, require repair
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Signs & Symptoms
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4-8 weeks
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•Easy fatigue, failure to thrive, dyspnea
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• A loud, harsh murmur on left sternal border (3rd/4th )
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• Thrill may be palpable, respiratory infections
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Treatment
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•Small VSD: no surgical intervention, just reassurance
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•Symptomatic VSD: meds, afterload reducers, diuretics
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•Moderate: cardiac catheterization
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•Larger: 3mm open heart surgery
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•Exceptionally large: Silastic or Dacron patch
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Complications
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• Cardiac or Heart failure
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• Endocarditis due to recirculating blood flow
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Narrowing of the pulmonary valve or PA that results in the obstruction of blood flow from the ventricles.
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Signs & Symptoms
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•Mild : Asymptomatic, split 2nd heart sound w/ delay
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•Heart failure (right) & cyanosis with severe
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• Systolic ejection murmur, Right ventricular enlargement
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• Exercise intolerance
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Treatment
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•Mild: No intervention needed, close follow up
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•Mid-severe: requires relieve of stenosis
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•Balloon valvuplasty, treatment of choice
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•Surgical valvotomy is also a consideration.
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•Open-heart needed only for more complex valve anomaly.
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Decreased pulmonary blood flow
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• Tetralogy of Fallot
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• Tricuspid atresia
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Mixed blood flow
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• Transposition of great vessels
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• Truncus arteriosus
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• Total anomalous pulmonary venous return
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• Hypoplastic left heart syndrome
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•Also called an endocardial cushion defect, results from incomplete fusion of the endocardial cushion. At the septum of the heart
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•Consists of a low atrial septal defect continuous with ventricular septal defect & clefts of mitral & tricuspid, creating a large central AV valve
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• Allows blood to flow between all heart chambers.
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Signs and Symptoms
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•CHF in infancy, Failure to thrive, recurrent infections
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•Exercise intolerance, easy fatigability
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•Cardiac enlargement on CX-ray
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•Late cyanosis from pulmonary vascular w/ R to L shunt
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Treatment
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• Surgery is always required
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• Treatment of congestive symptoms.
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•Pulmonary banding maybe req. in premature or <5kg
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Conduit between pulmonary artery & aorta fails to close and results in increased pul. blood flow (L to R shunt)
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Ductus Arteriousus fetal structure that connects PA to the aorta. Closure at first breath and is incomplete bet. 7 to 14 days. closure not until 3 mos.
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• blood will shunt from aorta (oxy) to the PA (deoxy) because of the increased pressure in the aorta.
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Signs & Symptoms
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• Small PDA: usually asymptomatic
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• Large PDA: symptoms of CHF & growth restriction
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• Bounding arterial pulses, Widened pulse pressure
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• Enlarged heart, prominent apical impulse.
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•Classic continuous machinery systolic murmur
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• Mild-diastolic murmur at the apex.
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Treatment
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• Indomethacin, inhibitor of prostaglandin synthesis
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• Surgical or catheter closure.
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Narrowing of aorta due to a constricting band
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Signs & Symptoms
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•Diminution or absence of femoral pulses
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•Higher BP in upper extremities, headache, vertigo
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•Weak lower extremity pulses. decrease cardiac output
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• Epistaxis & CVA not in children due to elevated BP
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•Leg pain due to diminished blood supply
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Treatments
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•Surgical intervention, prevent left vent dysfunction
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•Angoplasty is used by some centers
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•Balloon angioplasty is the procedure of choice
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•Antihypertensive - High BP post-op
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•Antibiotic as prophylactic
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