mosby items and derived items © 2005, 2001 by mosby, inc. cardiovascular dysfunction

Mosby items and derived items © 2005, 2001 by Mosby, Inc.

Cardiovascular Dysfunction


Fetal Circulation Structures

• Umbilical vein; umbilical arteries

• Foramen ovale

• Ductus arteriosus

• Ductus venosus


Changes at Birth


Pediatric Indicators of Cardiac Dysfunction

• Poor feeding

• Tachypnea/ tachycardia

• Failure to thrive/poor weight gain/activity intolerance

• Developmental delays

• + Prenatal history

• + Family history of cardiac disease


Two Types of Cardiac Defects

• Congenital

– Anatomic>abnormal function

• Acquired

– Disease process

• Infection

• Autoimmune response

• Environmental factors

• Familial tendencies


Causes of CHD

• Chromosomal/genetic = 10%-12%• Maternal or environmental = 1%-2%

– Maternal drug use• Fetal alcohol syndrome—50% have CHD

– Maternal illness• Rubella in 1st 7 wks of pregnancy→50% risk of

defects including PDA and pulmonary branch stenosis

• CMV, toxoplasmosis, other viral illnesses>> cardiac defects

• IDMs = 10% risk of CHD (VSD, cardiomyopathy, TGA most common)

• Multifactorial = 85%


CHD

• Incidence: 5-8 per 1000 live births

– About 2-3 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, +++ )


Older Classifications of CHD

• Acyanotic

– May become cyanotic

• Cyanotic

– May be pink

– May develop CHF


Newer Classification of CHD

• Hemodynamic characteristics

– Increased pulmonary blood flow

– Decreased pulmonary blood flow

– Obstruction of blood flow out of the heart

– Mixed blood flow


Increased Pulmonary Blood Flow Defects

• 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


Increased Pulmonary Blood Flow Defects

• Atrial septal defect

• Ventricular septal defect

• Patent ductus arteriosus


ASD


VSD


PDA


Obstructive Defects

• Coarctation of the aorta

• Aortic stenosis

• Pulmonic stenosis


Coarctation of the Aorta


Aortic Stenosis


Pulmonic Stenosis and Catheter Placement


Decreased Pulmonary Blood Flow Defects


Tetralogy of Fallot


Tricuspid Atresia


Mixed Defects

• Transposition of great vessels

• Total anomalous pulmonary venous connection

• Hypoplastic heart syndrome

– Right

– Left


Transposition of Great Vessels


Normal Heart


Totally Anomalous Pulmonary Venous Connection


Hypoplastic Left Heart


CHF in Children

• 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


Interventional Cardiac Catheter Procedures in Children

• Transposition of great vessels

• Some complex single-ventricle defects

• ASD

• Pulmonary artery stenosis


INTERVENTION

Balloon dilation

Balloon dilation

Balloon dilation

DIAGNOSIS

Valvular pulmonic stenosis

Recurrent coarctation of aorta

Congenital mitral stenosis

Interventional Cardiac Catheter Procedures in Children (cont’d)


Surgical Interventions

• Open heart

• Closed heart procedures

• Staged procedures

• Prepare child and family for procedures


Postpericardiotomy Syndrome

• Symptoms: fever, pericardial friction rub, pericardial and pleural effusion

• Occurs in immediate postoperative period

• Also can occur later (postoperative day 7-21)

• Etiology unknown

• Theories of etiology

– Viral infection; auto immune response; reaction to blood in pericardium

– May require pericardiocentesis or pleurocentesis


Acquired CardiovascularDisorders

Infectious and Inflammatory Cardiac Disorders


Endocarditis

• BE, IE, or SBE

• Strep

• Staph

• Fungal infections

• PROPHYLAXIS: 1 hr before procedures (IV) or may use PO in some cases


Rheumatic FeverRheumatic Heart Disease

• RF

– Inflammatory disease occurs after Group A

– ß-hemolytic streptococcal pharyngitis

– Infrequently seen in U.S.; big problem in Third World

– Self-limiting

• Affects joints, skin, brain, serous surfaces, and heart

• Rheumatic heart disease

– Most common complication of RF

– Damage to valves as result of RF


Clinical Manifestations of RF

• Carditis

• Polyarthritis

• Erythema marginatum

• Subcutaneous nodules


Prevention of RHD

• 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


Kawasaki Disease

A condition that causes inflammation in the walls of small- and medium-sized arteries throughout the body, including the coronary arteries.

Heart complications may include: Heart complications include: Vasculitis, myocarditis,

arrhythmia, and pericarditis.


Kawasaki Disease— Treatment

Then 3-5 mg/kg/day—antiplatelet

IVIGASA 80-100 mg/kg/day—fever


Systemic Hypertension

• 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


BP Screenings for Children


Hyperlipidemia

• Identify kids at risk and treat early

• Treatment: dietary

– Restrict intake of cholesterol and fats

• If no response to diet→Rx

– colestipol (Colestid)

– cholestyramine (Questran)


Pharmacology

• Iv IgG

• Digoxin/lanoxin

• ACE inhibitors

• ASA, NSAIDs

• Lasix

• Spironolactone (Aldactone)


Heart Transplantation

• Orthotopic transplant

• Heterotopic transplant (piggyback)

• Organ donation issues

• Nursing considerations


Anaphylaxis

• Definition

• Clinical manifestations

• Therapeutic management



Toxic Shock Syndrome (TSS)

• Diagnostic evaluation

• Therapeutic management


• Criteria for definition of TSS

mosby items and derived items © 2005, 2001 by mosby, inc. cardiovascular dysfunction

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