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Cardiovascular Dysfunction
Fetal circulation:
Placenta - Umbilical vein Liver (Ductus
Venosus) Inferior Vena Cava Right Atrium
Foramen Ovale Left Atrium Mitral valve left
ventricle aortic semilunar valve Aorta
ascending aorta head & upper extremities
superior vena cava right atrium tricuspid valve
right ventricle pulmonary semilunar valve
pulmonary artery Lungs pulmonary vein ductus
arteriosus descending aorta lower part of the
body umbilical artery placenta
INCREASE PULMONARY BLOOD FLOW
Atrial Septal Defect
CONGENITAL
INCIDENCE:
5 8 in 1000 live birth.
2 3 per 1000 birth is with symptoms needs
treatment.
Major cause of death in first year of life (after
prematurity)
Most common anomaly is VSD
Manifestation
The BP on the UPPER EXTREMITY is
GREATER relative to the pressure on the
LOWER EXTREMITY.
Epistaxis
Gum Bleeding
Intracranial Hemorrhage the most common
cause of death in COA.
Intervention
Manifestation
Clubbing of Fingers
Polycythemia
TET SPELL / blue spell
Intervention
Provide rest and Decrease Energy
expenditure.
Position: Knee Chest
Position, Squatting position.
COMPLETE REPAIR
First yr of life
Closure of VSD & resection of stenosis;
pericardial patch to enlarge RV outflow
Blalock total repair
ACQUIRED HEART DISEASE
Rheumatic Heart Disease
Inflammatory disease following an
infection by GABHS.
Jones Criteria
Major Criteria:
Subcutenous nodule
Polyarthritis
Erythema marginatum
Carditis
Syndenhamms Chorea or
St. Vitus Dance
Minor Criteria:
Arthralgia
Low Grade Fever
All Lab results
**Increase C- Reactive Protein, ESR and
ASO
Diagnosis
2 MAJOR or
1 MAJOR + 2 MINOR
Management
CBR
Treatment of streptococcal
tonsillitis/pharyngitis
Medications = penicillin; ASA
(tinnitus)
Kawasaki Disease
Mucocutaneuos lymph node
syndrome
Multisystem
disease
associated
with
Splenomegaly
Petichiae
Respi distress, dif, in feeding, tachycardia
Intervention
High-dose antibiotics= penicillin IV (2-8wks)
DOC: Amoxicillin 1 hour before any procedure
*dental prodedure; respi; GI;
Gatrourinary tract
Observe side effects of antibiotics; &
complications (embolism)
Teaching importance of follow up check up
Early dx & tx
Congestive heart failure
Inability of the heart to pump sufficiently to
meet the metabolic needs of the body.
Common cause by congenital heart defect.
inflammation (Vasculitis)
Phases:
Acute Phase
Fever
Unresponsive to antibiotics & antipyretics
Eyes redden, dry w/o drainage
Strawberry tongue
Rashes
Subacute Phase
10 days after the onset.
Increase in Platelet count
Aneurysm
Most dangerous phase
Convalescent Phase
25th 40 days
ESR returning to normal
Management
Administration of Acetylsalicylic acid (ASA)
Bacterial Endocarditis
Infective endocarditis
Infection of valve & inner lining of heart that can
damage & destroy heart valves
Usually affect mitral or aortic valve
After birth/ congenital heart defect
Autoimmune; environmental factor; infection
Sequela of bacteremia
Manifestation
Low grade fever, intermittent fever
Headache, malaise, diaphoresis, wt loss
New murmur damage in valve/perforation
Heart Failure
Right Sided
Jugular vein distention
Ascites
Hepatomegaly
Spleenomegaly
Peripheral edema
Left Sided
Dyspnea
Orthopnea
Crackles / Rales
Moist cough
Blood tinge frothy sputum
(Pulmonary Edema)
Intervention
Digitalis improves contractility.
3 Major Actions
1. Increase force of contraction
2. Decrease heart rate
3. Enhances diuresis
Angiotensin Converting Enzyme (ACE)
inihbitors it reduces afterload, thus make
heart easier to pump.
Example:
Captopril (Capoten)
Enalapril (Vasotec)
Diuretics - eliminate water and Salt
Example:
Furosemide (Lasix) & Thiazides
- It can cause K loss
- K supplement
Decrease K = Enhancement of Digoxin that
may lead to Digoxin Toxicity
Increase K = Decrease absorption of
Digoxin that may lead to no effect
Therefore normal K must be monitored
Normal K: 3.3-5.5mmol/L
Nursing Management
1. Administration of Digoxin
Calculating correct dosage.
Digoxin toxicity.
Check . . .
APICAL PULSE
***Not Given if Pulse is:
a. < 90 110 beats/min infant and
young children
b. 70 beats/min older children
c. 60 beats / min adult
Digoxin Toxicity
Bradycardia
Anoxeria
Nausea and Vomiting
Therapeutic Level: 0.8-2mcg/L
2. BP Monitoring
3. Position in SEMI FOLWERS - for Lung
expansion
4. Maintain Nutritional Needs small frequent meal
5. Maintain F & Electrolyte Balance
Cardiac catheterization- most invasive
diagnostic procedure
Inserting of catheter into the heart &
surrounding vessels
Obtain info about structure &
performance of the heart valves & circulatory
system; O2 sat.;
pressure changes;
cardiac output & stroke volume
Insertion of Cardiac Catheter
1. Right sided-(most common)
** Femoral vein to right atrium
2. Left sided
**artery to aorta to Right ventricle
Management
Consent
sedation
Assess allergy to dye, seafood, or radiopaque
dyes
No solid food 6-8hours & liquid 4 hrs
Document ht. & wt.
VS; local anesthesia;
Check peripheral pulse
+ fluttery feeling in insertion ; flushed; warm
feeling when dye is injected; desired to cough;
palpitation = heart irritability
Shaving & cleaning the site
IV Line