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

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

Cardiovascular Dysfunction

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

Fetal Circulation Structures

• Umbilical vein; umbilical arteries

• Foramen ovale

• Ductus arteriosus

• Ductus venosus

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

Changes at Birth

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

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

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

Two Types of Cardiac Defects

• Congenital

– Anatomic>abnormal function

• Acquired

– Disease process

• Infection

• Autoimmune response

• Environmental factors

• Familial tendencies

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

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%

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

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, +++ )

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

Older Classifications of CHD

• Acyanotic

– May become cyanotic

• Cyanotic

– May be pink

– May develop CHF

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

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

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

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

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

Increased Pulmonary Blood Flow Defects

• Atrial septal defect

• Ventricular septal defect

• Patent ductus arteriosus

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

ASD

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

VSD

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

PDA

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

Obstructive Defects

• Coarctation of the aorta

• Aortic stenosis

• Pulmonic stenosis

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

Coarctation of the Aorta

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

Aortic Stenosis

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

Pulmonic Stenosis and Catheter Placement

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

Decreased Pulmonary Blood Flow Defects

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

Tetralogy of Fallot

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

Tricuspid Atresia

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

Mixed Defects

• Transposition of great vessels

• Total anomalous pulmonary venous connection

• Hypoplastic heart syndrome

– Right

– Left

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

Transposition of Great Vessels

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

Normal Heart

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

Totally Anomalous Pulmonary Venous Connection

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

Hypoplastic Left Heart

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

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

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

Interventional Cardiac Catheter Procedures in Children

• Transposition of great vessels

• Some complex single-ventricle defects

• ASD

• Pulmonary artery stenosis

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

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)

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

Surgical Interventions

• Open heart

• Closed heart procedures

• Staged procedures

• Prepare child and family for procedures

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

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

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

Acquired CardiovascularDisorders

Infectious and Inflammatory Cardiac Disorders

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

Endocarditis

• BE, IE, or SBE

• Strep

• Staph

• Fungal infections

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

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

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

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

Clinical Manifestations of RF

• Carditis

• Polyarthritis

• Erythema marginatum

• Subcutaneous nodules

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

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

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

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.

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

Kawasaki Disease— Treatment

Then 3-5 mg/kg/day—antiplatelet

IVIGASA 80-100 mg/kg/day—fever

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

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

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

BP Screenings for Children

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

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)

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

Pharmacology

• Iv IgG

• Digoxin/lanoxin

• ACE inhibitors

• ASA, NSAIDs

• Lasix

• Spironolactone (Aldactone)

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

Heart Transplantation

• Orthotopic transplant

• Heterotopic transplant (piggyback)

• Organ donation issues

• Nursing considerations

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

Anaphylaxis

• Definition

• Clinical manifestations

• Therapeutic management

• Nursing considerations

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

Toxic Shock Syndrome (TSS)

• Diagnostic evaluation

• Therapeutic management

• Nursing considerations

• Criteria for definition of TSS